332 – Risk factors of qt interval prolongation in 1000 patients with schizophrenia

2008 ◽  
Vol 98 ◽  
pp. 170
Author(s):  
Y. Ozeki ◽  
K. Fujii ◽  
N. Kurimoto ◽  
K. Tsuji ◽  
N. Yamada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Qt Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation

Clinical characteristics of patients with drug-induced QT interval prolongation and torsade de pointes: identification of risk factors

2008 ◽  
Vol 98 (4) ◽  
pp. 208-212 ◽  
Author(s):  
Konstantinos P. Letsas ◽  
Michalis Efremidis ◽  
Stavros P. Kounas ◽  
Loukas K. Pappas ◽  
Gerasimos Gavrielatos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Qt Interval ◽  
Clinical Characteristics ◽  
Torsade De Pointes ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Qt Interval Prolongation

scholarly journals QT interval prolongation and Torsades de Pointes with donepezil, rivastigmine and galantamine

2020 ◽  
Vol 11 ◽  
pp. 204209862094241 ◽  
Author(s):  
Katie Malone ◽  
Jules C. Hancox
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Qt Interval ◽  
Case Reports ◽  
Acetylcholinesterase Inhibitors ◽  
Torsades De Pointes ◽  
Modifiable Risk Factors ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Mesh Terms

Background: Acetylcholinesterase inhibitors (AChEis) including donepezil, galantamine and rivastigmine are used to treat Alzheimer’s disease (AD). This study aimed to evaluate evidence from the case report literature for an association between these agents and risk of QT interval prolongation and Torsades de Pointes (TdP) arrhythmia. Methods: Published literature was mined with predetermined MeSH terms for each of donepezil, galantamine and rivastigmine, to identify cases of QT interval prolongation and TdP. Case reports were analysed using causality scales and a QT interval nomogram. Results: A total of 13 case reports were found (10 for donepezil, 2 for galantamine and 1 for rivastigmine) with rate corrected QT interval (QTc) prolongation. Five cases with donepezil exhibited TdP. TdP was not reported in the cases with galantamine and rivastigmine. The use of a QT heart rate nomogram highlighted risk with donepezil compared with the other two drugs and the application of the Naranjo causality scale suggested probable or possible causation for all donepezil cases. All patients had at least two other risk factors for TdP, including modifiable risk factors such as electrolyte disturbances, bradycardia, co-administration of QT prolonging drugs. A number of recent cases involved recent changes in medication. Conclusion: Our evaluation of the case report literature suggests that there is evidence for a causal association between donepezil and QTc/TdP risk. Attention to risk factors for QTc prolongation/TdP should be exercised when prescribing donepezil and modifiable risk factors corrected. Owing to the low number of cases with galantamine and rivastigmine, further work is needed to establish whether these drugs may be more suitable than donepezil for patients with other risk factors for TdP.

SSRIs and QT interval prolongation management. A review

2017 ◽  
Vol 41 (S1) ◽  
pp. S750-S750
Author(s):  
A. Ballesteros ◽  
H. Saiz ◽  
Á.S. Rosero ◽  
A. Portilla ◽  
L. Montes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Qt Interval ◽  
Future Research ◽  
Current Debate ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Cross Sectional ◽  
Qt Interval Prolongation ◽  
Qtc Interval Prolongation

IntroductionIn 2011, the FDA issued an alert recommending not to prescribe citalopram high doses, due to QT prolongation risk. We explored the clinical background of QT interval prolongation related to serotonin selective reuptake inhibitors (SSRI) use and the clinical implications of safety issues.MethodologyA review was conducted to clarify the mechanisms associated with the occurrence of TdP when using SSRI and investigating therapeutic measures to avoid/minimize these effects. The literature search was conducted in PubMed data reviewing articles between 2001 and 2016.Results(1) Related to risk factors/intraclass differences: risk factors are increase in QTc interval ≥60 ms from the pretreatment value, advanced age, female sex, acute myocardial infarction and electrolytic abnormalities among others. Citalopram appears more likely than others to induce this phenomenon but its importance is under current debate. (2) Related to dose: drug-induced QTc interval prolongation and TdP was associated to citalopram in doses > 40 mg/day. However, psychotropic drug-induced sudden cardiac death may be an outlier in the absence of identified risk factors for QTc interval prolongation and TdP. (3) Related to poly-pharmacy/management: there is an additive effect when using SSRI and antipsychotics (EKG control is recommended in those cases). Cross-sectional studies showed that SSRI use was not associated with QT interval prolongation. This could be explained by the EKG intra-intersubject variability.ConclusionsThere is little evidence that drug-associated QTc interval prolongation by itself is sufficient to predict TdP. Future research needs to improve its precision to better understand the factors that facilitate/attenuate that progression. Clarifying this may lead to a safer SSRI use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Approach to initiating QT-prolonging oncology drugs in the ambulatory setting

2018 ◽  
Vol 25 (1) ◽  
pp. 198-204
Author(s):  
Mário L de Lemos ◽  
Carrie Kung ◽  
Victoria Kletas ◽  
Nadine Badry ◽  
Isabell Kang
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Qt Interval ◽  
Torsades De Pointes ◽  
Drug Approval ◽  
Qt Prolongation ◽  
Ambulatory Setting ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Oncology Practice

Since the introduction of regulatory drug approval guidance on the evaluation of QT interval prolongation, an increasing number of drug monographs has included cautions on the risk of QT prolongation. For example, QT prolongation is mentioned in the Canadian product monographs of 29 drugs commonly seen in oncology practice. This presents two major challenges. First, most guidelines and risk predictive tools for QT prolongation have been developed for hospitalized patients in acute care settings. In contrast, most QT-prolonging oncology drugs are used in medically stable patients in the ambulatory setting. Second, many oncology drugs are unique for their indications and non-QT prolonging alternative agents are often not available. In this review, we will outline an empiric initial approach to ambulatory cancer patients who are treated with oncology drugs which may prolong QT interval. This includes the predictive value of QT prolongation on torsades de pointes, the risk factors of the patients and the drugs, and the limitations of existing guidance in this area.

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