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Tan H, Yan X, Chen Y, Huang G, Luo L, Li W, Lan W, Chen C, Xi X. A real-world pharmacovigilance study of drug-induced QT interval prolongation: analysis of spontaneous reports submitted to FAERS. Front Cardiovasc Med 2024; 11:1363382. [PMID: 38803662 PMCID: PMC11128590 DOI: 10.3389/fcvm.2024.1363382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose To identify the most commonly reported drugs associated with QT interval prolongation in the FDA Adverse Event Reporting System (FAERS) and evaluate their risk for QT interval prolongation. Methods We employed the preferred term (PT) "electrocardiogram QT prolonged" from the Medical Dictionary for Regulatory Activities (MedDRA) 26.0 to identify adverse drug events (ADEs) of QT interval prolongation in the FAERS database from the period 2004-2022. Reporting odds ratio (ROR) was performed to quantify the signals of ADEs. Results We listed the top 40 drugs that caused QT interval prolongation. Among them, the 3 drugs with the highest number of cases were quetiapine (1,151 cases, ROR = 7.62), olanzapine (754 cases, ROR = 7.92), and citalopram (720 cases, ROR = 13.63). The two most frequently reported first-level Anatomical Therapeutic Chemical (ATC) groups were the drugs for the nervous system (n = 19, 47.50%) and antiinfectives for systemic use (n = 7, 17.50%). Patients with missing gender (n = 3,482, 23.68%) aside, there were more females (7,536, 51.24%) than males (5,158, 35.07%) were involved. 3,720 patients (25.29%) suffered serious clinical outcomes resulting in deaths or life-threatening conditions. Overall, most drugs that caused QT interval prolongation had early failure types according to the assessment of the Weibull's shape parameter (WSP) analysis. Conclusions Our study offered a list of drugs that frequently caused QT interval prolongation based on the FAERS system, along with a description of some risk profiles for QT interval prolongation brought on by these drugs. When prescribing these drugs in clinical practice, we should closely monitor the occurrence of ADE for QT interval prolongation.
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Affiliation(s)
- Haowen Tan
- Department of Pharmacy, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, China
- Office of Good Clinical Practice, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, China
| | - Xida Yan
- Department of Pharmacy, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Ying Chen
- Office of Good Clinical Practice, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, China
| | - Guili Huang
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Luping Luo
- Department of Pharmacy, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, China
| | - Wenjun Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiwei Lan
- Department of Pharmacy, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, China
| | - Cheng Chen
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Xi
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Li D, Chai S, Wang H, Dong J, Qin C, Du D, Wang Y, Du Q, Liu S. Drug-induced QT prolongation and torsade de pointes: a real-world pharmacovigilance study using the FDA Adverse Event Reporting System database. Front Pharmacol 2023; 14:1259611. [PMID: 38186652 PMCID: PMC10771307 DOI: 10.3389/fphar.2023.1259611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction: Drug-induced QT prolongation and (or) Torsade de Pointes (TdP) is a well-known serious adverse reaction (ADR) for some drugs, but the widely recognized comprehensive landscape of culprit-drug of QT prolongation and TdP is currently lacking. Aim: To identify the top drugs reported in association with QT prolongation and TdP and provide information for clinical practice. Method: We reviewed the reports related to QT prolongation and TdP in the FDA Adverse Event Reporting System (FAERS) database from January 1, 2004 to December 31, 2022, and summarized a potential causative drug list accordingly. Based on this drug list, the most frequently reported causative drugs and drug classes of QT prolongation and TdP were counted, and the disproportionality analysis for all the drugs was conducted to in detect ADR signal. Furthermore, according to the positive-negative distribution of ADR signal, we integrated the risk characteristic of QT prolongation and TdP in different drugs and drug class. Results: A total of 42,713 reports in FAERS database were considered to be associated with QT prolongation and TdP from 2004 to 2022, in which 1,088 drugs were reported as potential culprit-drugs, and the largest number of drugs belonged to antineoplastics. On the whole, furosemide was the most frequently reported drugs followed by acetylsalicylic acid, quetiapine, citalopram, metoprolol. In terms of drug classes, psycholeptics was the most frequently reported drug classes followed by psychoanaleptics, analgesics, beta blocking agents, drugs for acid related disorders. In disproportionality analysis, 612 drugs showed at least one positive ADR signals, while citalopram, ondansetron, escitalopram, loperamide, and promethazine were the drug with the maximum number of positive ADR signals. However, the positive-negative distribution of ADR signals between different drug classes showed great differences, representing the overall risk difference of different drug classes. Conclusion: Our study provided a real-world overview of QT prolongation and TdP to drugs, and the presentation of the potential culprit-drug list, the proportion of reports, the detection results of ADR signals, and the distribution characteristics of ADR signals may help understand the safety profile of drugs and optimize clinical practice.
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Affiliation(s)
- Dongxuan Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Chai
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongli Wang
- Department of Pharmacy, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Dong
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunmeng Qin
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Dan Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yalan Wang
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Qian Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Songqing Liu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Held N, Atallah EL. Real-world Management of CML: Outcomes and Treatment Patterns. Curr Hematol Malig Rep 2023; 18:167-175. [PMID: 37395944 DOI: 10.1007/s11899-023-00703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW Chronic myeloid leukemia (CML) is a disease that previously signified a poor prognosis, but treatment options and outcomes have improved over the last several decades. Despite this, challenges remain in optimal management in clinical practice, as the characteristics in trial populations differ from patients who are treated in a real-world setting. This review describes recent updates in real-world treatment patterns and outcomes in patients with CML. RECENT FINDINGS Several analyses describing real-world practice patterns show that tyrosine kinase inhibitors (TKIs) are the most commonly prescribed agents in multiple lines of therapy. First-generation (1G) and second-generation (2G) TKIs are the most commonly prescribed, even in the third line and beyond. Third-generation (3G) TKIs are typically utilized in patients with resistant disease who are younger with fewer comorbidities. Hematopoietic stem cell transplant (HSCT) is utilized significantly less, given other treatment options available. The goals of treatment with CML have shifted to quality of life, cost savings, and treatment-free response (TFR). Despite clear guidelines for attempting TFR, discontinuation practice patterns remain inconsistent. TKIs are the mainstay of CML treatment, including those in later lines of therapy. In real-world practice, several challenges still remain with regard to optimal management. Specifically, ideal sequencing of treatments, side effect profiles of tyrosine kinase inhibitors (TKIs), current role and timing of transplant, and adherence to recommendations for attempting to achieve a treatment-free response (TFR). A national registry could characterize these practice patterns in order to find ways to optimize care for CML patients.
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Affiliation(s)
- Nicole Held
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ehab L Atallah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
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Chen M, Wang Z, Lai X, Wang S, Wu Z, Liu Q, Zhou S. Transient cardiac electrophysiological changes in a rat model of subarachnoid haemorrhage: a brain-heart interaction. Europace 2023; 25:euad171. [PMID: 37337928 PMCID: PMC10306271 DOI: 10.1093/europace/euad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/21/2023] Open
Abstract
AIMS Subarachnoid haemorrhage (SAH) is one of the causes of sudden cardiac death (SCD). However, the time course of ventricular arrhythmias and potential mechanisms responsible for this effect after SAH remain unknown. OBJECTIVE This study aims to investigate the effect of SAH on ventricular electrophysiological changes and its potential mechanisms in long-term phase. METHODS AND RESULTS We examined the ventricular electrophysiological remodelling and potential mechanisms in a Sprague Dawley rat model of SAH at six time points (baseline, and Days 1, 3, 7, 14 and 28) and explored the potential mechanisms. We measured the ventricular effective refractory period (ERP), ventricular fibrillation threshold (VFT) and left stellate ganglion (LSG) activity at different time points before and after SAH. We also detected neuropeptide Y (NPY) levels in plasma and myocardial tissues by enzyme-linked immunosorbent assay, and quantified NPY 1 receptor (NPY1R) protein and mRNA expression levels by western blotting and quantitative real-time reverse transcription-polymerase chain reaction, respectively. Subarachnoid haemorrhage gradually prolonged QTc intervals, shortened ventricular ERP and reduced VFT during the acute phase, peaking at Day 3. However, no significant changes were observed from Days 14 to 28 compared to Day 0. Subarachnoid haemorrhage gradually increased LSG activity, increased NPY concentrations and up-regulated NPY1R expression in the acute phase of SAH, peaking at Day 3. However, no significant variations were found from Days 14 to 28 compared to Day 0. CONCLUSION Subarachnoid haemorrhage increases the transient susceptibility of VAs in the acute phase, and the underlying mechanisms for this response included increased sympathetic activity and up-regulated NPY1R expression.
