Qt prolongation is a rare adverse event associated with many drugs, including antipsychotics and antidepressants. Qtc prolongation with antidepressants and antipsychotics. Patients with lqts should discuss all new medications prescription and over the counter with a health care provider. Drug class therapeutic use risk category route felbamate felbatol anticonvulsant epilepsy possible risk of tdp oral fenfluramine removed from market pondimin, ponderax, adafax appetite suppressant obesity avoid in congenital long qt oral fingolimod gilenya sphingosine phospate receptor modulator multiple sclerosis possible risk of tdp oral. An understanding of the pathophysiology of nausea and the mechanisms of antiemetics can help family physicians improve the costeffectiveness and. Cardiovascular quality and outcomes found that a computerized clinical decision support system cdss reduced drug induced changes in ecgs and the prescribing of dangerous drugs. The lists can be exported as pdf or excel files, printed and can be searched and. Drugs not available in canada have been removed from this table. Drugs causing qt prolongation litfl medical blog ecg. The majority of cases have occurred in patients taking an offending agent with multiple identifiable risk factors for corrected qt qtc prolongation. Crediblemeds using the list of qt prolonging drugs from. With this high of a result, reducing some medications would be likely appropriate.
The impact of drugrelated qt prolongation on fda regulatory decisions eunjung park, ph. It is recommended that you check the lists for drugs commonly used in your area of practice to familiarise yourself with the risks. Which psychotropics carry the greatest risk of qtc prolongation. Drug reported in the product labelling to prolong the qt interval, but evidence to support such an effect is lacking or published data suggest. Drugs that cause prolongation of the qtc interval have been extensively studied in the past decade 3. Remind the doctor to continue to monitor qtc after 1 month of therapy to reevaluate the new drug, then have an annual ekg after that. This section of crediblemeds includes tools to assist physicians, nurses, pharmacists and other healthcare professionals who play central roles in medication safety. While it can occur spontaneously in the congenital form, there is a wide array of drugs that have been implicated in the prolongation of the qt interval. Adapted from clinical relevance and management of drug related qt interval prolongation. Large, prospective, populationbased studies have linked qtc prolongation with increased mortality, figure 1.
Ray woosley, our founder and credible source on medication use. Generic name, brand name, risk category, pharmacologic class, and therapeutic use. The dangers of qtc interval prolongation and medications used. These drug interactions are really hard to know what to do. Antipsychotics have been known to be associated with qtc prolongation, as have drugs such as antidysrhythmics and antibiotics 9. Known risk of tdp kr, possible risk of tdp pr, conditional risk of tdp cr or special risk sr. In 17 case reports of cardiac changes associated with quetiapine use, doses ranged from 100 mgd 24 to an overdose of 36 gd. Drugs to avoid in congenital long qt generic name brand names partial list. Addressing qtc prolongation drug interactions has always been a challenging topic for me. Click on a drug and see if the fdaapproved label recommends ecg monitoring.
A long qt interval is most frequently seen with class i and class iii antiarrhythmic drugs. Crediblemeds offers resources for you to become an active participant and personalize your decisions for safe medication. The drug list below contains drugs from the categories. Unfortunately, many psychiatric medications such as antidepressants and antipsychotics have a risk of prolonging qt. Ecg a to z by diagnosis ecg interpretation in clinical context. Keller ga, alvarez pa, ponte ml, belloso wh, bagnes c, sparanochia c, gonzalez cd, villa etchegoyen mc, diez ra, di girolamo g1. A list of medications known to prolong the qt interval can be found in the credible. When assessing possible medication induced qtc prolongation, i would want to know if an ekg was checked in the past and if so, how much has it changedincreased since the last time it was checked.
Tdp andor qt prolongation, commonly referred to as the. Click herequick search qtdrugs for a drug no registration required. Using the list of qt prolonging drugs from the crediblemeds website and patient information in the electronic health records, recent research published in the journal of circulation. Crediblemeds filtered qtdrug list the last revision date. A minority of patients are symptomatic and typically present with one or more signs of arrhythmia, such as lightheadedness, syncope, or palpitations.
