Video answer: Qt prolongation
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Table 2 Some drugs associated with QTc prolongation
- Antibiotics. azithromycin. clarithromycin. erythromycin. roxithromycin. metronidazole. (with alcohol) moxifloxan.
- Antifungals. fluconazole. (in cirrhosis) ketoconazole.
- Antivirals. nelfinavir.
- Antimalarials. chloroquine. mefloquine.
Video answer: What is qtc prolongation and how to manage a prolonged qtc interval in psychiatry? - sanil rege
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Drug–drug interactions also lead to QT prolongation. Quetiapine . Proposed — QT : Risperidone . Proposed — QT . Sudden death reported in PI. Ziprasidone Definite — QT Cancer chemotherapeutic agents Arsenic trioxide . Definite — QT, TdP : Tamoxifen . Probable — QT . Overdose situations. Cardiovascular non-anti-arrhythmics Indapamide . Proposed
For example, prior to terfenadine's withdrawal from the market, the QTc prolongation associated with this drug was estimated to be about 8 to 18 milliseconds. When studied along with the administration of ketoconazole, a 3A4 inhibitor, the QTc interval increased by 82 milliseconds. 9 Renal impairment may also increase a patient's risk for QT interval prolongation by the accumulation of drug.
The BNF 80 (September 2020 – March 2021) lists the following examples of drugs which prolong the ...
Other classes of drugs that cause QT c prolongation include antihistamines, antidepressants, antibiotics, antifungal drugs and antipsychotics (Table 2). The prolongation of the QT c interval by these drugs is usually seen within several days of starting them.
Drugs associated with QT Prolongation, QTc prolongation including Antipsychotics, antiarrhythmics, antidepressants, and antihistamines
Certain drugs, including some anesthetics, are known to contribute to QT prolongation.
The effect of sotalol on QTc prolongation varies from 10 to 40 ms at doses of 160–640 mg/day. 12 It should also be noted that sotalol is associated with increased dispersion of ventricular repolarisation and can cause TdP in up to 5% of exposed patients. 9 Furthermore, the extent of QT prolongation can vary between individuals taking the same drug, and can often be dose dependent. 12 36
Prolongation of the QT interval can lead to a life threatening arrhythmia known as torsades de pointes. Over the last few years a number of warnings have highlighted the risk of QT prolongation with citalopram, domperidone, ondansetron, hydroxyzine and quinine.
Based on ongoing systematic analysis of all available evidence, CredibleMeds® places drugs into broad categories based on whether each can cause QT prolongation or TdP. These actions are highly dependent on the circumstances of each drug’s use AND each patient’s clinical characteristics. QT/TdP Risk Categories for Drugs