QT Prolongation and Torsade de Pointes Induced by Fluoroquinolones: Infrequent Side Effects from Commonly Used Medications

@article{Briasoulis2011QTPA,
  title={QT Prolongation and Torsade de Pointes Induced by Fluoroquinolones: Infrequent Side Effects from Commonly Used Medications},
  author={Alexandros Briasoulis and Vikram V Agarwal and Walter J. Pierce},
  journal={Cardiology},
  year={2011},
  volume={120},
  pages={103 - 110}
}
Although very useful agents, fluoroquinolones are associated with a number of adverse events, some with considerable clinical significance. Prolongation of the QT interval, for example, is an adverse effect associated with the use of fluoroquinolones. Fluoroquinolones prolong the QT interval by blocking voltage-gated potassium channels, especially the rapid component of the delayed rectifier potassium current IKr, expressed by HERG (the human ether-a-go-go-related gene). According to the… 

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References

SHOWING 1-10 OF 48 REFERENCES

QT Prolongation with Antimicrobial Agents

It appears that in most published cases of antimicrobial-associated TdP, multiple risk factors are present, and a risk stratification scheme may be useful to rank and compare the potential for cardiotoxicity of each drug.

QT prolongation with antimicrobial agents: understanding the significance.

It appears that in most published cases of antimicrobial-associated TdP, multiple risk factors are present, and a risk stratification scheme may be useful to rank and compare the potential for cardiotoxicity of each drug.

Effect of Ciprofloxacin and Levofloxacin on the QT Interval: Is This a Significant “Clinical” Event?

There is evidence that taking ciprofloxacin or levofloxacIn, assuming that there are not any concurrent risk factors, will not cause a significant prolongation in the QT interval, and this also held true for the longest QTc interval.

Moxifloxacin-Induced QT Prolongation and Torsades: An Uncommon Effect of a Common Drug

A rare case of TdP, associated with QT interval prolongation, caused by intravenous moxifloxacin given for pneumonia in a 71-year-old African American man is reported, and caution is still warranted when given someone with high risk of QT prolongation.

Moxifloxacin-induced torsades de pointes.

Torsade de pointes is increasingly recognized as a complication of drug therapy and TdP associated with moxifloxacin use, and careful assessment of the risk/benefit ratio is important before prescribing drugs known to cause QT prolongation.

Fluconazole- and levofloxacin-induced torsades de pointes in an intensive care unit patient.

This case describes an episode of TdP in which levofloxacin and fluconazole were likely significant factors, and it is recommended that neither drug be used alone or in combination when there is baseline QT prolongation.

Interactions of a series of fluoroquinolone antibacterial drugs with the human cardiac K+ channel HERG.

Results provide a mechanism for the QT prolongation observed clinically with administration of sparfloxacin and certain other fluoroquinolones because free plasma levels of these drugs after therapeutic doses approximate those concentrations that inhibit HERG channel current.

Effects of Three Fluoroquinolones on QT Analysis After Standard Treatment Courses

Evaluating the effects of three commonly prescribed FQs by comprehensive QT analysis finds that QT dispersion may be a more selective marker of Tdp.

QTc Prolongation Associated with Combination Therapy of Levofloxacin, Imipramine, and Fluoxetine

The use of levofloxacin alone, or more often in concomitant therapy with other medications that are known to prolong the QT intervals, may cause QT interval prolongation; however, additional studies/case reports are needed to validate this conclusion.