{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:16:46Z","timestamp":1790983006678,"version":"4.1.0"},"reference-count":23,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Verapamil-sensitive fascicular tachycardia is a type of ventricular tachycardia (VT) involving the specialised cardiac conducting tissue. Drug overdose is an important cause to consider when assessing patients with a new presentation of a broad complex tachycardia. Multiple antihistamines have been implicated as pro-arrhythmic, but these tend to precipitate Torsades de Pointes via drug-induced QT prolongation. We present an educational case of a Verapamil-sensitive fascicular VT with typical electrocardiogram (ECG) characteristics, which developed immediately following an overdose of promethazine and which was terminated successfully with verapamil, in a young person with a structurally normal heart. There have been no previous published reports of promethazine precipitating a fascicular VT and we aim to highlight this unusual link and the benefits of early recognition and management of similar presentations.<\/jats:p>","DOI":"10.1136\/bcr-2025-271685","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:15:16Z","timestamp":1787570116000},"page":"e271685","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Verapamil-sensitive fascicular ventricular tachycardia precipitated by promethazine overdose"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8706-4049","authenticated-orcid":false,"given":"Salma","family":"Hassan","sequence":"first","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Heart Institute, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Nisbet","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Heart Institute, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"2026082404151074000_19.8.e271685.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(00)88286-7"},{"key":"2026082404151074000_19.8.e271685.2","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1111\/exd.14602","article-title":"Pharmacogenomics for the efficacy and side effects of antihistamines","volume":"31","author":"Li","year":"2022","journal-title":"Exp Dermatol"},{"key":"2026082404151074000_19.8.e271685.3","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1097\/PEC.0b013e3182309ae2","article-title":"Pyrilamine-induced prolonged QT interval in adolescent with drug overdose","volume":"27","author":"Paudel","year":"2011","journal-title":"Pediatr Emerg Care"},{"key":"2026082404151074000_19.8.e271685.4","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1080\/15563650902952273","article-title":"Abstracts of the XXIX International Congress of the European Association of Poison Centres and Clinical Toxicologists, May 12\u201315, 2009, Stockholm, Sweden","volume":"47","year":"2009","journal-title":"Clin Toxicol"},{"key":"2026082404151074000_19.8.e271685.5","unstructured":"Promethazine hydrochloride. | Drugs | BNF content published by NICE. 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