scholarly journals Effects of Methadone on Corrected Q-T Interval Prolongation in Critically Ill Children

2018 ◽  
Vol 23 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Travis S. Heath ◽  
Rachel G. Greenberg ◽  
Susan R. Hupp ◽  
David A. Turner ◽  
Christoph P. Hornik ◽  
...  
Keyword(s):  
Critically Ill ◽  
Tertiary Care ◽  
Substantial Effect ◽  
Critically Ill Children ◽  
Admission Diagnosis ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qtc Interval Prolongation ◽  
Before And After

OBJECTIVES This study aimed to determine the association between methadone use and corrected Q-T interval (QTc) prolongation in critically ill children METHODS A retrospective cohort study of critically ill children receiving methadone at a tertiary care pediatric hospital was conducted. Patients younger than 19 years who had been admitted to the intensive care unit between January 1, 2009, and June 21, 2013, who had received methadone while inpatients, and who had had electrocardiograms (ECGs) performed within 30 days before and after methadone initiation were included. The primary outcome was the net change in QTc interval between baseline and postmethadone ECGs. Secondary outcomes included percent change in QTc interval and the proportion of patients whose QTc intervals changed from normal to prolonged following methadone initiation. We also evaluated potential predictors of QTc interval prolongation, including age, sex, admission diagnosis category, exposure to other QTc-prolonging medications, presence of congenital heart disease or known arrhythmias, and methadone daily dose and route of administration. RESULTS Sixty-four patients met the inclusion criteria. The median (25th, 75th percentiles) change in QTc interval following methadone initiation was −8 msec (−34, 13.5 msec; p = 0.19). Five patients (8%) had a baseline normal QTc interval that became prolonged after methadone initiation. We identified no statistically significant predictors of QTc prolongation after methadone initiation. CONCLUSIONS In this dedicated pediatric safety study, methadone initiation did not result in prolongation of the QTc interval. Although these findings suggest methadone initiation may not have a substantial effect of QTc prolongation in critically ill children, a controlled, prospective evaluation in this population remains warranted.

Evaluation of the Effects of Quetiapine on QTc Prolongation in Critically Ill Patients

2017 ◽  
Vol 31 (3) ◽  
pp. 292-297 ◽  
Author(s):  
Kevin M. Dube ◽  
Jeremy DeGrado ◽  
Benjamin Hohlfelder ◽  
Paul M. Szumita
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Multivariable Analysis ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Increased Risk ◽  
Qtc Interval Prolongation ◽  
The Impact ◽  
Median Change

Quetiapine, an atypical antipsychotic used in the intensive care unit (ICU) to manage delirium, has a possible adverse effect of corrected QT (QTc) interval prolongation. The objective of this analysis was to describe the impact of quetiapine on QTc interval prolongation in critically ill patients. This was a single-center, prospective cohort analysis of ICU patients who received quetiapine between October 2015 and February 2016. The major end point was the incidence of QTc prolongation greater than 60 milliseconds above baseline during therapy. Minor end points included median change in QTc interval and incidence of Torsades de Pointes (TdP). Univariate and multivariable analyses were performed to determine variables associated with higher risk of QTc prolongation. During the study period, 103 patients were enrolled in the analysis. QTc interval prolongation greater than 60 milliseconds occurred in 14 (13.6%) patients. The median change in QTc interval was 20 milliseconds. There were no cases of TdP. On multivariable analysis, the only variable associated with higher incidence of QTc prolongation was administration of a concomitant medication known to prolong the QTc interval ( P = .046). QTc prolongation was relatively uncommon among critically ill patients utilizing quetiapine. Patients receiving concomitant medications known to prolong the QTc interval may be at an increased risk.

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

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.

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]

Minimizing the Risks Associated with Significant QTc Prolongation in People with Schizophrenia: A Consensus Statement by The Cardiac Safety in Schizophrenia Group

2002 ◽  
Vol 10 (2) ◽  
pp. 115-124 ◽  
Author(s):  
David Ames ◽  
John Camm ◽  
Peter Cook ◽  
Peter Falkai ◽  
Charles Gury ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Consensus Statement ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Qtc Interval ◽  
Cardiac Safety ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Schizophrenia Group ◽  
Qtc Interval Prolongation

