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Drugs associated with qt interval prolongation

Drugs by Class
Associationa Torsadogenicb FDA Label ingc Comments
Non-specific arrhythmias reported in PI. Anti-arrhythmics
IV affects QTc less than oral; proarrhythmia infrequent. Rate appears lower than that of quinidine. Rate appears lower than that of quinidine. “Quinidine syncope” in 2–6% of patients. Anticonvulsants
Non-specific ECG changes reported in PI. 1 in 10,000 ventricular arrhythmias reported in PI. Non-specific arrhythmias reported in PI. Non-specific arrhythmias reported in PI. 1:1000 risk of arrhythmia reported in PI. Antihistamines
Anti nfectives
Known drug–drug interactions with other agents (e.g. Drugs by Class
Associationa Torsadogenicb FDA Label ingc Comments
Known drug–drug interactions with other agents (e.g. Antipsychotics
Non-specific ECG changes and sudden death reported in Non-specific ECG changes reported in PI. Drug–drug interactions also lead to QT prolongation. Cancer chemotherapeutic agents
Gastrointestinal agents
Migraine agents
Drugs by Class
Associationa Torsadogenicb FDA Label ingc Comments
Miscellaneous agents
FDA = United States Food and Drug Administration a Associations are based on the strength of evidence that supports whether QT prolongation can occur. This categorization does not delineate an individual patient’s risk of QT prolongation. b Torsadogenic potential is divided into four categories as characterized in a previous publication1: high = drugs that are potent blockers of currents prolonging myocardial repolarization; medium high = drugs that prolong myocardial repolarization at higher doses, or at normal doses with concurrent administration of drugs that inhibit drug metabolism; low = drugs that prolong action potential duration and QT interval at high doses or concentrations that are clearly above the therapeutic range; and not clear = drugs that block repolarizing ion currents in vitro but that have so far not been shown to prolong repolarization in other in vitro models. c Describes whether the FDA-approved product label ing includes mention of QT prolongation, torsades de pointes, or both.2–65 d Drug reported in the product label ing to prolong the QT interval, but evidence to support such an effect is lacking or published data suggest otherwise. 1. Haverkamp W, Eckardt L, Monnig G, et al. Clinical aspects of ventricular arrhythmias associated with QT prolongation. Eur Heart J 2001;3(suppl 2. Wyeth Ayerst. Fluothane (halothane) package insert. Philadelphia (PA); 2000. 3. Baxter Pharmaceutical Products Inc. Isoflurane [generic] package insert. New Providence (NJ); 2000. 4. Wyeth Laboratories. Cordarone (amiodarone) package insert. Philadelphia (PA); 1999. 5. Fujisawa Healthcare, Inc. Adenocard (adenosine) package insert. Deerfield (IL); 2000. 6. G. D. Searle. Norpace (disopyramide) package insert. Chicago; 1999. 7. Pfizer, Inc. Tikosyn (dofetilide) package insert. New York; 1999. 8. 3M Pharmaceuticals. Tambocor (flecainide) package insert. Northridge (CA); 1998. 9. Pharmacia and Upjohn Company. Corvert (ibutilide) package insert. Kalamazoo (MI); 1999. 10. Apothecon. Pronestyl (procainamide) package insert. Princeton (NJ); 1991. 11. Knol Pharmaceutical Company. Rythmol (propafenone) package insert. Mount Olive (NY); 1998. 12. A.H. Robins Company. Quinidex Extentabs (quinidine extended release) package insert. Richmond (VA); 1998. 13. Berlex Laboratories. Betapace (sotalol) package insert. Wayne (NJ); 2000. 14. Parke Davis. Cerebyx (fosphenytoin) package insert, Morris Plains (NJ); 1999. 15. Mylan Pharmaceuticals, Inc. Amitriptyline [generic] package insert. Morgantown (WV); November 2000. 16. Forest Laboratories, Inc. Celexa (citalopram) package insert. St. Louis (MO); 2000. 17. Aventis Pharmaceuticals. Norpramin (desipramine) package insert. Parsippany (NJ); 1997. 18. Pfizer, Inc. Sinequan (doxepin) package insert. New York; 1996. 19. Dista Products Company. Prozac (fluoxetine) package insert. Indianapolis (IN); 2001. 20. Geneva Pharmaceuticals, Inc. Imipramine [generic] package insert. Broomfield (CT); 1999. 21. Mylan Pharmaceuticals, Inc. Maprotiline [generic] package insert. Morgantown (WV); 2001. 22. Watson Laboratories, Inc. Nortriptyline [generic] package insert. Corona (CA); 2001. 