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

  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},
  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… 

Figures and Tables from this paper

Moxifloxacin-induced QT interval prolongation and torsades de pointes: a narrative review

Patients must be thoroughly assessed prior to the use of moxifloxacin and high-risk patients must be identified using risk assessment tools to ensure safe use and to safeguard patients’ health.

Drug safety of macrolide and quinolone antibiotics in a tertiary care hospital: administration of interacting co-medication and QT prolongation

In the studied real-life setting, a considerable number of MQAB users with additional risk factors for TdP but no ECG monitoring are found, and avoidable risk factors and selected contraindicated pharmacokinetic interactions are clear targets for implementation as automated alerts in electronic prescribing systems.

Comparison of hydroxychloroquine plus moxifloxacin versus hydroxychloroquine alone on corrected QT interval prolongation in COVID-19 patients

Patients who received HCQ for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with MOX was associated with greater changes in QT c, however, none of patients experienced malignant ventricular arrhythmia or death during treatment.

Risks associated with the therapeutic use of fluoroquinolones

Introduction: Quinolones are among the most often prescribed antimicrobial agents. Some types of toxicity observed during therapy with these drugs have gained much attention. Areas covered: Here, we

A Case of Ciprofloxacin-Induced QT Prolongation and Torsade de Pointes

The patient experienced an acquired QT interval prolongation followed by Torsade de pointes arrhythmia with ciprofloxacin administration for ileostomy closure surgery and unfortunately expired.

Drug-Induced Long-QT and Torsades de Pointes in Elderly Polymedicated Patients

It is mandatory to recognize the drugs that can cause malignant ventricular arrhythmias, avoiding their joint use or planning a close monitoring in case their combination cannot be avoided.

QT interval prolongation: Life-threatening consequences of life saving drugs

While in certain situations it is mandatory to administer drugs with proarrhythmogenic properties, it is also important to continuously monitor the high-risk patients with EKG to prevent worsening of QT interval prolongation.

Comparative Effects of Ciprofloxacin and Levofloxacin on Heart Rate and Qt/Qtcmeasurements in Dogs

From this study, neither Ciprofloxacin nor Levofloxacins appeared to have a significant effect on QT and QTc values measured, and at the dosage administered, the drugs did not show any observable risk for the manifestation of TdP.

Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review

Clinicians should be cautious when prescribing macrolide and fluoroquinolone medications to patients with risk factors that may lead to antibiotic-induced cardiac arrhythmia, including a slow heart rate and those that are taking medications to treat arrhythmias.

Drug-induced Inhibition and Trafficking Disruption of ion Channels: Pathogenesis of QT Abnormalities and Drug-induced Fatal Arrhythmias

  • L. Cubeddu
  • Medicine, Biology
    Current cardiology reviews
  • 2016
Although many drugs prolong the QT interval, TdP is a rare event and careful evaluation of risk factors and increased knowledge of drug use associated with repolarization abnormalities are strongly recommended.



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.