scholarly journals Methadone, Metoclopramide and Metronidazole Interaction Causing Torsades de Pointes

2021 ◽  
Vol 11 (1) ◽  
pp. 101-105 ◽  
Author(s):  
Karthik Gnanapandithan ◽  
Nishrutha Karthik ◽  
Jaime Gerber
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Torsades De Pointes ◽  
Qtc Interval ◽  
Hospital Personnel ◽  
Qtc Prolongation ◽  
Continuous Reinforcement ◽  
Iatrogenic Complication ◽  
Life Threatening ◽  
Life Threatening Complication

There are several classes of medications that can cause prolongation of the corrected QT (QTc) interval and potentially Torsades de Pointes (TdP). Most of these medications are commonly used in the emergency department, and interaction between these medications increases the risk of this iatrogenic complication. We describe a patient on methadone therapy who developed TdP after she received metoclopramide and metronidazole. Interaction between different classes of medications can increase the risk of QTc prolongation and TdP. Awareness of this condition and its risk factors need continuous reinforcement among all hospital personnel to reduce the risk of this life-threatening complication.

Drug interactions and creatinine levels are associated with QTc prolongation in intensive care units: a prospective, observational study

2019 ◽  
Vol 34 (4) ◽  
Author(s):  
Zeinab Hosseinpoor ◽  
Behrooz Farzanegan ◽  
Seyyed Reza Seyyedi ◽  
Mehdi Rajabi ◽  
Shadi Baniasadi
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Observational Study ◽  
Drug Interactions ◽  
Prospective Observational Study ◽  
High Serum ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Icu Admission ◽  
Life Threatening

Abstract Background Prolongation of the QTc interval may lead to life threatening arrhythmias. QTc prolongation is common in intensive care unit (ICU) patients. The objectives of this study were to identify the role of drug-drug interactions (DDIs) and other predictors (age, sex, cardiovascular diseases, and electrolyte abnormalities) in life threatening QTc prolongation in patients admitted to medical (M), surgical (S) and emergency (E) ICUs. Methods This prospective, observational study included patients above the age of 18 years who were admitted to SICU, EICU, and MICU at a tertiary respiratory referral center. Electrocardiogram (ECG) monitoring was performed during the first 5 days of ICU admission. Risk factors and DDIs which were anticipated to be associated with the prolongation of the QTc interval were assessed for all patients. Results Two hundred patients were included in the study. QTc prolongation occurred in 10.7% of patients and the majority of patients presenting with QTc prolongation had creatinine levels above 1.3 mg/dL during their 5 days of ICU admission. Incidence of pharmacodynamic (PD) DDIs was significantly higher in patients with QTc prolongation vs. other patients. Creatinine levels above 1.3 mg/dL and PD DDIs were associated with QTc prolongation during 5 days of ICU admission. Conclusions High serum creatinine and PD DDIs can increase the risk of QTc prolongation in patients admitted to the ICU. QTc interval measurements should be performed prior to initiation or after starting any drug that is associated with QT prolongation, specifically in patients with the known risk factors.

scholarly journals Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients

2019 ◽  
Vol 9 ◽  
pp. 204512531989138
Author(s):  
Nicolas Ansermot ◽  
Meredith Bochatay ◽  
Jürg Schläpfer ◽  
Mehdi Gholam ◽  
Ariane Gonthier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychotropic Drugs ◽  
Psychiatric Patients ◽  
Torsades De Pointes ◽  
University Hospital ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Qtc Interval Prolongation ◽  
Set Up ◽  
Ecg Abnormalities

Background: Psychiatric patients are at risk of cardiovascular diseases, and many psychotropic drugs can prolong QTc interval. Requirements for electrocardiogram (ECG) monitoring have been set up in our psychiatric university hospital. The objective of this study was to determine the proportion of adult patients who had an ECG during their hospitalization, the prevalence of ECG abnormalities, the evolution of the QTc after admission, and the risk factors for QTc prolongation. Methods: Retrospective analysis of ECGs and clinical data of all patients with a complete hospitalization in 2015. Assessment of the influence of covariates on QTc using linear mixed-effects models. Results: At least one ECG ( n = 600) was performed during 37.6% of the stays ( n = 1198) and in 45.5% of the patients ( n = 871). Among the patients with an ECG, 17.9% had significant ECG abnormalities, including 7.6% with a prolonged QTc. QTc measured at admission and during hospitalization did not change significantly ( n = 46, 419.4 ± 29.7 ms, 417.2 ± 27.6 ms, p = 0.71). In the multivariate model (292 patients, 357 ECGs), the covariates significantly associated with the QTc were gender (+15.9 ms if female, p < 0.0001), age (+0.4 ms/year, p = 0.0001), triglyceride levels (+5.7 ms/mmol/l, p = 0.005), and drugs with known risk of torsades de pointes (+6.2 ms if ⩾1 drug, p = 0.028). Conclusions: The prevalence of hospitalized psychiatric patients with an abnormal ECG indicates that ECGs should be performed systematically in this population. Prescription of psychotropic drugs should be done cautiously, particularly in patients with QTc prolongation risk factors.