Cardiac Safety in Schizophrenia Group Objectes: This study was designed to help identify and clarify issues associated with cardiac safety in schizophrenia, particularly QTc interval prolongation; to raise awareness among psychiatrists of the cardiac issues involved in prescribing for schizophrenia and help psychiatrists minimise the potential cardiac risks associated with treating schizophrenia. Methods: The currently available literature on cardiac dysfunction associated with antipsychotic treatments was reviewed by an independent panel of international psychiatric and cardiology experts. Following individual review, a joint meeting was held and a consensus statement produced. Results: Prolongation of QTc interval is relatively common among antipsychotic drugs although there is marked variation in the extent to which the different agents exert their effect. If a patient is considered to be at high risk of significantly prolonged QTc interval (e.g. increasing age, female gender, comorbid cardiovascular disease) prescription of an antipsychotic drug with low QTc prolonging potential is recommended. Evaluation of a patient's risk factors for significant QTc prolongation is an important part of patient assessment at presentation. To significantly reduce the risk of morbidity and mortality from prolonged QTc interval a team approach involving the hospital emergency psychiatric care team, the office-based psychiatrist, the primary care physician, the cardiologist and the pharmacist is advocated. Conclusions: Significant QTc interval prolongation caused by some antipsychotics is a risk factor that may lead to sudden death in patients with schizophrenia receiving these medications. Not all antipsychotic drugs prolong QTc interval. Careful clinical and pharmacological management of the patient with schizophrenia can significantly reduce the risks of morbidity and mortality from QTc interval prolongation.

scholarly journals Incidence of Corrected QT Prolongation With Concomitant Methadone and Atypical Antipsychotics in Critically Ill Children

2021 ◽  
Vol 26 (3) ◽  
pp. 271-276
Author(s):  
Kaitlin M. Hughes ◽  
Anne Thorndyke ◽  
Emma M. Tillman
Keyword(s):  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Pilot Trial ◽  
Critically Ill Children ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Significant Difference ◽  
Before And After ◽  
Observational Cohort ◽  
Clinically Significant

OBJECTIVE To evaluate the safety of the combination of methadone and an atypical antipsychotic in PICU patients. METHODS This was a retrospective observational cohort pilot study in a single-center PICU in an academic children's hospital. Children 1 month to 18 years of age were included if they received methadone, were then initiated on an atypical antipsychotic (i.e., quetiapine or risperidone), and had EKG monitoring before and after medication initiation. RESULTS Prolongation of the corrected QT (QTc) interval occurred in 5 of the 34 included patients when an atypical antipsychotic was added to methadone. Of the 5 patients who had a prolonged QTc interval, 4 (80%) were older than 12 years and had a median weight of 91.3 kg. There were statistical differences between age and weight when comparing patients who experienced QTc prolongation, but no differences in sex, ethnicity, electrolyte deficiencies, number of additional QTc-prolonging medications, and number of additional drug-drug interactions were identified. When comparing atypical antipsychotics, 9.5% of patients receiving risperidone had a prolonged QTc interval, versus 23% of patients receiving quetiapine (p = 0.04). The net change in QTc interval after initiation of methadone was 0.19 milliseconds (IQR: −3, 15), which increased after atypical antipsychotic initiation to 4 milliseconds (IQR: −16, 15). CONCLUSIONS Our pilot trial suggests there is no clinically significant difference in incidence of QTc prolongation with addition of atypical antipsychotics to methadone.

scholarly journals Hydroxychloroquine and QTc: beyond COVID-19

2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Alberto Castagna ◽  
Francesco Vetta ◽  
Giuseppe Attisani ◽  
Raffaele Costa ◽  
Carmen Ruberto ◽  
...  
Keyword(s):  
Focal Point ◽  
Elderly Subjects ◽  
Cardiac Repolarization ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Antiviral Effects ◽  
Qtc Interval Prolongation ◽  
Electrocardiogram Monitoring ◽  
Potential Use

Hydroxychloroquine is an antimalarial drug also known for its anti-inflammatory and antiviral effects, which have raised the interest of many researchers for its potential use in COVID-19 patients. It is known that this drug, being able to influence the cardiac repolarization phase with QTc interval prolongation, can be potentially harmful, chiefly in elderly subjects with frailty syndrome, several comorbidities and polypharmacotherapy. Therefore, although electrocardiogram monitoring of QTc prolongation is the focal point for reducing the arrhythmic risk of these patients, in order to identify the most exposed patients, the traditional Comprehensive Geriatric Assessment should be combined with a multiparametric risk score for QTc prolongation.