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Affiliation(s)
- Mingxian Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Renmin Road, Furong District, Changsha 410011, China
| | - Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Lai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhihong Wu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Renmin Road, Furong District, Changsha 410011, China
| | - Qiming Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Renmin Road, Furong District, Changsha 410011, China
| | - Shenghua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Renmin Road, Furong District, Changsha 410011, China
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Könemann H, Dagres N, Merino JL, Sticherling C, Zeppenfeld K, Tfelt-Hansen J, Eckardt L. Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects. Europace 2023; 25:euad091. [PMID: 37102266 PMCID: PMC10228619 DOI: 10.1093/europace/euad091] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/28/2023] Open
Abstract
Sudden cardiac death and ventricular arrhythmias are a global health issue. Recently, a new guideline for the management of ventricular arrhythmias and prevention of sudden cardiac death has been published by the European Society of Cardiology that serves as an update to the 2015 guideline on this topic. This review focuses on 10 novel key aspects of the current guideline: As new aspects, public basic life support and access to defibrillators are guideline topics. Recommendations for the diagnostic evaluation of patients with ventricular arrhythmias are structured according to frequently encountered clinical scenarios. Management of electrical storm has become a new focus. In addition, genetic testing and cardiac magnetic resonance imaging significantly gained relevance for both diagnostic evaluation and risk stratification. New algorithms for antiarrhythmic drug therapy aim at improving safe drug use. The new recommendations reflect increasing relevance of catheter ablation of ventricular arrhythmias, especially in patients without structural heart disease or stable coronary artery disease with only mildly impaired ejection fraction and haemodynamically tolerated ventricular tachycardias. Regarding sudden cardiac death risk stratification, risk calculators for laminopathies, and long QT syndrome are now considered besides the already established risk calculator for hypertrophic cardiomyopathy. Generally, 'new' risk markers beyond left ventricular ejection fraction are increasingly considered for recommendations on primary preventive implantable cardioverter defibrillator therapy. Furthermore, new recommendations for diagnosis of Brugada syndrome and management of primary electrical disease have been included. With many comprehensive flowcharts and practical algorithms, the new guideline takes a step towards a user-oriented reference book.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - José Luis Merino
- Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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Vita G, Compri B, Matcham F, Barbui C, Ostuzzi G. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2023; 3:CD011006. [PMID: 36999619 PMCID: PMC10065046 DOI: 10.1002/14651858.cd011006.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have a negative impact in terms of quality of life, compliance with anticancer treatment, suicide risk and possibly the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results. OBJECTIVES To evaluate the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was November 2022. SELECTION CRITERIA We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was 1. efficacy as a continuous outcome. Our secondary outcomes were 2. efficacy as a dichotomous outcome, 3. Social adjustment, 4. health-related quality of life and 5. dropouts. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified 14 studies (1364 participants), 10 of which contributed to the meta-analysis for the primary outcome. Six of these compared antidepressants and placebo, three compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update, we included four additional studies, three of which contributed data for the primary outcome. For acute-phase treatment response (six to 12 weeks), antidepressants may reduce depressive symptoms when compared with placebo, even though the evidence is very uncertain. This was true when depressive symptoms were measured as a continuous outcome (standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.92 to -0.12; 7 studies, 511 participants; very low-certainty evidence) and when measured as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.74, 95% CI 0.57 to 0.96; 5 studies, 662 participants; very low-certainty evidence). No studies reported data on follow-up response (more than 12 weeks). In head-to-head comparisons, we retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) and for mirtazapine versus TCAs. There was no difference between the various classes of antidepressants (continuous outcome: SSRI versus TCA: SMD -0.08, 95% CI -0.34 to 0.18; 3 studies, 237 participants; very low-certainty evidence; mirtazapine versus TCA: SMD -4.80, 95% CI -9.70 to 0.10; 1 study, 25 participants). There was a potential beneficial effect of antidepressants versus placebo for the secondary efficacy outcomes (continuous outcome, response at one to four weeks; very low-certainty evidence). There were no differences for these outcomes when comparing two different classes of antidepressants, even though the evidence was very uncertain. In terms of dropouts due to any cause, we found no difference between antidepressants compared with placebo (RR 0.85, 95% CI 0.52 to 1.38; 9 studies, 889 participants; very low-certainty evidence), and between SSRIs and TCAs (RR 0.83, 95% CI 0.53 to 1.22; 3 studies, 237 participants). We downgraded the certainty of the evidence because of the heterogeneous quality of the studies, imprecision arising from small sample sizes and wide CIs, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, the available studies were few and of low quality. This review found a potential beneficial effect of antidepressants against placebo in depressed participants with cancer. However, the certainty of evidence is very low and, on the basis of these results, it is difficult to draw clear implications for practice. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which drug to prescribe may be based on the data on antidepressant efficacy in the general population of people with major depression, also taking into account that data on people with other serious medical conditions suggest a positive safety profile for the SSRIs. Furthermore, this update shows that the usage of the newly US Food and Drug Administration-approved antidepressant esketamine in its intravenous formulation might represent a potential treatment for this specific population of people, since it can be used both as an anaesthetic and an antidepressant. However, data are too inconclusive and further studies are needed. We conclude that to better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
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Affiliation(s)
- Giovanni Vita
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Beatrice Compri
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Faith Matcham
- School of Psychology, University of Sussex, Brighton, UK
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Then MI, Tümena T, Sledziewska A, Gaßmann KG, Maas R, Fromm MF. Development in Prescriptions of Contraindicated and Potentially Harmful QT Interval-Prolonging Drugs in a Large Geriatric Inpatient Cohort From 2011 to 2021. Clin Pharmacol Ther 2023; 113:435-445. [PMID: 36471654 DOI: 10.1002/cpt.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
Regulatory authorities put major emphasis on QT (interval)-prolonging properties of new molecular entities. Product information/Summaries of Product Characteristics (SmPCs) of multiple drugs contain warnings or contraindications regarding QT prolongation, e.g., on coadministration of QT-prolonging drugs (QT drugs). To characterize the development of the QT drug burden, we performed a trend analysis of prescriptions and co-prescriptions of QT drugs in a large geriatric inpatient cohort. The German SmPCs (status of 2014 and of 2021) and the year-wise listings in the CredibleMeds® database from 2011 to 2021 were used as sources. There were 402,631 geriatric cases included. The group of QT drugs according to SmPCs in 2014, which must not be combined with other QT drugs, was less frequently involved in contraindicated co-prescriptions in 2021 compared with 2015 (3.0% (2.5-3.7%) of cases with at least one of those drugs in 2021 vs. 4.0% (3.5-4.5%) in 2015), with citalopram, escitalopram, and amiodarone involved in nearly 90% of the co-prescriptions. The number of CredibleMeds-QT-drugs per patient increased from 0.4 (SD=1.1) in 2011 to 1.8 (SD=3.9) in 2021. The percentage of contraindicated co-prescriptions of drugs with known risk for torsade de pointes according to CredibleMeds® listings at the beginning of the respective years increased from 1.7% in 2011 to 6.1% in 2021. Considering the regularly updated CredibleMeds® QT drugs list, the contraindicated co-prescriptions of QT drugs markedly increased in the last decade. If prescribers considered only the few most frequently (co-) prescribed QT drugs, then most of the medication errors regarding QT drugs could be prevented.
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Affiliation(s)
- Melanie I Then
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Anna Sledziewska
- Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Karl-Günter Gaßmann
- Geriatrics in Bavaria Database, Nürnberg, Germany.,Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin F Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Fernandes DDA, Camões GDF, Ferreira D, Queijo C, Fontes-Ribeiro C, Gonçalves L, Pina R, António N. Prevalence and risk factors for acquired long QT syndrome in the emergency department: a retrospective observational study. World J Emerg Med 2023; 14:454-461. [PMID: 37969211 PMCID: PMC10632761 DOI: 10.5847/wjem.j.1920-8642.2023.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Long QT syndrome (LQTS) is a heterogeneous syndrome that may be congenital or, more frequently, acquired. The real-world prevalence of acquired LQTS (aLQTS) in the emergency department (ED) remains to be determined. The aim of this study was to determine prevalence of aLQTS and its impact on symptoms on ED admissions. METHODS Electrocardiograms (ECG) of 5,056 consecutively patients admitted in the ED of a tertiary hospital between January 28th and March 17th of 2020 were reviewed. All patients with aLQTS were included. Clinical data with a focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without corrected QT (QTc) interval greater than 500 ms (value that is considered severely increased). RESULTS A total of 383 ECGs with prolonged QTc were recognized, corresponding to a prevalence of aLQTS at admission of 7.82%. Patients with aLQTS were more commonly men (53.3%) with an age of (73.49±14.79) years old and QTc interval of (505.3±32.4) ms. Only 20.4% of these patients with aLQTS were symptomatic. No ventricular arrhythmias were recorded. Patients with QT interval greater than 500 ms were more frequently female (59.5%; P<0.001) and were more frequently on QT prolonging drugs (77.3%; P=0.025). Main contributing factor was intake of antibiotics (odds ratio [OR] 4.680) followed by female gender (OR 2.473) and intake of antipsychotics (OR 1.925). CONCLUSION aLQTS is particularly prevalent in the ED. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made to avoid, detect and treat aLQTS as early as possible.
