Drugs that prolong the QT interval

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

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

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

Print versions of the BNF contain a table with a list of some drugs that prolong the QT interval within Appendix 1, Interactions. The BNF 80 (September 2020 – March 2021) lists the following examples of drugs which prolong the QT interval (note this list is not exhaustive, and not all drugs are included within the Devon Formulary):

AmifampridineClarithromycinHaloperidol
PasireotideTizanidine
AmiodaroneClomipramineHydroxyzinePazopanibTolterodine
AmisulprideCrizotinibInotuzumab ozogamicinPimozideToremifene
AnagrelideDasatinibLapatinibQuinineVandetanib
ApalutamideDelamanidLenvatinibRanolazineVardenafil
ApomorphineDisopyramideLevomepromazineRibociclibVemurafenib
Arsenic TrioxideDronedaroneLithiumRisperidoneVenlafaxine
ArtemetherDroperidolLofexidineSaquinavirVernakalant
ArtenimolEfavirenzMethadoneSildenafilVinflunine
BedaquilineEncorafenibMoxifloxacinSorafenibVoriconazole
BosutinibEribulinNilotinibSotalolZuclopenthixol
CabozantinibErythromycinOndansetronSulpiride
CeritinibEscitalopramOsimertinibSunitinib
ChlorpromazineFlecainidePaliperidoneTelavancin
CitalopramFluconazolePanobinostatTetrabenazine

The BNF 80 (September 2020 – March 2021) also lists the following drugs that are predicted by the manufacturer to increase the risk of QT prolongation, and therefore concurrent use alongside drugs that prolong the QT interval should be avoided:

DomperidoneGranisetronMefloquinePalonosetronSiponimod
FingolimodIvabradineMizolastineIntravenous Pentamidine

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

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

Last updated: 10-11-2020

 

Home > Formulary > Chapters > 2. Cardiovascular > Drugs that prolong the QT interval

 

  • First line
  • Second line
  • Specialist
  • Hospital