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):

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

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:

Domperidone Granisetron Mefloquine Palonosetron Siponimod
Fingolimod Ivabradine Mizolastine Intravenous Pentamidine

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

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

Last updated: 10-11-2020

 

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