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Affiliation(s)
- Diogo de Almeida Fernandes
- Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Guilherme de Freitas Camões
- Department of Internal Medicine, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Diana Ferreira
- Department of Internal Medicine, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Carolina Queijo
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Carlos Fontes-Ribeiro
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
| | - Rui Pina
- Department of Internal Medicine, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
| | - Natália António
- Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
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Watanabe Y, Nakamura I, Takebayashi Y, Watanabe H. A fatal case of repeated ventricular fibrillation due to torsade de pointes following repeated administration of metoclopramide. Clin Case Rep 2022; 10:e6213. [PMID: 35957789 PMCID: PMC9361716 DOI: 10.1002/ccr3.6213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yusuke Watanabe
- Department of Infection Prevention and Control Tokyo Medical University Hospital Tokyo Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control Tokyo Medical University Hospital Tokyo Japan
| | - Yasuyuki Takebayashi
- Department of Infection Prevention and Control Tokyo Medical University Hospital Tokyo Japan
| | - Hidehiro Watanabe
- Department of Infection Prevention and Control Tokyo Medical University Hospital Tokyo Japan
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The effects of combined hydroxychloroquine and azithromycin therapy on QRS wave in COVID-19 patients. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.985876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gray B, Baruteau AE, Antolin AA, Pittman A, Sarganas G, Molokhia M, Blom MT, Bastiaenen R, Bardai A, Priori SG, Napolitano C, Weeke PE, Shakir SA, Haverkamp W, Mestres J, Winkel BG, Witney AA, Chis-Ster I, Sangaralingam A, Camm AJ, Tfelt-Hansen J, Roden DM, Tan HL, Garbe E, Sturkenboom M, Behr ER. Rare Variation in Drug Metabolism and Long QT Genes and the Genetic Susceptibility to Acquired Long QT Syndrome. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003391. [PMID: 35113648 DOI: 10.1161/circgen.121.003391] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acquired long QT syndrome (aLQTS) is a serious unpredictable adverse drug reaction. Pharmacogenomic markers may predict risk. METHODS Among 153 aLQTS patients (mean age 58 years [range, 14-88], 98.7% White, 85.6% symptomatic), computational methods identified proteins interacting most significantly with 216 QT-prolonging drugs. All cases underwent sequencing of 31 candidate genes arising from this analysis or associating with congenital LQTS. Variants were filtered using a minor allele frequency <1% and classified for susceptibility for aLQTS. Gene-burden analyses were then performed comparing the primary cohort to control exomes (n=452) and an independent replication aLQTS exome sequencing cohort. RESULTS In 25.5% of cases, at least one rare variant was identified: 22.2% of cases carried a rare variant in a gene associated with congenital LQTS, and in 4% of cases that variant was known to be pathogenic or likely pathogenic for congenital LQTS; 7.8% cases carried a cytochrome-P450 (CYP) gene variant. Of 12 identified CYP variants, 11 (92%) were in an enzyme known to metabolize at least one culprit drug to which the subject had been exposed. Drug-drug interactions that affected culprit drug metabolism were found in 19% of cases. More than one congenital LQTS variant, CYP gene variant, or drug interaction was present in 7.8% of cases. Gene-burden analyses of the primary cohort compared to control exomes (n=452), and an independent replication aLQTS exome sequencing cohort (n=67) and drug-tolerant controls (n=148) demonstrated an increased burden of rare (minor allele frequency<0.01) variants in CYP genes but not LQTS genes. CONCLUSIONS Rare susceptibility variants in CYP genes are emerging as potentially important pharmacogenomic risk markers for aLQTS and could form part of personalized medicine approaches in the future.
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Affiliation(s)
- Belinda Gray
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Alban-Elouen Baruteau
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France (A.-E.B.)
| | - Albert A Antolin
- Systems Pharmacology, Research Program on Biomedical Informatics (GRIB), IMIM Hospital del Mar Medical Research Institute & University Pompeu Fabra, Parc de Recerca Biomedica, Barcelona, Catalonia, Spain (A.A.A., M.J.M.)
| | - Alan Pittman
- Genetics Research Centre (A.P.), St George's University of London, United Kingdom
| | - Giselle Sarganas
- Clinical Pharmacology & Toxicology, Charite Universitaetsmedizin, Berlin, Germany (G.S.)
| | - Mariam Molokhia
- Department of Population Health Sciences, King's College London, United Kingdom (M.M.)
| | - Marieke T Blom
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Abdenasser Bardai
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Silvia G Priori
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy (S.G.P., C.N.)
- Department of Molecular Medicine, University of Pavia, Italy (S.G.P., C.N.)
| | - Carlo Napolitano
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy (S.G.P., C.N.)
- Department of Molecular Medicine, University of Pavia, Italy (S.G.P., C.N.)
| | - Peter E Weeke
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France (A.-E.B.)
- Departments of Medicine, Pharmacology & Biomedical Informatics Vanderbilt University Medical Centre (P.E.W., D.M.R.)
| | - Saad A Shakir
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, United Kingdom (S.A.S.)
- Associate Department of the School of Pharmacy & Biomedical Sciences, University of Portsmouth, United Kingdom (S.A.S.)
| | - Wilhelm Haverkamp
- Charité-Campus Virchow-Klinikum (CVK), Department of Cardiology, Berlin, Germany (W.H.)
| | - Jordi Mestres
- Systems Pharmacology, Research Program on Biomedical Informatics (GRIB), IMIM Hospital del Mar Medical Research Institute & University Pompeu Fabra, Parc de Recerca Biomedica, Barcelona, Catalonia, Spain (A.A.A., M.J.M.)
| | - Bo Gregers Winkel
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (B.W., J.T.-H.)
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (P.E.W., B.W., J.T.-H.)
| | - Adam A Witney
- Institute of Infection & Immunity (A.A.W., I.C.-S.), St George's University of London, United Kingdom
| | - Irina Chis-Ster
- Institute of Infection & Immunity (A.A.W., I.C.-S.), St George's University of London, United Kingdom
| | - Ajanthah Sangaralingam
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (P.E.W., B.W., J.T.-H.)
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (B.W., J.T.-H.)
| | - Dan M Roden
- Departments of Medicine, Pharmacology & Biomedical Informatics Vanderbilt University Medical Centre (P.E.W., D.M.R.)
| | - Hanno L Tan
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Edeltraut Garbe
- Leibniz Institute for Prevention Research & Epidemiology - BIPS, Bremen, Germany (E.G.)
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht, the Netherlands (M.S.)
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
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12
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Occurrence of early afterdepolarization under healthy or hypertrophic cardiomyopathy conditions in the human ventricular endocardial myocyte: In silico study using 109 torsadogenic or non-torsadogenic compounds. Toxicol Appl Pharmacol 2022; 438:115914. [DOI: 10.1016/j.taap.2022.115914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/19/2022] [Accepted: 02/05/2022] [Indexed: 11/18/2022]
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13
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Jha S. A Case Report on QTc Prolongation: Understanding the Medication Risks and Electrolyte Imbalance. Cureus 2022; 14:e21421. [PMID: 35198326 PMCID: PMC8855979 DOI: 10.7759/cureus.21421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/01/2022] Open
Abstract
Prolonged QTc interval is one of the critical risk factors for sudden cardiac death. We all know that sudden cardiac death is often caused by acute onset ventricular arrhythmia, and QTc prolongation is one of the potential risk factors. It can be congenital or acquired. The acquired ones are commonly witnessed in day-to-day clinical practice. Several classes of mediations are well known to cause these conditions. Among many antiarrhythmic agents, especially amiodarone, is a critical drug to be monitored, as it strongly potentiates QTc prolongation. Especially in combination with metabolic abnormalities, this abnormality can occur rapidly with notable clinical presentation. This case report elicits an interesting clinical scenario in which a 79-year-old pleasant lady with multiple comorbidities presents with a syncopal episode. Missing the cardiologist’s appointment for dose adjustments of her medication, amiodarone was noteworthy. Also, an acute electrolyte imbalance from the possibly recent use of diuretics aggravated the clinical situation. On presentation, the electrocardiogram showed a remarkably prolonged QTc, which was way more compared to the prior ones available. Discontinuation of amiodarone and repletion of the electrolytes brought down the QTc interval to almost a normal range and no syncopal episode within two days. Hence, understanding the medications’ potential risks and having a close watch on the possible side effects is key to avoiding dreadful complications of arrhythmia and sudden cardiac death from the same. This case report cumulatively covers this essential medical knowledge and practical, vital points.
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14
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Tiver KD, Dharmaprani D, Quah JX, Lahiri A, Waddell-Smith KE, Ganesan AN. Vomiting, electrolyte disturbance, and medications; the perfect storm for acquired long QT syndrome and cardiac arrest: a case report. J Med Case Rep 2022; 16:9. [PMID: 35012656 PMCID: PMC8751273 DOI: 10.1186/s13256-021-03204-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Acquired long QT syndrome is an important and preventable cause of cardiac arrest. Certain medications and electrolyte disturbance are common contributors, and often coexist. In this case, we report five contributors to cardiac arrest. Case presentation This case is of a 51-year-old Caucasian female patient who presented with vomiting associated with hypokalemia and hypomagnesemia. She subsequently received ondansetron and metoclopramide, on the background of chronic treatment with fluoxetine. She then suffered an in-hospital monitored cardiac arrest, with features of long QT and torsades de pointes retrospectively noted on her prearrest electrocardiogram. She was diagnosed with acquired long QT syndrome, and her QT interval later normalized after removal of offending causes. Conclusions This case highlights the importance of proper consideration prior to prescribing QT prolonging medications, especially in patients who have other risk factors for prolonged QT, such as electrolyte disturbances and pretreatment with QT prolonging medications.
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Affiliation(s)
- K D Tiver
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - D Dharmaprani
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - J X Quah
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - A Lahiri
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - K E Waddell-Smith
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - A N Ganesan
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia. .,College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
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15
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Desmarais J, Rosenbaum JT, Costenbader KH, Ginzler EM, Fett N, Goodman S, O'Dell J, Pineau CA, Schmajuk G, Werth VP, Link MS, Kovacs R. American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity. Arthritis Rheumatol 2021; 73:2151-2160. [PMID: 34697918 DOI: 10.1002/art.41934] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
Hydroxychloroquine (HCQ) and chloroquine (CQ) are well-established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)-prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID-19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus-based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long-term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk-benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.
