Torsades de pointes associated with terfenadine in a case of liver cirrhosis and hepatocellular carcinoma.

A 65-year-old woman with liver cirrhosis complicated by hepatocellular carcinoma lost consciousness due to torsades de pointes with prolongation of the QT-interval after 10 days of treatment with terfenadine. Before terfenadine administration, she had shown neither symptoms of heart disease nor any electrocardiographic abnormalities. Serum electrolytes were all normal, although the Ca level was near the lower limit of the normal range. After the withdrawal of terfenadine, the QT-interval was normalized and the torsades de pointes disappeared. Since she had liver cirrhosis, the development of torsades de pointes was thought to be attributable to the impairment of hepatic metabolism by terfenadine.