Prevalence of drug to drug induced QT interval prolongation in critically Ill cardiac patients in a tertiary cardiac center in Malaysia

Cancer patients are at an increased risk for QT interval prolongation and subsequent potentially fatal Torsade de pointes tachycardia due to the multiple drugs used for treatment of malignancies and the associated symptoms and complications. Based on a systematic review of the literature, this article analyzes the risk for prolongation of the QT interval with antineoplastic agents and commonly used concomitant drugs. This includes anthracyclines, fluorouracil, alkylating agents, and new molecularly targeted therapeutics, such as vascular disruption agents. Medications used in the supportive care can also prolong QT intervals, such as methadone, 5-HT3-antagonists and antihistamines, some antibiotics, antifungals, and antivirals. We describe the presumed mechanism of QT interval prolongation, drug-specific considerations, as well as important clinical interactions. Multiple risk factors and drug–drug interactions increase this risk for dangerous arrhythmias. We propose a systematic approach to evaluate cancer patients for the risk of QT interval prolongation and how to prevent adverse effects.

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Drug-Induced QT Interval Prolongation and Torsade De Pointes in Children and Adolescents—Part III of a Four Part Series

Child and Adolescent Psychopharmacology News ◽

10.1521/capn.8.3.1.23078 ◽

2003 ◽

Vol 8 (3) ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

W. Victor R. Vieweg ◽

Nancy L. McDaniel

Keyword(s):

Children And Adolescents ◽

Qt Interval ◽

Torsade De Pointes ◽

Interval Prolongation ◽

Drug Induced ◽

Qt Interval Prolongation

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Modelling of drug-induced QT-interval prolongation: estimation approaches and translational opportunities

Journal of Pharmacokinetics and Pharmacodynamics ◽

10.1007/s10928-015-9434-0 ◽

2015 ◽

Vol 42 (6) ◽

pp. 659-679 ◽

Cited By ~ 3

Author(s):

Eleonora Marostica ◽

Karel Van Ammel ◽

Ard Teisman ◽

Koen Boussery ◽

Jan Van Bocxlaer ◽

...

Keyword(s):

Qt Interval ◽

Interval Prolongation ◽

Drug Induced ◽

Qt Interval Prolongation

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Absence of relevant QT interval prolongation in not critically ill COVID-19 patients

Scientific Reports ◽

10.1038/s41598-020-78360-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Juan Jiménez-Jáimez ◽

Rosa Macías-Ruiz ◽

Francisco Bermúdez-Jiménez ◽

Ricardo Rubini-Costa ◽

Jessica Ramírez-Taboada ◽

...

Keyword(s):

Critically Ill ◽

Qt Interval ◽

Treatment Initiation ◽

Qtc Interval ◽

Risk Markers ◽

Interval Prolongation ◽

Qt Interval Prolongation ◽

Qtc Interval Prolongation ◽

Ambulatory Patients ◽

Reported Data

AbstractSARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients. We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 h after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors. We included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404–433), and after treatment QTc was prolonged to 423 ms (405–438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14.1%) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation. Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.

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