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Affiliation(s)
| | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
| | | | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | - Nicole Fett
- Oregon Health & Science University, Portland
| | - Susan Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - James O'Dell
- University of Nebraska Medical Center and Omaha VA Hospital, Omaha, Nebraska
| | | | - Gabriela Schmajuk
- University of California San Francisco, San Francisco VA Medical Center, and Philip R. Lee Institute for Health Policy, San Francisco, California
| | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas
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16
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Das B, Ramasubbu SK, Agnihotri A, Kumar B, Rawat VS. Leading 20 drug-drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients. Ther Adv Cardiovasc Dis 2021; 15:17539447211058892. [PMID: 34841978 PMCID: PMC8641120 DOI: 10.1177/17539447211058892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients. METHODS This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions. RESULTS A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with 'known', 'possible', and 'conditional risk of TdP', respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H2 receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015. CONCLUSION Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Virbhadra Road, Rishikesh 249 203, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Akash Agnihotri
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
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17
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Potnuri AG, Reddy KP, Suresh P, Husain GM, Kazmi MH, Harishankar N. Obesity Potentiates the Risk of Drug-Induced Long QT Syndrome - Preliminary Evidence from WNIN/Ob Spontaneously Obese Rat. Cardiovasc Toxicol 2021; 21:848-858. [PMID: 34302627 DOI: 10.1007/s12012-021-09675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Drug-induced long QT syndrome (DI-LQTS) is fatal and known to have a higher incidence in women rather than in men. Multiple risk factors potentiate the incidence of DI-LQTS, but the actual contribution of obesity remains largely unexplored. Correspondingly, the present study is aimed to evaluate the susceptibility of DI-LQTS in WNIN/Ob rat in comparison with its lean counterpart using 3-lead electrocardiography. Four- and eight-month-old female WNIN/Ob and their lean controls were used for the experimentation. Non-invasive blood pressure measurement and total body electric conductivity (TOBEC) analysis were carried out. After the baseline evaluations, animals were anesthetized with Ketamine (50 mg/kg). Haloperidol (12.5 mg/kg single dose) was administered intraperitoneally and ECG was taken at 0, 10, 20, 30, 60 min, and 24 h time points. Myocardial lystes were used to assess the BNP, protein carbonylation, and hydroxyproline content. Adiposity, as assessed by TOBEC, is higher in obese rats with elevated mean arterial blood pressure. Baseline-corrected QT interval (QTc) is significantly higher in the obese rat with a wider QRS complex. The incidence of PVC and VT are more intense in the obese rat. Haloperidol-induced QT prolongation in obese rats was rapidly induced than in lean, which was observed to remain till 24 h in obese groups while normalized in lean controls. Higher levels of BNP, protein carbonylation, hydroxyproline content, and relative heart weights indicated the presence of cardiac hypertrophy. The study provides preliminary evidence that obesity can be a potential risk factor for DI-LQTS with faster onset and longer subsistence.
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Affiliation(s)
- Ajay Godwin Potnuri
- Department of Animal Physiology and Pharmacology, ICMR- National Animal Resource Facility for Biomedical Research, Genome Valley, Shamirpet, Hyderabad, 500101, India
| | - Kallamadi Prathap Reddy
- Animal Facility, ICMR- National Institute of Nutrition, Jamai Osmania, Hyderabad, 500007, India
| | - Pothani Suresh
- Department of Animal Physiology and Pharmacology, ICMR- National Animal Resource Facility for Biomedical Research, Genome Valley, Shamirpet, Hyderabad, 500101, India
| | - Gulam Mohammed Husain
- Pharmacology Research Laboratory, National Research Institute of Unani Medicinefor Skin Disorders, Hyderabad, 500038, India
| | - Munawwar Husain Kazmi
- Pharmacology Research Laboratory, National Research Institute of Unani Medicinefor Skin Disorders, Hyderabad, 500038, India
| | - Nemani Harishankar
- Animal Facility, ICMR- National Institute of Nutrition, Jamai Osmania, Hyderabad, 500007, India.
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18
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Cowan A, Garg AX, McArthur E, Muanda Tsobo F, Weir MA. Cardiovascular Safety of Metoclopramide Compared to Domperidone: A Population-Based Cohort Study. J Can Assoc Gastroenterol 2021; 4:e110-e119. [PMID: 34617008 PMCID: PMC8489520 DOI: 10.1093/jcag/gwaa041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Metoclopramide and domperidone are common prokinetics used to alleviate gastrointestinal symptoms. However, both drugs may trigger ventricular arrhythmias. AIM We conducted this population-based study to compare the 30-day cardiovascular safety of metoclopramide versus domperidone in outpatient care. METHODS We used health care databases to identify a cohort of patients in Ontario, Canada newly dispensed metoclopramide or domperidone. Inverse probability of treatment weighting based on propensity scores was used to balance the baseline characteristics of the two groups. All outcomes were assessed in the 30 days following drug dispensing. The primary outcome was hospital encounter with ventricular arrhythmia. The secondary outcomes were hospital encounter with cardiac arrest, all-cause mortality and cardiovascular mortality. RESULTS We identified 196,544 patients, 19% of whom were prescribed metoclopramide. There was no difference in the risk of a hospital encounter with ventricular arrythmia (0.02% in both groups), or cardiac arrest (0.10% with metoclopramide and 0.08% with domperidone). However, 1.34% of patients died after starting metoclopramide compared to 0.52% of patients starting domperidone; weighted risk ratio 2.50 (95% confidence interval [CI] 2.13 to 3.03). Similarly, 0.42% of patients died of cardiovascular causes after starting metoclopramide compared to 0.19 % of patients starting domperidone; weighted risk ratio 2.00 (95% CI 1.44 to 2.77). CONCLUSION The 30-day risk for a hospital encounter with ventricular arrhythmia was low for both metoclopramide and domperidone, with no significant difference in the rate between the two drugs. The higher 30-day risk of death observed with metoclopramide compared with domperidone in this study has also been observed in other studies and warrants further investigation.
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Affiliation(s)
- Andrea Cowan
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, London, Ontario, Canada
| | | | | | - Matthew A Weir
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, London, Ontario, Canada
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Mantri N, Lu M, Zaroff JG, Risch N, Hoffmann T, Oni-Orisan A, Lee C, Iribarren C. Torsade de pointes: A nested case-control study in an integrated healthcare delivery system. Ann Noninvasive Electrocardiol 2021; 27:e12888. [PMID: 34547155 PMCID: PMC8739596 DOI: 10.1111/anec.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background TdP is a form of polymorphic ventricular tachycardia which develops in the setting of a prolonged QT interval. There are limited data describing risk factors, treatment, and outcomes of this potentially fatal arrhythmia. Objective Our goals were as follows: (1) to validate cases presenting with Torsade de Pointes (TdP), (2) to identify modifiable risk factors, and (3) to describe the management strategies used for TdP and its prognosis in a real‐world healthcare setting. Methods Case–control study (with 2:1 matching on age, sex, and race/ethnicity) nested within the Genetic Epidemiology Research on Aging (GERA) cohort. Follow‐up of the cohort for case ascertainment was between January 01, 2005 and December 31, 2018. Results A total of 56 cases of TdP were confirmed (incidence rate = 3.6 per 100,000 persons/years). The average (SD) age of the TdP cases was 74 (13) years, 55 percent were female, and 16 percent were non‐white. The independent predictors of TdP were potassium concentration <3.6 mEq/L (OR = 10.6), prior history of atrial fibrillation/flutter (OR = 6.2), QTc >480 ms (OR = 4.4) and prior history of coronary artery disease (OR = 2.6). Exposure to furosemide and amiodarone was significantly greater in cases than in controls. The most common treatment for TdP was IV magnesium (78.6%) and IV potassium repletion (73.2%). The in‐hospital and 1‐year mortality rates for TdP cases were 10.7% and 25.0% percent, respectively. Conclusions These findings may inform quantitative multivariate risk indices for the prediction of TdP and could guide practitioners on which patients may qualify for continuous ECG monitoring and/or electrolyte replacement therapy.
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Affiliation(s)
- Neha Mantri
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Meng Lu
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Jonathan G Zaroff
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Neil Risch
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas Hoffmann
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Akinyemi Oni-Orisan
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente, Oakland, CA, USA
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Ahuja P, Walian A, Magoon R, Kashav R. Amiodarone in junctional ectopic tachycardia: A word of caution! J Anaesthesiol Clin Pharmacol 2021; 37:302-304. [PMID: 34349389 PMCID: PMC8289648 DOI: 10.4103/joacp.joacp_403_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pooja Ahuja
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Ashish Walian
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Ramesh Kashav
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
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21
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Warda AEA, Tammam M, El-Gazar RA, Sarhan RM, Gaber S. Hydroxychloroquine and Azithromycin Combination in The Management of COVID-19 Infection: Safety and Effectiveness Challenges. Curr Drug Saf 2021; 17:143-151. [PMID: 34315385 DOI: 10.2174/1574886316666210727152609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The treatment of COVID-19 disease remains a dilemma so far because there is no approved therapy for it. This study aimed to evaluate the use of hydroxychloroquine and azithromycin combination in treatment. OBJECTIVE This study was carried out to determine the safety and effectiveness of hydroxychloroquine and azithromycin combination in COVID 19 patients. METHODS This study included 90 adult COVID 19 patients. Treatment of all patients followed Egyptian Ministry of Health COVID-19 protocols, receiving a combination of hydroxychloroquine 400mg twice on day 1, then 200 mg twice daily in addition to azithromycin 500mg/day for 5 days. ECG findings especially the QTc interval was assessed before and after 5 days from the administration. RESULTS All patients showed a statistically significant higher post-treatment QTc readings (433.6 ± 37.2) compared to baseline QTc (402.4 ± 31.3) at p<0.005 with a median QTc prolongation by 26 mSec and IQR (17.8-41.3), but without serious clinical complications. Only 5.6% of patients showed QTc more than 500 mSec and no torsade de points or cardiac arrest. Geriatric patients were at higher risk for QTc prolongation compared to patients aged less than 65 years but without a significant difference as regards the median max QTc difference p˂0.65. The expected therapeutic effectiveness was 82.5% for moderate patients compared to 26% in severe patients (P<0.005). CONCLUSION In a modest safety profile, we support the evidence that HQ/AZ therapy can be used to treat Covid-19 infection with more effectiveness in moderate rather than severe cases, which might be a reflection to the time of administration in the disease course.