scholarly journals Risk of QTc Interval Prolongation Associated With Circulating Anti‐Ro/SSA Antibodies Among US Veterans: An Observational Cohort Study

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Pietro Enea Lazzerini ◽  
Gabriele Cevenini ◽  
Yongxia Sarah Qu ◽  
Frank Fabris ◽  
Nabil El‐Sherif ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Small Sample ◽  
Observational Cohort Study ◽  
Current Evidence ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Increased Risk ◽  
Observational Cohort ◽  
Us Veterans

Background Anti‐Sjögren's syndrome‐related antigen A‐antibodies (anti‐Ro/SSA‐antibodies) are responsible for a novel form of acquired long‐QT syndrome, owing to autoimmune‐mediated inhibition of cardiac human ether‐a‐go‐go‐related gene‐potassium channels. However, current evidence derives only from basic mechanistic studies and relatively small sample‐size clinical investigations. Hence, the aim of our study is to estimate the risk of QTc prolongation associated with the presence of anti‐Ro/SSA‐antibodies in a large population of unselected subjects. Methods and Results This is a retrospective observational cohort study using the Veterans Affairs Informatics and Computing Infrastructure. Participants were veterans who were tested for anti‐Ro/SSA status and had an ECG. Descriptive statistics and univariate and multivariate logistic regression analyses were performed to identify risk factors for heart rate‐corrected QT interval (QTc) prolongation. The study population consisted of 7339 subjects (61.4±12.2 years), 612 of whom were anti‐Ro/SSA‐positive (8.3%). Subjects who were anti‐Ro/SSA‐positive showed an increased prevalence of QTc prolongation, in the presence of other concomitant risk factors (crude odds ratios [OR], 1.67 [1.26–2.21] for QTc >470/480 ms; 2.32 [1.54–3.49] for QTc >490 ms; 2.77 [1.66–4.60] for QTc >500 ms), independent of a connective tissue disease history. Adjustments for age, sex, electrolytes, cardiovascular risk factors/diseases, and medications gradually attenuated QTc prolongation estimates, particularly when QT‐prolonging drugs were added to the model. Nevertheless, stepwise‐fully adjusted OR for the higher cutoffs remained significantly increased in anti‐Ro/SSA‐positive subjects, particularly for QTc >500 ms (2.27 [1.34–3.87]). Conclusions Anti‐Ro/SSA‐antibody positivity was independently associated with an increased risk of marked QTc prolongation in a large cohort of US veterans. Our data suggest that within the general population individuals who are anti‐Ro/SSA‐positive may represent a subgroup of patients particularly predisposed to ventricular arrhythmias/sudden cardiac death.

scholarly journals Electrocardiographic abnormalities with quinine and artesunate combinations in comparison to quinine or artesunate alone in severe falciparum malaria

2020 ◽  
Vol 9 (10) ◽  
pp. 1520
Author(s):  
Anjali Tarai ◽  
Kali Prasad Pattnaik ◽  
Kumar Haraprasad Mishra
Keyword(s):  
Falciparum Malaria ◽  
Cardiac Arrhythmia ◽  
Electrolyte Imbalance ◽  
High Dose ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Treatment Regimens ◽  
Life Threatening ◽  
Electrocardiographic Recordings ◽  
Severe Falciparum Malaria

Background: In Multi drug resistant falciparum malaria anti-malarial combinations are frequently used i.e. Quinine and IV Artesunate. Quinine is associated with electrocardiographic disturbances. Artesunate in high dose produce QTC prolongation in animal models, so the electrocardiogram (ECG) is thoroughly studied.Methods: Severe falciparum malaria cases 15 to 60 years were randomly allocated into 3 treatment regimens i.e. Artesunate, Quinine alone and their combination. Electrocardiographic recordings were taken periodically in 3 groups and compared statistically.Results: The mean QTC interval is significantly prolonged in combination treatment group from 0.40+0.02 to 0.49+0.09 (P<0.05) ECG disturbance (44%). QTC prolongation was commonest (i.e. 27%) with electrolyte imbalance could produce life threatening cardiac arrhythmia (Polymorphic VT with Sr K+ 2.9). Artesunate alone was list prone (i.e. only 6%) Quinine though has comparatively more (i.e. 25%) but there is no life-threatening cardiac arrhythmia in artesunate and Quinine.

