OfficialreprintfromUpToDate

www.uptodate.com2017UpToDate

SomereportedcausesandpotentiatorsofthelongQTsyndrome*

Congenital Acquired(continued)
JervellandLangeNielsensyndrome(including Antihistamines
"channelopathies")
Astemizole ,bilastine ,hydroxyzine,
RomanoWardsyndrome terfenadine

Idiopathic Antineoplasticdrugs

Acquired Arsenictrioxide,bendamustine,
capecitabine,ceritinib,cesiumchloride ,
Metabolicdisorders crizotinib,dasatinib,eribulin,fluorouracil,
Hypokalemia nilotinib,lapatinib,lenvatinib,osimertinib,
oxaliplatin,panobinostat,pazopanib,
Hypomagnesemia
romidepsin,sorafenib,sunitinib,tegafur ,
Hypocalcemia toremifene,vandetanib,vemurafenib,
Starvation vorinostat

Anorexianervosa Analgesic,anesthetic,andsedativedrugs

Liquidproteindiets Anesthetic/sedative:Chloralhydrate,
propofol
Hypothyroidism
Opioids:Buprenorphine ,hydrocodone,
Bradyarrhythmias loperamide (inoverdose),methadone
Sinusnodedysfunction Bronchodilators(beta 2 agonists)
Atrioventricular(AV)blocksecondor Arformoterol,albuterol,formoterol,
thirddegree levalbuterol,indacaterol,olodaterol,
Antiarrhythmicdrugs salmeterol,terbutaline,vilanterol

Quinidine,procainamide,disopyramide Diuretics

Flecainide,propafenone Viaelectrolytechanges(especially
hypokalemiaorhypomagnesemia)
Amiodarone ,dronedarone,vernakalant
Gastrointestinaldrugs
Sotalol
Antidiarrheal:Loperamide (inoverdose)
Dofetilide,ibutilide
Antiemetics:Ondansetron,granisetron,
Antianginaldrugs
dolasetron,droperidol(maybesafeatthe
Ranolazine,ivabradine lowdosesusedbyanesthesiologists[0.625
Anticholinergicdrugs(antimuscarinics) to1.25mg]),hydroxyzine,tropisetron

Solifenacin,tolterodine
Antiinfectivedrugs
Antimalarial:
Knownrisk:Artemether,artemether
lumefantrine,chloroquine,
halofantrine,lumefantrine,quinidine
Possibleorconditionalrisk:
Delamanid ,hydroxychloroquine,
mefloquine,primaquine,quinine
Promotility:Cisapride(restricted
availability),domperidone ,
metoclopramide
Protonpumpinhibitors:Chronicuseleading
tohypomagnesemia(rare)
Gonadotropinreleasinghormone
agonistsandantagonists
Buserelin,degarelix,goserelin,histrelin,
leuprolide,triptorelin

Antituberculous:Bedaquiline Neurologicdrugs

Azoleantifungals:Fluconazole, Apomorphine,donepezil,ezogabine,
 itraconazole,ketoconazole(systemic), fingolimod,pimavanserin,tetrabenazine
posaconazole,voriconazole
Psychotropicdrugs
Fluoroquinolones(systemic):Ciprofloxacin,
Antipsychotics:
gatifloxacin ,levofloxacin,moxifloxacin,
Knownrisk:Chlorpromazine,
ofloxacin,sparfloxacin
haloperidol,
HIVantiretrovirals: levosulpiride ,methotrimeprazine
Knownrisk:Efavirenz,lopinavir, (levomepromazine) ,pimozide,
saquinavir sulpiride ,thioridazine
Possibleorconditionalrisk: Possibleorconditionalrisk:
Atazanavir,nelfinavir,rilpivirine, Amisulpride ,aripiprazole,
ritonavir asenapine,clozapine,cyamemazine ,
flupentixol ,iloperidone,
Macrolideantibiotics:Azithromycin,
melperone ,olanzapine,
erythromycin,clarithromycin,
paliperidone,perphenazine,
roxithromycin,telithromycin
pipamperone ,quetiapine,
Metronidazole risperidone,sertindole ,tiapride ,
Pentamidine(intravenous) ziprasidone

Pentavalentantimonials
(antiparasitic/antiprotozoal):Meglumine
antimoniate,sodiumstibogluconate
Telavancin
Tricyclicandtetracyclicantidepressants
(TCAs)
Selectiveserotoninreuptakeinhibitors
(lowerriskthanTCAs):Escitalopram,
citalopram,fluoxetine

Others:Atomoxetine,pimavanserin,
trazodone

Vasodilatordrugs

Bepridil ,cilostazol

Otherdrugsandherbs

Miscellaneous:Anagrelide,alfuzosin,
cocaine,mifepristone,papaverine
(intracoronary),pasireotide,probucol ,
terlipressin

Herbs:Cinchona(containsquinine),licorice
extract(glycyrrhizin)inoveruseleadingto
electrolytechanges

Otherfactors

Myocardialischemiaorinfarction,especially
withprominentTwaveinversions

Intracranialdisease

HIVinfection

Hypothermia

Toxicexposure:Organophosphate
insecticides

Connectivetissuediseaseswithanti
Ro/SSAantibodies

HIV:humanimmunodeficiencyvirus.
*ThelongandgrowinglistofmedicationsandotherfactorscapableofprolongingtheQTrepresentsan
evolvingareaofclinicalresearch.InsomecasesoflongQT,twoormorefactorsmaybeinvolved.Thisisnot
acompletelistofallQTprolongingdrugs.AdditionalclinicalinformationisprovidedattheArizonaCenterfor
EducationandResearchonTherapeutics(AZCERT)website:http://crediblemeds.org/.
IncontrastwithotherclassIIIantiarrhythmicdrugs,amiodaroneisrarelyassociatedwithtorsadesde
pointes(TdP)refertoaccompanyingtextwithinUpToDatetopicreviewofacquiredlongQTsyndrome.
NotavailableintheUnitedStates.
Removedfrommarketinmostcountriesduetoadversecardiovasculareffects.
AlthoughproductlabelingforbuprenorphineanalgesicswarnofQTcprolongationatdosesexceedingthose
recommended,dataforbuprenorphineinusualdosesfortreatmentofopioidusedisorderarereassuring,and
itappearstobeasuitablealternativeforpatientswithsignificantQTcprolongationduetomethadone.Refer
totheUpToDatetopicreviewsofopioidintoxicationandopioidusedisorderfordetail.
Overthecounteravailablewithoutaprescription.
AlthoughamoxapineandprotriptylinearenotincludedontheAZCERTlistofdrugsassociatedwithacquired
QTprolongation,overdoseofthesetricyclicantidepressantshasbeenassociatedwithcardiovasculartoxicity
andfatalities.

Datafrom:
1.NielsenJ,GraffC,KantersJ,etal.AssessingQTintervalprolongationanditsassociatedriskswith
antipsychotics.CNSDrugs201125:473.
2.LiE,EsterlyJ,PohlS,etal.DruginducedQTintervalprolongation:Considerationsforclinicians.
Pharmacotherapy201030:684.
3.CredibleMedsQTdrugslistwebsitesponsoredbyScienceFoundationoftheUniversityofArizona.
Availableathttp://crediblemeds.org/(AccessedJanuary6,2017).
4.LexicompOnline.Copyright19782017Lexicomp,Inc.AllRightsReserved.

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