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Affiliation(s)
| | | | - Rabab Ahmed El-Gazar
- Clinical Pharmacy Department, Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Rania Mohammad Sarhan
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni Suef University, Beni Suef, Egypt
| | - Sayed Gaber
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
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22
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Qi Z, Yang S, Li M, Qu J, Han Q, Zheng J, Wang H. Risk factors and predictors of QTc prolongation in critically ill Chinese patients. Am J Emerg Med 2021; 49:24-28. [PMID: 34051398 DOI: 10.1016/j.ajem.2021.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To recognize and validate the predictor of risk factors for ICU patients with QTc intervals ≥500 ms. METHODS We retrospectively reviewed 160 ICU patients with their medical electronic records including all demographic data, diagnosis measurements, ECGs and medication from March 1, 2018 to December 1, 2018. All information of patients' baseline, comorbidities, electrolytes and Long QT syndrome (LQTS)-inducing medications of patients with QT interval corrected (QTc) ≥ 500 ms (n = 80) and <500 ms (n = 80) were collected and analyzed using univariate and multivariate analyses to find predictors. RESULTS Comparing to patients with QTc < 500 ms, patients with QTc ≥ 500 ms had increased SOFA (P = 0.010) and APACHE II scores (P = 0.002), longer lengths of ICU stays (P < 0.001), greater incidence of congestive heart failure (P = 0.005) and more preset risk factors (P < 0.001). The frequency of administration of mosapride (P = 0.015), amiodarone (P = 0.027) and number of combined LQTS-inducing medications (P = 0.012) were greater in patients with QTc ≥ 500 ms than in those with QTc < 500 ms. But after multivariate analysis, we found that risk factors related to a QTc ≥ 500 ms were only congestive heart failure (OR: 5.28), number of combined LQTS-inducing medications (OR: 1.60) and APACHE II score (OR: 1.08). CONCLUSIONS For critically ill patients, congestive heart failure, number of combined LQTS-inducing medications and APACHE II score are proved as risk factors associated with QTc > 500 ms.
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Affiliation(s)
- Zhidong Qi
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sibo Yang
- Department of Pediatrics, The 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming Li
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingdong Qu
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiuyuan Han
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junbo Zheng
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huaiquan Wang
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
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23
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Torsade de pointes associated with chloroquine, hydroxychloroquine, and azithromycin: a retrospective analysis of individual case safety reports from VigiBase. Eur J Clin Pharmacol 2021; 77:1513-1521. [PMID: 33938974 PMCID: PMC8089128 DOI: 10.1007/s00228-021-03133-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/03/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To analyze the cases of torsade de pointes (TdP) and related symptoms reported in association with chloroquine (CQ), hydroxychloroquine (HCQ), and azithromycin (AZT) to the World Health Organization (WHO) global database of individual case safety reports (ICSRs) for drug monitoring (VigiBase) using qualitative and quantitative pharmacovigilance approaches. METHODS The main characteristics of the ICSRs reporting TdP with CQ, HCQ, and AZT have been summarized. Co-reported drugs with risk to cause QT prolongation have been described. Reporting odds ratios (RORs) as a measure of disproportionality for reported TdP and individual drugs have been calculated. RESULTS One hundred seventy ICSRs reporting TdP in association with the drugs of interest were identified (CQ: 11, HCQ: 31, CQ + HCQ: 1, HCQ + AZT: 27, AZT: 100). From these, 41 (24.3%) were received during the pandemic period (December 2019 to February 2021). The median age of the patients was 63, 53, and 63 years old for CQ, HCQ, and AZT, respectively. Reports included concomitant use of other QT-prolonging drugs (CQ 25.0%, HCQ 71.2%, AZT 64.6%). A proportion of the cases were fatal (CQ 25.0%, HCQ 8.6%, AZT 16.1%). Increased disproportionality has been found for the individual drugs and TdP: CQ (ROR: 7.41, 95% confidence interval (CI): 3.82, 12.96), HCQ (ROR: 8.49, 95% CI: 6.57, 10.98), azithromycin (ROR: 8.06, 95% CI: 6.76, 9.61). Disproportionality was also found for other related symptoms, Standardized MedDRA Query for torsade de pointes/QT prolongation (narrow): CQ (ROR: 11.95, 95% CI: 10.04-14.22); HCQ (ROR: 20.43, 95% CI: 19.13, 21.83), AZT (ROR: 7.78, 95% CI: 7.26, 8.34). CONCLUSIONS The prescription of CQ, HCQ, and AZT should be restricted to therapeutic indications with established positive benefit/risk profile. Doctors and patients should be aware of this potential adverse reaction especially when several risk factors are present.
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24
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Kovacs RJ. Proarrhythmia and Oncotherapy: So Much To Be Done! JACC CardioOncol 2021; 3:98-100. [PMID: 34396310 PMCID: PMC8352192 DOI: 10.1016/j.jaccao.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Richard J. Kovacs
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
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25
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Kim P, Masha L, Olson A, Iliescu C, Karimzad K, Hassan S, Palaskas N, Durand JB, Leung CH, Lopez-Mattei J. QT Prolongation in Cancer Patients. Front Cardiovasc Med 2021; 8:613625. [PMID: 33718445 PMCID: PMC7946823 DOI: 10.3389/fcvm.2021.613625] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: QT prolongation and torsades de pointes pose a major concern for cardiologists and oncologists. Although cancer patients are suspected to have prolonged QT intervals, this has not been investigated in a large population. The purpose of this study was to analyze the QT interval distribution in a cancer population and compare it to a non-cancer population in the same institution. Methods: The study was a retrospective review of 82,410 ECGs performed in cancer patients (51.8% women and 48.2% men) and 775 ECGs performed in normal stem cell donors (47.9% women and 52.1% men) from January 2009 to December 2013 at the University of Texas MD Anderson Cancer Center. Pharmacy prescription data was also collected and analyzed during the same time period. Correction of the QT interval for the heart rate was performed using the Bazett and Fridericia formulas. Results: After QT correction for heart rate by the Fridericia formula (QTcF), the mean and 99% percentile QTc for cancer patients were 414 and 473 ms, respectively. These were significantly longer than the normal stem cell donors, 407 and 458 ms, p < 0.001, respectively. Among the cancer patients, the QTc was longer in the inpatient setting when compared to both outpatient and emergency center areas. The most commonly prescribed QT prolonging medications identified were ondansetron and methadone. Conclusion: Our study demonstrates significantly longer QTc intervals in cancer patients, especially in the inpatient setting. Frequently prescribed QT prolonging medications such as antiemetics and analgesics may have a causative role in QT prolongation seen in our cancer hospital.
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Affiliation(s)
- Peter Kim
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luke Masha
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Cardiology, Oregon Health and Science University, Portland, OR, United States
| | - Amanda Olson
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kaveh Karimzad
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean-Bernard Durand
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cheuk Hong Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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26
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Fung KW, Baye F, Kapusnik-Uner J, McDonald CJ. Using Medicare Data to Assess the Proarrhythmic Risk of Non-Cardiac Treatment Drugs that Prolong the QT Interval in Older Adults: An Observational Cohort Study. Drugs Real World Outcomes 2021; 8:173-185. [PMID: 33569737 PMCID: PMC7875170 DOI: 10.1007/s40801-021-00230-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Serious cardiac arrhythmias caused by QT-prolonging drugs are difficult to predict based on physiological measurement and pre-approval clinical trials. Post-marketing surveillance and monitoring are important to generate safety data. Objectives To assess whether an observational study using Medicare claims data can detect the arrhythmogenic risk of QT-prolonging drugs. Methods We identified 17 QT-prolonging drugs with known risk of torsades des pointes (TdP) that were not used to treat cardiac arrhythmias. Amoxicillin and four serotonin-norepinephrine reuptake inhibitors (SNRIs) were used as controls. De-identified claims data of 1.2 million Medicare beneficiaries were accessed. Two separate Cox regressions were done for short-term and chronic-use drugs. The primary outcome was a composite of ventricular arrhythmias and/or sudden death, identified by ICD diagnostic codes. We explored the independent effect of each study drug on the outcomes. Other covariates included patient demographics, comorbidities, and known risk factors for drug-induced cardiac arrhythmia. Results We were able to detect increased risk in 14 of 17 study drugs (82.3%), and none of the control drugs. Among the fluoroquinolones, ciprofloxacin was the safest. Azithromycin and clarithromycin were relatively safe compared to erythromycin. Compared to SNRIs, both citalopram and escitalopram had increased risk, more so with escitalopram than citalopram. Comorbidities associated with increased risk included ischemic heart disease, electrolyte imbalance, bradycardia, acute myocardial infarction, heart failure, and chronic kidney and liver disease. Conclusion Medicare data can be utilized for post-marketing surveillance and monitoring of the proarrhythmic risk of QT-prolonging drugs in older adults. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00230-1.
