Drugs that prolong the QT interval

Prolongation of the QT interval can lead to a life threatening ventricular arrhythmia known as torsades de pointes which can result in sudden cardiac death.

The risk of torsades de pointes depends on patient factors and current medication. A safe drug in one patient may be potentially harmful in another. The risks and benefits must be determined on a case by case basis.

In general, manufacturers advise that the use of two or more drugs that are associated with QT prolongation should be avoided. Increasing age, female sex, cardiac disease and some metabolic disorders (notably hypokalaemia) predispose to QT prolongation. Prescribers should also use caution when prescribing concurrent drugs that reduce serum potassium.

Print versions of the BNF contain a table with a list of some drugs that prolong the QT interval within Appendix 1, Interactions. The BNF 76 (September 2018 – March 2019) lists the following examples of drugs which prolong the QT interval (note this list is not exhaustive, and not all drugs are included within the Devon Formularies):

Amifampridine Clarithromycin Fluphenazine Panobinostat Telavancin
Amiodarone Clomipramine Haloperidol Pasireotide Tetrabenazine
Amisulpride Crizotinib Hydroxyzine Pazopanib Tizanidine
Anagrelide Dasatinib Inotuzumab ozogamicin Pimozide Tolterodine
Apomorphine Delamanid Iapatinib Quinine Toremifene
Arsenic Trioxide Disopyramide Levomepromazine Ranolazine Vandetanib
Artemether Dronaderone Lithium Ribociclib Vardenafil
Artenimol Droperidol Lofexidine Risperidone Vemurafenib
Bedaquiline Efavirenz Methadone Saquinavir Venlafaxine
Bosutinib Eribulin Moxifloxacin Sildenafil Vinflunine
Cabozantinib Erythromycin Nilotinib Sorafenib Voriconazole
Ceritinib Escitalopram Ondansetron Sotalol Zuclopenthixol
Chlorpromazine Flecainide Osimertinib Sulpiride
Citalopram Fluconazole Paliperidone Sunitinib

The BNF 76 (September 2018 – March 2019) also lists the following drugs that are predicted by the manufacturer to increase the risk of QT prolongation, and therefore concurrent use alongside drugs that prolong the QT interval should be avoided:

Domperidone Granisetron Mefloquine Palonosetron
Fingolimod Ivabradine Mizolastine Intravenous Pentamidine

Further guidance can also be found on the Specialist Pharmacy Service website; a UKMi Medicines Q&A resource is available here.

Individual drug interactions can also be checked using the online BNF, here.

 

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