23. GlaxoSmithKline. Paxil (paroxetine) package insert. Research Triangle Park (NC); 2002. 24. Pfizer, Inc. Zoloft (sertraline) package insert. New York; 2001. 25. Wyeth Laboratories. Effexor (venlafaxine) package insert. Philadelphia (PA); 2001. 26. Geneva Pharmaceuticals, Inc. Clemastine [generic] package insert. Broomfield (CT); 2000. 27. Major Pharmaceuticals. Diphenhydramine [generic] package insert. Livonia (MI); 2001. 28. Schering Corporation. Claritin (loratadine) package insert. Kenilworth (NJ); 2000. 29. Abbott Laboratories. Biaxin (clarithromycin) package insert North Chicago (IL); 2000. 30. Abbott Laboratories. Erythromycin lactobionate i.v. [generic] package insert. North Chicago (IL); 1992. 31. Pfizer, Inc. Diflucan (fluconazole) package insert. New York; 1998. 32. AstraZeneca Pharmaceuticals LP. Foscavir (foscarnet) package insert. Wilmington (DE); 1999. 33. Roche Laboratories Inc. Cytovene (ganciclovir) package insert. Nutley (NJ); 2000. 34. Bristol-Myers Squibb. Tequin (gatifloxacin) package insert. Princeton (NJ); 2000. 35. Janssen Pharmaceutica Products. Sporanox (itraconazole capsules) package insert. Titusvil e (NJ); 2000. 36. Janssen Pharmaceutica Products. Sporanox (itraconazole oral solution) package insert. Titusvil e (NJ) ; 2000. 37. Janssen Pharmaceutica Products. Sporanox (itraconazole injection) package insert. Titusvil e (NJ); 2000. 38. Janssen Pharmaceutica Products. Nizoral (ketoconazole) package insert. Titusvil e (NJ); 1998. 39. Ortho-McNeil Pharmaceuticals. Levaquin (levofloxacin) package insert. Raritan (NJ); 2000. 40. Roche Laboratories Inc. Lariam (mefloquine) package insert. Nutley (NJ); 1999. 41. Bayer Corporation. Avelox (moxifloxacin) package insert. West Haven (CT); 2001. 42. American Pharmaceutical Partners. Nebupent (pentamidine) package insert. Los Angeles; 1999. 43. Roche Laboratories Inc. Bactrim (trimethoprimsulfamethoxazole) package insert. Nutley (NJ); 2000. 44. GlaxoSmithKline. Thorazine (chlorpromazine) package insert. Research Triangle Park (NC); 2000. 45. Ortho-McNeil Pharmaceutical, Inc. Haldol (haloperidol) package insert. Raritan (NJ); October 1998. 46. Gate Pharmaceuticals. Orap (pimozide) package insert. Sel ersvil e (PA); 1999. 47. AstraZeneca Pharmaceuticals LP. Seroquel (quetiapine) package insert. Wilmington (DE); 2001. 48. Janssen Pharmaceutica Products. Risperdal (risperidone) package insert. Titusvil e (NJ); 2000. 49. Novartis Pharmaceutical Corporation. Clozaril (clozapine) package insert. East Hanover (NJ); 2001. 50. Pfizer, Inc. Geodon (ziprasidone) package insert. New York; July 2002. 51. Cel Therapeutics, Inc. Trisenox (arsenic trioxide) package insert. Seattle (WA); 2000. 52. AstraZeneca Pharmaceuticals LP. Nolvadex (tamoxifen) package insert. Wilmington (DE); 1999. 53. Mylan Pharmaceuticals, Inc. Indapamide [generic] package insert. Morgantown (WV); 1998. 54. Novartis Pharmaceuticals Corporation. Sandostatin (octreotide) package insert. East Hanover (NJ); 1999. 55. Abbott Laboratories. Droperidol [generic] package insert. North Chicago (IL); 1995. 56. Aventis Pharmaceuticals, Inc. Anzemet (dolasetron) package insert. Kansas City (MO); 1999. 57. GlaxoSmithKline. Amerge (naratriptan) package insert. Research Triangle Park (NC); 1999. 58. GlaxoSmithKline. Imitrex (sumatriptan) package insert. Research Triangle Park (NC); 2001. 59. Merck and Co., Inc. Maxalt (rizatriptan) package insert. West Point (PA); 2000. 60. AstraZeneca Pharmaceuticals LP. Zomig (zolmitriptan) package insert. Wilmington (DE); 2000. 61. American Regent Laboratories, Inc. Epinephrine [generic] package insert. Shirley (NY); June 1999. 62. Roxane Laboratories, Inc. Dolophine (methadone) package insert. Columbus (OH); 2001. 63. GlaxoSmithKline. Serevent (salmeterol) package insert. Research Triangle Park (NC); 2000. 64. Fujisawa Healthcare, Inc. Prograf (tacrolimus) package insert. Deerfield Park (IL); 2001. 65. Elan Pharmaceuticals Inc. Zanaflex (tizanidine) package insert. South San Francisco (CA); 2000. Adapted from Clinical relevance and management of drug-related QT interval prolongation. Pharmacotherapy. 2003;23(7):881–908. (Drugs not available in Canada have been removed from this table.)


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