Antipsychotic drugs ad are effective and frequently prescribed to more females than males. Learn basic principles and tips for safe medication use, download a list of over 90 medicines that have potential risk of causing heart rhythm disturbances, read articles about drug interactions and bookmark ones that pertain to you, log your medications and submit questions to dr. The qt interval should be measured from the beginning of the qrs complex to the end of the t wave and averaged over 3 to 5 beats. Drugs by themselves can cause them in patients with underlying risk to be discussed, and also in the setting of polypharmacy. List of drugs to be avoided by patients with congenital long qt syndrome lqts updated april 2015 this list is not comprehensive but is meant to be a practical list for those clinicians managing patients with lqts in canada. The patient has not had cardiac concerns in the past. In such cases, clinicians should not only perform manual measurements, but also. Ecg library basics waves, intervals, segments and clinical interpretation. Visitors to the crediblemeds website can use quick search to find drugs that are in the qtdrugs lists. Drug therapy is the most common cause of acquired lqts. Drugs that cause qtc prolongation the mechanism of drug induced qt c prolongation is believed to be usually due to blockade of cardiac potassium channels.
Mar 01, 2004 an understanding of the pathophysiology of nausea and the mechanisms of antiemetics can help family physicians improve the costeffectiveness and efficacy of therapy. Evaluation of qtc prolongation and dosage effect with. A multicenter study to detect drugs and clinical factors involved in every day practice. Roden et al drug interactions on qtc in exploratory covid19 treatment. Access to download the lists of qtdrugs requires registration so that users can be notified when the lists have been revised. Antipsychotic and antidepressant drugs with qt interval. Antipsychotic medication and risk of qtc prolongation. Guide for qtc monitoring and management of drugresistant. The use of antipsychotics is a first6 line treatment for psychotic disorders such as schizophrenia. Additional drug information provided when you click on a drug name. Resources for everyone you are the most important member of your healthcare team. Paul morales patients who experience a prolonged qtc interval are at risk for developing torsade. Qtdrugs list of drugs that can cause arrhythmias click here for a downloadable list of over 180 medicines that have a potential risk of causing heart rhythm disturbances and perhaps death.
Qtc interval monitoring in the prescription of psychotropic medications. There are few instances in medical history of a single clinical entity that has been as disruptive for so many diverse groups and individual patients as drug induced long qt syndrome dilqts 1, 2. Crediblemeds is an online database of independent information regarding the safe use of medicines. All nine drugs had reports of qt prolongation or tdp reported.
The prevalence of qtc prolongation increased with citalopram dose in the entire study population p. Over the past 20 years, several drugs, including terfenadine, astemizole, cisapride and grepafloxacin, have been withdrawn from the canadian market as a result of causing deaths due to tdp. The lists can be exported as pdf or excel files, printed and can be searched and sorted by. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Aug 23, 2017 addressing qtc prolongation drug interactions has always been a challenging topic for me.
The impact of drugrelated qt prolongation on fda regulatory. Prolongation of the qt interval can be of particular concern to. Aug 25, 2011 qtc prolongation is one of the most common reasons drugs are removed from the market or restricted. Qt prolongation can occur due to congenital and acquired causes. It is not possible to include a full list of all medicines known to increase the qt interval in this bulletin.
Hctz electrocardiogram ventricular fibrillation tricyclic antidepressant not applicable hydrochlorothiazide. For patients at risk of qt prolongation, address modifiable risk factors, use caution with medications that. How to address qtc prolongation drug interactions med ed 101. Recently, controversy has surrounded a 2011 food and drug administration warning against using citalopram at doses 40 mgday due to qtc prolonging effects. Known risk of tdp kr, possible risk of tdp pr or have a conditional risk of tdp cr. Drugs to be avoided by congenital long qt patients drugs above plus drugs with special risk. Jul 1, causes and management of drug induced long qt syndrome. Crediblemeds website lists of drugs that are associated with. Antipsychotic drugs and qt prolongation request pdf. Drugs to avoid while you wait for your appointment over time, researchers and physicians have discovered that a large number of prescription medications and overthecounter drugs can prolong the qt interval andor have side effects that are negative for people with certain sads conditions. For more information regarding the qtdrugs lists, please consult our faq section.