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Affiliation(s)
- Kin Wah Fung
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, U.S. National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, USA.
| | - Fitsum Baye
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, U.S. National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, USA
| | - Joan Kapusnik-Uner
- First Databank. Inc., San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Clement J McDonald
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, U.S. National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, USA
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27
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Parfrey D, O'Connor Byrne N, Murphy P. Electrocardiography before treatment with anthracycline-based chemotherapy in a tertiary hospital in the Republic of Ireland. J Electrocardiol 2021; 65:64-65. [PMID: 33549987 DOI: 10.1016/j.jelectrocard.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- David Parfrey
- Department of Haematology, Beaumont Hospital, Dublin 9, Ireland.
| | | | - Philip Murphy
- Department of Haematology, Beaumont Hospital, Dublin 9, Ireland
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28
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Assessment of inappropriate prescribing of QT interval-prolonging drugs in end-stage renal disease patients in Jordan. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-020-00806-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Nordkin I, Levinas T, Rosenfeld I, Halabi M. Torsades de pointes after prolonged intravenous amiodarone therapy for atrial fibrillation. Clin Case Rep 2021; 9:391-394. [PMID: 33489188 PMCID: PMC7813084 DOI: 10.1002/ccr3.3539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
Amiodarone can induce TdP; therefore, it should be avoided as a first choice for therapy in patients without heart disease. Careful QT interval monitoring, especially during intravenous use, can prevent development of this life-threatening arrhythmia.
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Affiliation(s)
- Irina Nordkin
- Ziv Medical CenterCardiology DepartmentTzfatIsrael
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
| | - Tatyana Levinas
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
- Ziv Medical CenterHeart Rehabilitation DepartmentTzfatIsrael
| | - Inna Rosenfeld
- Ziv Medical CenterCardiology DepartmentTzfatIsrael
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
| | - Majdi Halabi
- Ziv Medical CenterCardiology DepartmentTzfatIsrael
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
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30
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Niimi N, Yuki K, Zaleski K. Long QT Syndrome and Perioperative Torsades de Pointes: What the Anesthesiologist Should Know. J Cardiothorac Vasc Anesth 2020; 36:286-302. [PMID: 33495078 DOI: 10.1053/j.jvca.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Naoko Niimi
- Department of Anesthesiology, Juntendo University, Tokyo, Japan.
| | - Koichi Yuki
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Katherine Zaleski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesia, Harvard Medical School, Boston, MA
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31
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Das B, Ramasubbu SK, Kumar B, Rawat VS. Top 20 drug - drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients. J Family Med Prim Care 2020; 9:6023-6040. [PMID: 33681037 PMCID: PMC7928114 DOI: 10.4103/jfmpc.jfmpc_1060_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients. METHODS This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions. RESULTS A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories. CONCLUSIONS Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
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32
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Gibbs C, Thalamus J, Kristoffersen DT, Svendsen MV, Holla ØL, Heldal K, Haugaa KH, Hysing J. QT prolongation predicts short-term mortality independent of comorbidity. Europace 2020; 21:1254-1260. [PMID: 31220237 PMCID: PMC6680365 DOI: 10.1093/europace/euz058] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/11/2019] [Indexed: 01/24/2023] Open
Abstract
Aims A prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc <500 ms after adjustment for comorbidity and main diagnosis. Methods and results Patients with QTc ≥500 ms who were hospitalized at Telemark Hospital Trust, Norway between January 2007 and April 2014 were identified. Thirty-day and 3-year all-cause mortality in 980 patients with QTc ≥500 ms were compared with 980 patients with QTc <500 ms, matched for age and sex and adjusting for Charlson comorbidity index (CCI), previous admissions, and main diagnoses. QTc ≥500 ms was associated with increased 30-day all-cause mortality [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.38–2.62; P < 0.001]. There was no significant difference in mortality between patients with QTc ≥500 ms and patients with QTc <500 ms who died between 30 days and 3 years; 32% vs. 29%, P = 0.20. Graded CCI was associated with increased 3-year all-cause mortality (CCI 1–2: HR 1.62, 95% CI 1.34–1.96; P < 0.001; CCI 3–4: HR 2.50, 95% CI 1.95–3.21; P < 0.001; CCI ≥5: HR 3.76, 95% CI 2.85–4.96; P < 0.001) but was not associated with 30-day all-cause mortality. Conclusion QTc ≥500 ms is a powerful predictor of short-term mortality overruling comorbidities. QTc ≥500 ms also predicted long-term mortality, but this effect was mainly caused by the increased short-term mortality. For long-term mortality, comorbidity was more important.
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Affiliation(s)
- Charlotte Gibbs
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jacob Thalamus
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
| | - Doris Tove Kristoffersen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Skøyen, N Oslo, Norway
| | - Martin Veel Svendsen
- Department of Occupational and Environmental medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
| | - Øystein L Holla
- Department of Medical Genetics, Telemark Hospital Trust, Kjørbekk, Skien, Norway
| | - Kristian Heldal
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Hysing
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
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33
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Ali Z, Ismail M, Khan F, Sajid H. Association of H1-antihistamines with torsade de pointes: a pharmacovigilance study of the food and drug administration adverse event reporting system. Expert Opin Drug Saf 2020; 20:101-107. [PMID: 33141610 DOI: 10.1080/14740338.2021.1846717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: This study aimed to measure the association of various H1-antihistamines (H1A) with Torsade de Pointes (TdP), and present a comprehensive overview of H1A-induced TdP cases reported to the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: All H1A-induced TdP cases (n = 406) were retrieved from the FAERS database using the preferred term 'Torsade de Pointes' of MedDRA version-22 from 1990 to 2019. Four data-mining algorithms were used for disproportionality analysis: Reporting Odds Ratio (ROR); Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Information Content (IC). H1A with >3 TdP cases were included. Results: A total of 12 signals (Astemizole, cetirizine, chlorpheniramine, clemastine, desloratadine, diphenhydramine, hydroxyzine, loratadine, meclizine, promethazine, terfenadine, and trimeprazine) were identified including six new signals (cetirizine, chlorpheniramine, clemastine, desloratadine, loratadine, and meclizine). The number of risk factors (p = 0.031) and concomitant QT-prolonging drugs (p = <0.001) were significantly lower among new signals vs old signals. Moreover, new signals were strongly associated with QT-prolongation, cardiac reactions, and electrolyte abnormalities as compared with old signals. Conclusions: Our study found the increased torsadogenic potential of new signals compared with previously known old signals, hence necessitating clinical studies to determine the actual torsadogenic potential of newly identified signals.
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Affiliation(s)
- Zahid Ali
- Department of Pharmacy, University of Peshawar , Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Ismail
- Department of Pharmacy, University of Peshawar , Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Fahadullah Khan
- Department of Pharmacy, University of Peshawar , Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Hira Sajid
- Department of Pharmacy, University of Peshawar , Peshawar, Khyber Pakhtunkhwa, Pakistan
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Oscanoa TJ, Vidal X, Kanters JK, Romero-Ortuno R. Frequency of Long QT in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine: A Meta-analysis. Int J Antimicrob Agents 2020; 56:106212. [PMID: 33164789 PMCID: PMC7584880 DOI: 10.1016/j.ijantimicag.2020.106212] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/28/2020] [Accepted: 10/17/2020] [Indexed: 02/07/2023]
Abstract
Introduction Hydroxychloroquine (HCQ) has been proposed as a SARS-CoV-2 treatment but the frequency of long QT (LQT) during use is unknown. Objective To conduct a meta-analysis of the frequency of LQT in patients with SARS-CoV-2 infection treated with HCQ. Data Sources PubMed, EMBASE, Google Scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv, Research Square) were searched for studies published between December 2019 and June 30, 2020. Methods Effect statistics were pooled using random effects. The quality of observational studies and randomized controlled trials was appraised with STROBE and the Cochrane Risk of Bias Assessment tools, respectively. Outcomes Critical LQT was defined as: (1) maximum QT corrected (QTc)≥500 ms (if QRS<120 ms) or QTc≥550 ms (if QRS≥120 ms), and (2) QTc increase ≥60 ms. Results In the 28 studies included (n=9124), the frequency of LQT during HCQ treatment was 6.7% (95% confidence interval [CI]: 3.7-10.2). In 20 studies (n=7825), patients were also taking other QT-prolonging drugs. The frequency of LQT in the other 8 studies (n=1299) was 1.7% (95% CI: 0.3-3.9). Twenty studies (n=6869) reported HCQ discontinuation due to LQT, with a frequency of 3.7% (95% CI: 1.5-6.6). The frequency of ventricular arrhythmias during HCQ treatment was 1.68% (127/7539) and that of arrhythmogenic death was 0.69% (39/5648). Torsades de Pointes occurred in 0.06% (3/5066). Patients aged >60 years were at highest risk of HCQ-associated LQT (P<0.001). Conclusions HCQ-associated cardiotoxicity in SARS-CoV-2 patients is uncommon but requires ECG monitoring, particularly in those aged >60 years and/or taking other QT-prolonging drugs.
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Affiliation(s)
- Teodoro J Oscanoa
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Drug Safety Research Center, Facultad de Medicina Humana, Universidad de San Martín de Porres. Hospital Almenara, ESSALUD, Lima, Perú.
| | - Xavier Vidal
- Clinical Pharmacology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
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Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S469-S523. [PMID: 33081526 DOI: 10.1161/cir.0000000000000901] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tisdale JE, Chung MK, Campbell KB, Hammadah M, Joglar JA, Leclerc J, Rajagopalan B. Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e214-e233. [PMID: 32929996 DOI: 10.1161/cir.0000000000000905] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome. Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, atrioventricular node reentrant tachycardia) are significant predominantly because of their symptoms; others (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes) may result in serious consequences, including sudden cardiac death. Mechanisms of arrhythmias are well known for some medications but, in other instances, remain poorly understood. For some drug-induced arrhythmias, particularly torsades de pointes, risk factors are well defined. Modification of risk factors, when possible, is important for prevention and risk reduction. In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment. Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed. Awareness of drugs that may cause arrhythmias and knowledge of distinct arrhythmias that may be drug-induced are essential for clinicians. Consideration of the possibility that a patient's arrythmia could be drug-induced is important.