scholarly journals QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

CNS Spectrums ◽  
2017 ◽  
Vol 23 (4) ◽  
pp. 278-283 ◽  
Author(s):  
Anja Elliott ◽  
Thibault Johan Mørk ◽  
Mikkel Højlund ◽  
Thomas Christensen ◽  
Rasmus Jeppesen ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Torsades De Pointes ◽  
Small Sample ◽  
Polymorphic Ventricular Tachycardia ◽  
Antipsychotic Treatment ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Worst Case ◽  
Clinical Interviews ◽  
Observational Cohort

ObjectiveAntipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.MethodsWe carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.ResultsElectrocardiograms were available for 65 patients, and 6% had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.ConclusionsWe recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.

scholarly journals Prevalence and risk factors of prolonged corrected QT interval in general Chinese population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Qun Ma ◽  
Zhao Li ◽  
Xiaofan Guo ◽  
Liang Guo ◽  
Shasha Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Chinese Population ◽  
Liaoning Province ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Cvd Risk ◽  
Specific Risk ◽  
Increased Risk ◽  
General Chinese Population

Abstract Background Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community. Methods A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett’s formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders. Results The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35–44 years; 28.3%, 45–54 years; 35.2%, 55–64 years; 43.4%, ≥65 years, P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval. Conclusions The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community.

scholarly journals Pattern of antimalaria treatment and risk factors for torsades de pointes in admitted heart failure patients in Lagos-Nigeria

2014 ◽  
Vol 3 (5) ◽  
pp. 161
Author(s):  
Janet N. Ajuluchukwu ◽  
Emmanuel N. Anyika ◽  
Christiana A. Boyle
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Torsades De Pointes ◽  
Malaria Treatment ◽  
Qtc Prolongation ◽  
Mean Values ◽  
Group 2 ◽  
Sulphadoxine Pyrimethamine

Background: In a malaria-holoendemic region, concurrent malaria complicating heart failure (HF) occurs; with higher morbidity and increased adverse drug-drug interactions. Aim: To characterise malaria treatment and risk factors of cardio-toxicity among HF patients. Objectives: To characterise the use of anti-malaria agents (AMA), compare risk factors of torsades de pointes (TdP) amongst AMA-users and non-users, and to assess length of hospital stay. Methods: Admitted HF patients were retrospectively studied, and grouped on the basis of malaria treatment. TdP risk factors- advanced age, bradycardia, hypokalemia, and QTc prolongation were compared in the two groups. Results: The 160 HF patients (mean ejection fraction 39.6% ± 12.6%, mean age 54.9 ± 14.6 years) included 82 males (51.3%), with predominant non-ischemic HF. Malaria treatment occurred in 32.5% (52), though diagnosis was presumptive in 48 (92.3%). All (100%) malaria prescriptions were artemisinin-based, but monotherapeutic in 6 (11.4%). Partner-drugs included sulphadoxine-pyrimethamine (SP) 26 (50%), and lumefantrine 7 (13.5%). TdP risk-factors of age 65 years, prolonged QTc, hypokalemia, and bradycardia occurred in 43 (26.9%), 63 (39.4%), 48 (30%), and 8 (5.0%) respectively. Group 1 (AMA treated) and group 2 patients were comparable on all mean values of risk factors. Nevertheless, affected proportions were significantly different for hypokalemia (X2 = 6.1), QTc prolongation (48.1% versus 35.2%, p < .05), and older age (38.5% versus, 21.3%, p < .05%). Conclusion: Though all HF patients similarly demonstrated risks of TdP, univariate analysis indicates a significantly higher proportion in malaria-treated patients; supporting further therapeutic caution in this patient subset.

Risk of QTc interval prolongation among cancer patients treated with tyrosine kinase inhibitors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3033-3033
Author(s):  
Anan Abdelmoti Abu Rmilah ◽  
Grace Lin ◽  
Joerg Herrmann
Keyword(s):  
Tyrosine Kinase ◽  
Cancer Patients ◽  
Tyrosine Kinase Inhibitors ◽  
Kinase Inhibitors ◽  
Complication Rates ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qtc Interval Prolongation ◽  
Life Threatening

