International Journal of Clinical Pharmacy

, Volume 33, Issue 6, pp 905–908 | Cite as

Ventricular bigeminy associated with voriconazole, methadone and esomeprazole

  • Julie Scholler
  • Yasmine Nivoix
  • Raoul Herbrecht
  • Véronique Kemmel
  • Dominique LevêqueEmail author
Case Report


Case We report a case of ventricular bigeminy with concomitant administration of methadone, voriconazole and esomeprazole in a Caucasian woman aged 26 with acute lymphoblastic leukaemia. Plasma concentrations of voriconazole and methadone were high, 12.4 mg/l (therapeutic range: 1–4 mg/l) and 1.6 mg/l (therapeutic range: 0.2–0.4 mg/l), respectively. In the absence of esomeprazole, no more episode of cardiac arrhythmia occurred and 7 days after, methadone plasma concentration fell at 0.57 ml/l while voriconazole concentration was at 5.5 mg/l. We speculate that a pharmacokinetic interaction between methadone and voriconazole was amplified by the addition of esomeprazole. This led to the large increase of the plasma concentration of methadone and was potentially responsible for its cardiac toxicity. Conclusion Physicians should be aware of the potential interaction between voriconazole, esomeprazole and methadone leading to arrhythmia. The inhibitory potential of voriconazole is possibly increased by esomeprazole.


Bigeminy Drug–drug interaction Esomeprazole Methadone Voriconazole 




Conflicts of interest

D Levêque, J Scholler, Y Nivoix declare no conflicts of interest; R Herbrecht has served as consultant for Astellas, Basilea, Gilead, Merck Sharp & Dohme, Pfizer, and Schering-Plough.


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Julie Scholler
    • 1
  • Yasmine Nivoix
    • 1
  • Raoul Herbrecht
    • 2
  • Véronique Kemmel
    • 3
  • Dominique Levêque
    • 1
    Email author
  1. 1.Pharmacy, Hôpital HautepierreHôpitaux Universitaires de StrasbourgStrasbourgFrance
  2. 2.Oncology-HematologyHôpital Hautepierre, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
  3. 3.BiochemistryHôpital Hautepierre, Hôpitaux Universitaires de StrasbourgStrasbourgFrance

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