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Davies MR, Martinec M, Walls R, Schwarz R, Mirams GR, Wang K, Steiner G, Surinach A, Flores C, Lavé T, Singer T, Polonchuk L. Use of Patient Health Records to Quantify Drug-Related Pro-arrhythmic Risk. CELL REPORTS MEDICINE 2020; 1:100076. [PMID: 33205069 PMCID: PMC7659582 DOI: 10.1016/j.xcrm.2020.100076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 12/30/2022]
Abstract
There is an increasing expectation that computational approaches may supplement existing human decision-making. Frontloading of models for cardiac safety prediction is no exception to this trend, and ongoing regulatory initiatives propose use of high-throughput in vitro data combined with computational models for calculating proarrhythmic risk. Evaluation of these models requires robust assessment of the outcomes. Using FDA Adverse Event Reporting System reports and electronic healthcare claims data from the Truven-MarketScan US claims database, we quantify the incidence rate of arrhythmia in patients and how this changes depending on patient characteristics. First, we propose that such datasets are a complementary resource for determining relative drug risk and assessing the performance of cardiac safety models for regulatory use. Second, the results suggest important determinants for appropriate stratification of patients and evaluation of additional drug risk in prescribing and clinical support algorithms and for precision health. In vitro data and computational models can assist with calculating pro-arrhythmic risk We use patient health records and FDA Adverse Event Reporting System reports Use of such datasets helps assess relative drug risk and cardiac safety models We quantify how patient characteristics can affect arrhythmia incidence
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Affiliation(s)
| | - Michael Martinec
- PHC Data Science, Personalized Healthcare, Product Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Robert Walls
- PHC Data Science, Personalized Healthcare, Product Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Roman Schwarz
- Safety Analytics and Reporting, Drug Safety, Pharmaceutical Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Gary R Mirams
- Centre for Mathematical Medicine & Biology, School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Ken Wang
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Guido Steiner
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche AG, Basel, Switzerland
| | | | | | - Thierry Lavé
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Thomas Singer
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Liudmila Polonchuk
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche AG, Basel, Switzerland
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Al Rihani SB, Smith MK, Bikmetov R, Deodhar M, Dow P, Turgeon J, Michaud V. Risk of Adverse Drug Events Following the Virtual Addition of COVID-19 Repurposed Drugs to Drug Regimens of Frail Older Adults with Polypharmacy. J Clin Med 2020; 9:E2591. [PMID: 32785135 PMCID: PMC7463624 DOI: 10.3390/jcm9082591] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022] Open
Abstract
Determination of the risk-benefit ratio associated with the use of novel coronavirus disease 2019 (COVID-19) repurposed drugs in older adults with polypharmacy is mandatory. Our objective was to develop and validate a strategy to assess risk for adverse drug events (ADE) associated with COVID-19 repurposed drugs using hydroxychloroquine (HCQ) and chloroquine (CQ), alone or in combination with azithromycin (AZ), and the combination lopinavir/ritonavir (LPV/r). These medications were virtually added, one at a time, to drug regimens of 12,383 participants of the Program of All-Inclusive Care for the Elderly. The MedWise Risk Score (MRSTM) was determined from 198,323 drug claims. Results demonstrated that the addition of each repurposed drug caused a rightward shift in the frequency distribution of MRSTM values (p < 0.05); the increase was due to an increase in the drug-induced Long QT Syndrome (LQTS) or CYP450 drug interaction burden risk scores. Increases in LQTS risk observed with HCQ + AZ and CQ + AZ were of the same magnitude as those estimated when terfenadine or terfenadine + AZ, used as positive controls for drug-induced LQTS, were added to drug regimens. The simulation-based strategy performed offers a way to assess risk of ADE for drugs to be used in people with underlying medical comorbidities and polypharmacy at risk of COVID-19 infection without exposing them to these drugs.
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Affiliation(s)
- Sweilem B. Al Rihani
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
| | - Matt K. Smith
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
| | - Ravil Bikmetov
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
| | - Malavika Deodhar
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
| | - Pamela Dow
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
| | - Jacques Turgeon
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Veronique Michaud
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (S.B.A.R.); (M.K.S.); (R.B.); (M.D.); (P.D.); (J.T.)
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3C 3J7, Canada
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Berger FA, van der Sijs H, Becker ML, van Gelder T, van den Bemt PMLA. Development and validation of a tool to assess the risk of QT drug-drug interactions in clinical practice. BMC Med Inform Decis Mak 2020; 20:171. [PMID: 32703198 PMCID: PMC7376881 DOI: 10.1186/s12911-020-01181-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The exact risk of developing QTc-prolongation when using a combination of QTc-prolonging drugs is still unknown, making it difficult to interpret these QT drug-drug interactions (QT-DDIs). A tool to identify high-risk patients is needed to support healthcare providers in handling automatically generated alerts in clinical practice. The main aim of this study was to develop and validate a tool to assess the risk of QT-DDIs in clinical practice. METHODS A model was developed based on risk factors associated with QTc-prolongation determined in a prospective study on QT-DDIs in a university medical center inthe Netherlands. The main outcome measure was QTc-prolongation defined as a QTc interval > 450 ms for males and > 470 ms for females. Risk points were assigned to risk factors based on their odds ratios. Additional risk factors were added based on a literature review. The ability of the model to predict QTc-prolongation was validated in an independent dataset obtained from a general teaching hospital against QTc-prolongation as measured by an ECG as the gold standard. Sensitivities, specificities, false omission rates, accuracy and Youden's index were calculated. RESULTS The model included age, gender, cardiac comorbidities, hypertension, diabetes mellitus, renal function, potassium levels, loop diuretics, and QTc-prolonging drugs as risk factors. Application of the model to the independent dataset resulted in an area under the ROC-curve of 0.54 (95% CI 0.51-0.56) when QTc-prolongation was defined as > 450/470 ms, and 0.59 (0.54-0.63) when QTc-prolongation was defined as > 500 ms. A cut-off value of 6 led to a sensitivity of 76.6 and 83.9% and a specificity of 28.5 and 27.5% respectively. CONCLUSIONS A clinical decision support tool with fair performance characteristics was developed. Optimization of this tool may aid in assessing the risk associated with QT-DDIs. TRIAL REGISTRATION No trial registration, MEC-2015-368.
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Affiliation(s)
- Florine A Berger
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.
| | - Heleen van der Sijs
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Matthijs L Becker
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
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40
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Funck-Brentano C, Nguyen LS, Salem JE. Retraction and republication: cardiac toxicity of hydroxychloroquine in COVID-19. Lancet 2020; 396:e2-e3. [PMID: 32653079 PMCID: PMC7347305 DOI: 10.1016/s0140-6736(20)31528-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Christian Funck-Brentano
- AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Centre, Paris 75013, France; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université, Faculty of Medicine, Paris, France.
| | - Lee S Nguyen
- AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Centre, Paris 75013, France; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université, Faculty of Medicine, Paris, France
| | - Joe-Elie Salem
- AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Centre, Paris 75013, France; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université, Faculty of Medicine, Paris, France
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Huang Y, Alsabbagh MW. Estimates of population‐based incidence of malignant arrhythmias associated with medication use—a narrative review. Fundam Clin Pharmacol 2020; 34:418-432. [DOI: 10.1111/fcp.12578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Yichang Huang
- School of Pharmacy Faculty of Science University of Waterloo Room 4015, 10A Victoria St. S. Kitchener ON Canada
| | - Mhd. Wasem Alsabbagh
- School of Pharmacy Faculty of Science University of Waterloo Room 3006, 10A Victoria St. S. Kitchener ON Canada
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Saleh M, Gabriels J, Chang D, Soo Kim B, Mansoor A, Mahmood E, Makker P, Ismail H, Goldner B, Willner J, Beldner S, Mitra R, John R, Chinitz J, Skipitaris N, Mountantonakis S, Epstein LM. Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection. Circ Arrhythm Electrophysiol 2020; 13:e008662. [PMID: 32347743 PMCID: PMC7299095 DOI: 10.1161/circep.120.008662] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death. METHODS Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death. RESULTS Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms, P=0.834). The maximum corrected QT interval during treatment was significantly longer in the combination group versus the monotherapy group (470.4±45.0 ms versus 453.3±37.0 ms, P=0.004). Seven patients (3.5%) required discontinuation of these medications due to corrected QT interval prolongation. No arrhythmogenic deaths were reported. CONCLUSIONS In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.