3033 Background: QTc interval prolongation can lead to life-threatening complications such as torsade de pointes (TdP), ventricular tachycardia (VT), and sudden cardiac death (SCD). It can occur with various tyrosine kinase inhibitors (TKIs) but comparative analyses on the incidence and complication rates are scarce. We thus conducted a comprehensive analysis of TKI use and QTc prolongation in clinical practice. Methods: We retrospectively reviewed the electronic medical records of all cancer patients who were treated with TKI between 01/2005 and 12/2018 at our institution. QTc prolongation was defined as a QTc ≥ 450 ms or 460 ms among male or female patients, respectively. For each type of TKIs, we determined the administration rate and incidence of QTc interval prolongation. We also studied the frequency of QTc prolongation ≥ 500 ms, rate of increase of the QTc interval by ≥ 60 ms, and the development of complications (VT, TdP and SCD). Results: In the present study, we analyzed the data of 685 cancer patients (431 male and 254 female), including 299 patients with RCC, 188 with chronic leukemia, 55 with acute leukemia, 65 with thyroid cancer, 48 with lung cancer and 39 with GIST. These patients received 902 TKI administrations and QTc prolongation was reported in 1/3 of these (289 administrations). The highest frequency was seen with imatinib, nilotinib and dasatinib (30, 40 and 50%). Among cases of QTc prolongation, a QTc interval ≥ 500 ms was documented in 53 (18.3%) and QTc progression ≥ 60 ms in 72 (25%). Complications were found in 14 cases (5%) including VT in 9, TdP in 2 and SCD in 3 administrations. Conclusions: The current findings suggest that TKI therapy leads to QTc prolongation in 1/3 of patients on average and most commonly with the Bcr-Abl TKIs, imatinib, nilotinib and dasatinib. While SCD is rare (1%) it can still evolve and in 5% of all QTc prolongations with TKIs are potentially life-threatening. These data support recommendations for serial ECGs in cancer patients undergoing TKI therapy. [Table: see text]

scholarly journals Association between QTc prolongation and mortality in patients with suspected poisoning in the emergency department: a transnational propensity score matched cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020036 ◽  
Author(s):  
Camilla Schade Hansen ◽  
Anton Pottegård ◽  
Ulf Ekelund ◽  
Helene Kildegaard Jensen ◽  
Jakob Lundager Forberg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Propensity Score ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
First Time

ObjectivesPoisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of QTc prolongation among ED patients with suspected poisoning and to calculate the absolute and relative risk of mortality or cardiac arrest associated with a prolonged QTc interval.MethodsWe performed a register-based cohort study, including all adult first-time contacts with suspected poisoning to the ED of two Swedish hospitals (January 2010–December 2014) and two Danish hospitals (March 2013–April 2014). We used propensity score matching to calculate HRs for all-cause mortality or cardiac arrest (combined endpoint) within 30 days after contact comparing patients with a prolonged QTc interval (≥450 ms men, ≥460 ms women) with patients with a QTc interval of <440 ms.ResultsAmong all first-time contacts with suspected poisoning that had an ECG recorded within 4 hours after arrival (n=3869), QTc prolongation occurred in 6.5%. The overall mortality after a 30-day follow-up period was 0.8% (95% CI 0.6 to 1.2), with an absolute risk of mortality or cardiac arrest in patients with QTc prolongation of 3.2% (95% CI 1.4 to 6.1). A prolonged QTc interval on arrival was associated with a HR of 3.6 (95% CI 1.0 to 12.2).ConclusionIn the ED, a prolonged QTc interval in patients arriving with suspected poisoning seems to be associated with a threefold increased risk of 30-day all-cause mortality or cardiac arrest.

scholarly journals QT Interval Prolongation in Patients Treated for COVID-19

2020 ◽  
Author(s):  
Parham Habibzadeh ◽  
Abdollah Sarami ◽  
Mahboobeh Yadollahie ◽  
Kourosh Hashemiasl ◽  
Arezoo Salahi ◽  
...  
Keyword(s):  
Serum Potassium ◽  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Serum Magnesium ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Effective Measure ◽  
Qt Interval Prolongation ◽  
Life Threatening

AbstractBackgroundMany of the drugs commonly used for the treatment of COVID-19 cause QT interval prolongation and increase the risk of life-threatening cardiac arrhythmias. It has been shown that maintaining serum potassium and magnesium levels above 4 and 3 mg/dL, respectively, would prevent the QTc prolongation.ObjectiveTo determine if keeping only the serum magnesium level above 3 mg/dL could be considered an effective measure to prevent QTc prolongation in patients with COVID-19 receiving these drugs.MethodsIn a retrograde observational study, QTc interval was measured in 14 patients diagnosed with COVID-19 before and 3 days after initiation of treatment with either hydroxychloroquine or lopinavir-ritonavir, while their serum magnesium levels were kept ≥3 mg/dL.ResultsThe baseline QTc interval of 412 (SD 36) ms significantly increased by an average of 34 (95% CI 13 to 55) ms after 3 days of treatment. 5 patients, mostly those with lower serum potassium levels, had QTc prolongation ≥60 ms.ConclusionAlthough it seems that the risk of fatal cardiac arrhythmias in this setting is not high, it is prudent to monitor the serum electrolytes, particularly potassium, in patients with COVID-19 who are treated with either hydroxychloroquine or lopinavir-ritonavir.

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