A NURSE suffered a fatal cardiac arrest after being prescribed a fatal combination of three common drugs.
Her sudden passing prompted an urgent warning to doctors dishing out the medications, over fears the drugs’ dangers weren’t “widely appreciated” and could lead to further deaths.
Chloe Burgess, 34, passed away after being prescribed a dangerous combination of drugs[/caption]
A coroner warned that prescribers didn’t seem to be aware of the dangers of the medication mix[/caption]
Chloé Elizabeth Burgess, 34, was described as “beautiful, generous and caring” by her family, always putting “others’ needs above her own”.
The nurse passed away on September 8, 2023, at her home in Southampton, Hampshire, four year after being prescribed a deadly mix of medications.
Chloé was already taking two common antidepressants in 2019 when she was prescribed ivabradine – sold as Procoralan – to treat an abnormally fast heart beat and branch block, a disruption to the electrical impulses causing the heart to beat.
The nurse was also taking amitriptyline – a tricyclic antidepressant sold as Elavil – and paroxetine, a selective serotonin reuptake inhibitor (SSRI) known under the brand name Seroxat.
The NHS advises that neither drug be given to be people with heart problems, as they may make them worse or cause dangerous heart rhythm issues.
A coroner said that health workers treating Chloé weren’t aware that the three drugs could make a lethal combination – finding that the mix had “contributed” to her death.
Coroner Nicholas Walker wrote in his report: “She had been using the combination of drugs for four years before she died without concern.
“The potential dangers of the combination of drugs in Chloé’s case was not well known or appreciated by those treating her.”
The three medications the nurse had been prescribed likely with each other to raise the levels of amitriptyline in her blood.
Combined with an episode of sleep apnoea – when breathing stops and starts during sleep – “induced severe cardiac arrhythmia and sudden cardiac death”, Mr Walker said.
“The potential dangers related to a failure to metabolise amitriptyline which can, incrementally, lead to toxicity,” he added.
The coroner flagged a number of issues in Chloé’s sad case, which he feared may lead to further deaths if not mitigated.
“In my opinion, there is a risk that future deaths could occur unless action is taken,” he said.
Common side effects from medicines – and red flags to know
ANY medicine, vaccine, herbal or complementary remedy can cause an unwanted side effect, commonly referred to as an adverse drug reaction (ADR) by healthcare professionals.
Many side effects are linked to the way the medicine works to treat a patient. For instance, medicines known as ‘beta-blockers’ treat high blood pressure by acting on particular sites in the muscles of blood vessels, causing the muscles to relax, and reducing blood pressure.
But it also acts on the same type of sites in the heart, which may cause an undesirable effect in some patients where the heart beat is slowed down.
Some side effects are not clearly linked to how the medicine works in the body so are more unpredictable.
Different patients may respond in different ways to the same medicine and so it’s very difficult to predict whether a patient will experience any side effects.
Sometimes side effects can be delayed, happen after long term use or through interaction with certain foods or other medicines, on stopping a medicine, or as a result of a medication error, misuse or abuse.
Common side effects to medications include constipation, diarrhoea, dizziness, drowsiness, dry mouth, headache, insomnia, nausea, rash, and sore stomach.
Serious adverse reactions include death, life-threatening conditions, inpatient hospitalisation, prolonged hospitalisation, persistent disability, birth defects, blood disorders, severe skin reactions, renal impairment, and jaundice.
The Medicines and Healthcare products Regulatory Agency (MHRA) uses the Yellow Card Scheme to monitor and collect information on suspected side effects of medications.
Reports can be submitted directly to the MHRA through the Yellow Card scheme using the online form, by downloading a copy of the form from the Yellow Card website, using the Yellow Card app, or by freephone on 0800 731 6789.
Source: MHRA
“The inquest heard evidence that the potential dangers of the combination of amitriptyline, paroxetine and ivabradine is not widely appreciated and does not trigger an alert on the prescribing software used in primary care or by pharmacists,” Mr Walker warned.
Health professionals prescribing ivabradine must have a “full understanding” of how they could interact with amitriptyline and paroxetine, he added.
The coroner sent his report to National Institute for Health and Care Excellence (NICE), which provides national guidance and advice to improve health and social care in England, the British National Formulary (BNF), which provide prescribers, pharmacists, and other healthcare professionals with information about safe use of medicines.
The Royal College of Physicians also received a copy.
All three organisations “have the power” to “prevent future deaths”, Mr Walker warned.
Prevention of Future Death reports are used to draw attention to matters that could result in further deaths under similar circumstances.
Organisations named in the reports are compelled to provide a response within 56 days of the report being published, detailing what actions they intend to take and by when.
It comes after experts warned that a common drug prescribed to treat restless leg syndrome and Parkinson’s can trigger disturbing side effects.
Several women came forward reporting how the medicine has led to dangerous and impulsive sexual behaviours, as well as gambling – say they were never warned about the devastating side effects of dopamine agonist drugs, taken by potentially hundreds of thousands of Brits.