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Affiliation(s)
- Moussa Saleh
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - James Gabriels
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - David Chang
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Beom Soo Kim
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Amtul Mansoor
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Eitezaz Mahmood
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Parth Makker
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - Haisam Ismail
- Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.)
| | - Bruce Goldner
- Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.)
| | - Jonathan Willner
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Stuart Beldner
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Raman Mitra
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Roy John
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Jason Chinitz
- Division of Electrophysiology, Department of Cardiology, Southside Hospital, Northwell Health, Bay Shore (J.C.)
| | - Nicholas Skipitaris
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - Stavros Mountantonakis
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - Laurence M. Epstein
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
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Funck-Brentano C, Salem JE. Chloroquine or hydroxychloroquine for COVID-19: why might they be hazardous? Lancet 2020:S0140-6736(20)31174-0. [PMID: 32450109 PMCID: PMC7255131 DOI: 10.1016/s0140-6736(20)31174-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Christian Funck-Brentano
- AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Centre, Paris 75013, France; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université, Faculty of Medicine, Paris, France.
| | - Joe-Elie Salem
- AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Centre, Paris 75013, France; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université, Faculty of Medicine, Paris, France
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Summary of Torsades de Pointes (TdP) Reports Associated with Intravenous Drug Formulations Containing the Preservative Chlorobutanol. Drug Saf 2020; 42:907-913. [PMID: 30888625 DOI: 10.1007/s40264-019-00804-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Drug-induced torsades de pointes (TdP) is a potentially lethal ventricular arrhythmia that is associated with drugs that prolong the QT interval on the electrocardiogram (ECG) due to their interference with the cardiac potassium current, IKR. Intravenous (IV) formulations of methadone have been associated with TdP and contain the preservative chlorobutanol, which, like methadone, blocks IKR. The combinations of chlorobutanol with methadone or terfenadine, another IKR blocker, produce synergistic IKR block. OBJECTIVE The aim of this study was to examine and summarize the evidence available to address the question: what other IV drug formulations contain chlorobutanol and are they associated with TdP? METHODS IV drug products containing the preservative chlorobutanol were identified by searching the websites DailyMed ( https://dailymed.nlm.nih.gov/dailymed/index.cfm ) and Drugs@FDA ( https://www.accessdata.fda.gov/scripts/cder/daf/ ). For each drug identified, PubMed and the FDA's Adverse Event Reporting System (FAERS) were searched for reports of TdP and/or QT prolongation and FAERS data were analyzed for disproportionality of reports. RESULTS The search found nine drugs (methadone, epinephrine, papaverine, oxytocin, vasopressin, testosterone, estradiol, isoniazid, and desmopressin) that contain chlorobutanol 2.5 (n = 1) or 5.0 mg/mL. All nine drugs had reports of QT prolongation or TdP reported in FAERS and all but estradiol, testosterone, desmopressin, and isoniazid had reports of QT prolongation or TdP in PubMed. Two of the nine drugs (epinephrine and methadone) had positive signals (by disproportionality analysis) for TdP in FAERS (EB05 2.88 and 23.81, respectively) and four (methadone, epinephrine, papaverine, and vasopressin) were reported in published articles as the suspect drugs in cases of TdP. CONCLUSION The pharmacologic profile of chlorobutanol (synergistic IKR block) and its association with reports of TdP and QT prolongation suggest the need for a full evaluation of its cardiac safety when used as a preservative in IV drug and vitamin formulations.
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4750] [Impact Index Per Article: 1187.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5242] [Impact Index Per Article: 1048.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Martinez-Matilla M, Blanco-Verea A, Santori M, Ansede-Bermejo J, Ramos-Luis E, Gil R, Bermejo AM, Lotufo-Neto F, Hirata MH, Brisighelli F, Paramo M, Carracedo A, Brion M. Genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying drug-induced arrhythmia and sudden unexplained deaths. Forensic Sci Int Genet 2019; 42:203-212. [PMID: 31376648 DOI: 10.1016/j.fsigen.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/14/2019] [Accepted: 07/14/2019] [Indexed: 12/21/2022]
Abstract
Drug-induced arrhythmia is an adverse drug reaction that can be potentially fatal since it is mostly related to drug-induced QT prolongation, a known risk factor for Torsade de Pointes and sudden cardiac death (SCD). Several risk factors have been described in association to these drug-induced events, such as preexistent cardiac disease and genetic variation. Our objective was to study the genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying suspected drug-induced arrhythmias and sudden unexplained deaths in 32 patients. The genetic component in the pharmacodynamic pathway was studied by analysing 96 genes associated with higher risk of SCD through massive parallel sequencing. Pharmacokinetic-mediated genetic susceptibility was investigated by studying the genes encoding cytochrome P450 enzymes using medium-throughput genotyping. Pharmacodynamic analysis showed three probably pathogenic variants and 45 variants of uncertain significance in 28 patients, several of them previously described in relation to mild or late onset cardiomyopathies. These results suggest that genetic variants in cardiomyopathy genes, in addition to those related with channelopathies, could be relevant to drug-induced cardiotoxicity and contribute to the arrhythmogenic phenotype. Pharmacokinetic analysis showed three patients that could have an altered metabolism of the drugs they received involving CYP2C19 and/or CYP2D6, probably contributing to the arrhythmogenic phenotype. The study of genetic variants in both pharmacodynamic and pharmacokinetic pathways may be a useful strategy to understand the multifactorial mechanism of drug-induced events in both clinical practice and forensic field. However, it is necessary to comprehensively study and evaluate the contribution of the genetic susceptibility to drug-induced cardiotoxicity.
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Affiliation(s)
- M Martinez-Matilla
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (A Coruña), Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain.
| | - A Blanco-Verea
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (A Coruña), Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - M Santori
- Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - J Ansede-Bermejo
- Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain; Centro Nacional de Genotipado-CeGen-USC-PRB3-ISCIII, Santiago de Compostela, Spain
| | - E Ramos-Luis
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (A Coruña), Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - R Gil
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (A Coruña), Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - A M Bermejo
- Instituto de Ciencias Forenses "Luis Concheiro" (INCIFOR), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - F Lotufo-Neto
- Psiquiatry Institute - Faculty of Medicine at University of São Paulo, São Paulo, Brazil
| | - M H Hirata
- Institute Dante Pazzanese of Cardiology, São Paulo, Brazil; School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - F Brisighelli
- Institute of Public Health, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Paramo
- Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - A Carracedo
- Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain; Centro Nacional de Genotipado-CeGen-USC-PRB3-ISCIII, Santiago de Compostela, Spain
| | - M Brion
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (A Coruña), Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain; Centro Nacional de Genotipado-CeGen-USC-PRB3-ISCIII, Santiago de Compostela, Spain
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Bajrangee A, Mahabir S, Khalifa W, Maree AO, McAdam B. QT prolongation in non-telemetered hospitalized elderly patients. J Electrocardiol 2019; 55:91-96. [PMID: 31152997 DOI: 10.1016/j.jelectrocard.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/22/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- A Bajrangee
- New Cross Hospital, Wolverhamtpon, England, United Kingdom of Great Britain and Northern Ireland.
| | - S Mahabir
- Leicester Royal Infirmary, Leicester, England, United Kingdom of Great Britain and Northern Ireland
| | - W Khalifa
- Sunderland Royal Hospital, Sunderland, England, United Kingdom of Great Britain and Northern Ireland
| | - A O Maree
- St James Hospital, James's Street, Dublin 2, Ireland
| | - B McAdam
- Beaumont Hospital, Beaumont Road, Dublin 8, Ireland
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El-Sherif N, Turitto G, Boutjdir M. Acquired Long QT Syndrome and Electrophysiology of Torsade de Pointes. Arrhythm Electrophysiol Rev 2019; 8:122-130. [PMID: 31114687 PMCID: PMC6528034 DOI: 10.15420/aer.2019.8.3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/04/2019] [Indexed: 12/16/2022] Open
Abstract
Congenital long QT syndrome (LQTS) has been the most investigated cardiac ion channelopathy. Although congenital LQTS remains the domain of cardiologists, cardiac electrophysiologists and specialised centres, the much more frequently acquired LQTS is the domain of physicians and other members of healthcare teams required to make therapeutic decisions. This paper reviews the electrophysiological mechanisms of acquired LQTS, its ECG characteristics, clinical presentation, and management. The paper concludes with a comprehensive review of the electrophysiological mechanisms of torsade de pointes.
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Affiliation(s)
- Nabil El-Sherif
- SUNY Downstate Medical CenterNY, US
- VA NY Harbor Healthcare SystemNY, US
| | - Gioia Turitto
- Weill Cornell Medical College, NewYork-Presbyterian Brooklyn Methodist HospitalNY, US
| | - Mohamed Boutjdir
- SUNY Downstate Medical CenterNY, US
- VA NY Harbor Healthcare SystemNY, US
- NYU School of MedicineNew York NY, US
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QTc Prolongation Associated With Psychiatric Medications: A Retrospective Cross-Sectional Study of Adult Inpatients. J Clin Psychopharmacol 2019; 39:72-77. [PMID: 30531476 DOI: 10.1097/jcp.0000000000000992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of our study was to assess the impact of psychiatric medications and concomitant risk factors on the prevalence of QTc prolongation and torsades de pointes (TdP) in hospitalized subjects. We examined the association between individual risk scores and QTc prolongation and proposed an evidence-based protocol for electrocardiogram monitoring on psychotropic medications. METHOD Electrocardiograms (ECGs) of subjects hospitalized over a 1-year period were analyzed for QTc prolongation, associated risk factors, and use of medications. Analysis was performed using logistic regression to identify independent predictors of QTc prolongation, and the Pearson χ test was used for risk score assessment. RESULTS A total of 1249 ECGs of 517 subjects were included in this study. Eighty-seven subjects had QTcB intervals greater than 470 milliseconds for females and greater than 450 milliseconds for males. Twelve (2.3%) subjects had QTcB of 500 milliseconds or greater, or greater than 60 milliseconds of change from baseline. Of these subjects, only 1 case of QTc interval change was related to routine use of psychiatric medications. There were no incidents of TdP. Age, diabetes, hypokalemia, overdose, diphenhydramine, and haloperidol were significant independent predictors of QTc prolongation. Risk scores were significantly correlated with QTc prolongation (P = 0.001). CONCLUSION Our retrospective review study found that the occurrence of TdP and QTc prolongation was low in this subject population. QT abnormalities were associated with known risk factors, and risk scores correlated well with QTc prolongation. Providers can use the protocol proposed in this study, which incorporates risk scores and the CredibleMeds classification system to determine the need for ECG monitoring and to guide treatment.
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