Simplifying qt prolongation for busy clinicians canadian family. At the crediblemeds website, a drugs tdp risk is designated to a risk category. There are few instances in medical history of a single clinical entity that has been as disruptive for so many diverse groups and individual patients as druginduced long qt syndrome dilqts 1, 2. There are a number of widely used drugs which are known to cause qt prolongation. National medicines volume 21 information centre number 6. Terfenadine may have a steeper curve than the antipsychotic agents studied. The qt interval should be measured manually, preferably by using one of the limb leads that best shows the end of the t wave on a 12lead ecg.
It is important to balance the need for medications, such as psychotropic drugs, versus the risk of qt prolongation when managing patients. In clinical practice, if the qt interval appears to be greater than half of the rr interval and heart rate is close to 60 bpm an observer can easily and rapidly identify qtc prolongation. Ad may cause serious cardiovascular sideeffects, including prolonged qt interval, eventually leading. This disorder is characterized by a prolongation of the qt interval on electrocardiogram which increases the risk of ventricular tachycardia.
Drugs associated with qt prolongation, qtc prolongation. Crediblemeds is a nonprofit, universitybased, federally funded center for education and research on therapeutics, with a mission to foster safe medication use. Drug reported in the product labelling to prolong the qt interval, but evidence to support such an effect is lacking or published data suggest otherwise. Practical selection of antiemetics american family physician. Clinical aspects of ventricular arrhythmias associated with qt prolongation. Long qt syndrome is a cardiac conduction disorder characterized by prolongation and increased dispersion of ventricular repolarization, manifested by lengthening of the qt interval on the surface electrocardiography. If you have inherited sudden death in your family, click here for the list of over 210 medicines that you may want to avoid. Certain drugs, including some anesthetics, are known to contribute to qt prolongation. Drug drug interaction ddi is a vital information when physicians and pharmacists prepare for the combined use of two or more drugs. Qt interval prolongation has been reported in chronic heart failure, acute and chronic heart disease, and cardiomyopathies. Drugs that cause qtc prolongation the mechanism of druginduced qt c prolongation is believed to be usually due to blockade of cardiac potassium channels.
The risk of qtc prolongation with this group of drugs has been addressed in fluoroquinolones view in chinese available, we avoid fluoroquinolone use for patients taking other qtprolonging drugs and patients with long qt syndromes or other significant risk factors for arrhythmia available clinical data suggest. An analysis in a large cohort of geriatric patients article pdf available in plos one 115. Recently, the fda has been requesting drug developers to do qtc testing over a range of drug concentrations likely to occur during drug use. We recommend that patients with congenital long qt syndrome avoid use of these medicines if at all possible or take them under close medical. May 01, 2019 drugs associated with qt prolongation, qtc prolongation. Considering that not all agents that prolong the qt interval increase tdr, drugs can be distinguished into the following groups depending on their simultaneous effects on the qt corrected using the bazzets formula qtc interval and on tdr. Drugs to be avoided in patients with long qt syndrome. Qtc interval prolongation is an established, though imperfect, risk marker for tdp. Alternatively, these studies may indicate that drugs possess very different concentrationresponse curves for qtc prolongation. We recommend that patients with congenital long qt syndrome avoid.
Drugs to be avoided by congenital long qt patients crediblemeds. A list of medications known to prolong the qt interval can be found in the credible meds website here. Treating an adolescent with long qt syndrome for bipolar. Most patients with druginduced qt prolongation are asymptomatic and are diagnosed solely by ekg in association with a history of using medications known to cause qt prolongation. Drugs are the most common cause of acquired long qt syndrome.
Though tdp is a relatively rare event, it is a serious and lifethreatening polymorphic ventricular tachycardia. Drugs used to treat long qt syndrome the following list of medications are in some way related to, or used in the treatment of this condition. There are three mechanisms by which drugs can interact. Qtc prolongation and psychotropic medications american. Thus, several ddi databases are constructed to avoid. Several years ago, she had been diagnosed with anxiety, and treated with citalopram, which she continues to take.