Role of Co-occurring Alcohol and Substances Abuse on QTc Interval Prolongation Among Psychiatric Patients: A Cross-sectional National Survey

2017 ◽  
Vol 41 (S1) ◽  
pp. S201-S202
Author(s):  
M. Corbo ◽  
T. Acciavatti ◽  
F. Fiori ◽  
R. Santacroce ◽  
A. Aguglia ◽  
...  
Keyword(s):  
National Survey ◽  
Psychotropic Drugs ◽  
Polymorphic Ventricular Tachycardia ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Cross Sectional ◽  
Star Network ◽  
Qtc Interval Prolongation

IntroductionQTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.ObjectivesThe objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.AimsThe Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.MethodsA sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.ResultsA total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.ConclusionsThe present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals QTc interval prolongation in critically ill patients: Prevalence, risk factors and associated medications

PLoS ONE ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. e0199028 ◽  
Author(s):  
Flávia Medeiros Fernandes ◽  
Eliane Pereira Silva ◽  
Rand Randall Martins ◽  
Antonio Gouveia Oliveira
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Interval Prolongation

scholarly journals QTc interval prolongation in asymptomatic HIV – infected patients treated and untreated with antiretroviral therapy

2019 ◽  
Vol 73 ◽  
pp. 225-231
Author(s):  
Ewa Siwak ◽  
Magdalena M. Suchacz ◽  
Iwona Cielniak ◽  
Joanna Kubicka ◽  
Piotr Pulik ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Multivariable Analysis ◽  
Antiretroviral Drugs ◽  
Control Group ◽  
Qtc Interval ◽  
Interval Duration ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qtc Interval Prolongation ◽  
Asymptomatic Hiv

Aim: QTc interval prolongation has been found in HIV-infected patients. There are contradictory reports about the effects of antiretroviral drugs on QT interval duration. The aim of the study was to assess if the prolongation of the QTc interval depends on the antiretroviral treatment and other risk factors related to HIV infection. Material/Methods: 283 adult HIV-infected patients treated in HIV Outpatient Clinic in Warsaw were enrolled in the prospective, single-centre study. Factors related to ART and HIV infection were collected. Electrocardiograms were performed for each patient and QTc interval duration was measured and corrected using Bazett’s heart rate formula. Results: Prolonged QTc interval was identified in 4.9 % HIV-infected patients (median age 34.5 years, 85% male, 89% HIV RNA<50 copies/mL). The average length of QTc interval in ART HIV(+) patients was 403 ms, in untreated HIV(+) subjects – 398ms and in the control group of healthy individuals – 400ms. ART regimen included PI in 47.4% cases, NNRTI in 24.1% and INI in 28.5% patients. The longest QTc interval was found in patients treated with the PI scheme – 408 ms, shorter with INI – 399ms and with NNRTI – 397ms. A multivariable analysis revealed that only older age and female gender were significantly associated with QTc prolongation. Conclusions: In the group of young, asymptomatic HIV-infected patients with good immunovirological control, the prevalence of QTc prolongation was low – only 4.9% of subjects. ARV treatment seem to have no significant influence on the QTc interval duration.

scholarly journals Lack of an Effect of Standard and Supratherapeutic Doses of Linezolid on QTc Interval Prolongation

2011 ◽  
Vol 55 (9) ◽  
pp. 4302-4307 ◽  
Author(s):  
Bharat Damle ◽  
Robert R. LaBadie ◽  
Cheryl Cuozzo ◽  
Christine Alvey ◽  
Heng Wee Choo ◽  
...  
Keyword(s):  
Vital Signs ◽  
Systemic Exposure ◽  
Pharmacokinetic Profile ◽  
Ventricular Rate ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Double Blind ◽  
Qtc Interval Prolongation ◽  
Clinically Significant

ABSTRACTA double-blind, placebo-controlled, four-way crossover study was conducted in 40 subjects to assess the effect of linezolid on corrected QT (QTc) interval prolongation. Time-matched, placebo-corrected QT intervals were determined predose and at 0.5, 1 (end of infusion), 2, 4, 8, 12, and 24 h after intravenous dosing of linezolid 600 and 1,200 mg. Oral moxifloxacin at 400 mg was used as an active control. The pharmacokinetic profile of linezolid was also evaluated. At each time point, the upper bound of the 90% confidence interval (CI) for placebo-corrected QTcF values (i.e., QTc values adjusted for ventricular rate using the correction methods of Fridericia) for linezolid 600 and 1,200-mg doses were <10 ms, which indicates an absence of clinically significant QTc prolongation. At 2 and 4 h after the moxifloxacin dose, corresponding to the populationTmax, the lower bound of the two-sided 90% CI for QTcF when comparing moxifloxacin to placebo was >5 ms, indicating that the study was adequately sensitive to assess QTc prolongation. The pharmacokinetic profile of linezolid at 600 mg was consistent with previous observations. Systemic exposure to linezolid increased in a slightly more than dose-proportional manner at supratherapeutic doses, but the degree of nonlinearity was small. At a supratherapeutic single dose of 1,200 mg of linezolid, no treatment-related increase in adverse events was seen compared to 600 mg of linezolid, and no clinically meaningful effects on vital signs and safety laboratory evaluations were noted.

Sign in / Sign up

Export Citation Format

Share Document