A Case of Torsade de Pointes after Treatment with Terfenadine and Ketoconazole

Oh, Seok; Kuk, Hiang; Lim, Sung Eun; Jeong, Jaehoon; Park, Yang-Kyu; Park, Ock-Kyu

doi:10.4070/kcj.1998.28.3.458

Cited by 2 publications

(3 citation statements)

References 10 publications

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“…We reviewed 21 reports of 28 patients with TdP induced by SAFAs 5–9,18,19,30–43 . Reported patients ages ranged from 15 years to 80 years, mean age 47.5 ± 17.4 years.…”

Section: Resultsmentioning

confidence: 99%

Torsade de pointes induced by systemic antifungal agents: lessons from a retrospective analysis of published case reports

Justo

Zeltser

2006

Mycoses

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Torsade de pointes (TdP) is a potentially fatal arrhythmia that might be associated with systemic antifungal agent (SAFAs) administration. The objective of this study was to investigate all published reports on TdP induced by SAFAs in order to characterise this association. Each original report was analysed for the presence of risk factors for TdP: female gender, structural heart disease, electrolyte imbalance, concomitant use of a QT interval prolonging agent which SAFA inhibits its liver metabolism, liver cirrhosis, renal failure and more. Naranjo probability scale for adverse drug reactions was applied for every full report. Twenty-one reports on 28 patients were analysed. All patients survived. Most patients (25/28; 89.2%) used one or more agents that might have prolonged the QT interval and their liver metabolism might have been inhibited by SAFA. Female gender was the second most common risk factor for TdP (20/28; 71.4%). All patients, including female patients, had one or more risk factors for TdP prior to SAFA administration. According to Narajno probability scale, there was no definite association between TdP and SAFA in any report. SAFA alone might seldom trigger TdP. We wish to raise the level of awareness of risk factors for TdP prior to SAFA administration and for concomitant use of other dysrhythmogenic agents in particular.

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“…We reviewed 21 reports of 28 patients with TdP induced by SAFAs 5–9,18,19,30–43 . Reported patients ages ranged from 15 years to 80 years, mean age 47.5 ± 17.4 years.…”

Section: Resultsmentioning

confidence: 99%

Torsade de pointes induced by systemic antifungal agents: lessons from a retrospective analysis of published case reports

Justo

Zeltser

2006

Mycoses

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“…For example, terfenadine, 14) an antihistamine, cisapride, 12) a gastric promotility agent, and erythromycin, 26) an antibiotic, have been shown to cause torsades de pointes under certain circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…Although its frequency is relatively low, the development of TdP caused by druginduced QT interval prolongation has also been reported in the Republic of Korea. [12][13][14] Therefore, the correlation between the concentration of a drug and a QT interval change and QT interval prolongation in the Korean population is a very important issue.…”

Section: Discussionmentioning

confidence: 99%

Quinidine-Induced QTc Interval Prolongation and Gender Differences in Healthy Korean Subjects

Kim

et al. 2007

Korean Circ J

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Background and Objectives: Drug-induced electrocardiographic QT interval prolongation is associated with the occurrence of a potentially lethal form of polymorphic ventricular tachycardia, termed 'torsades de pointes' (TdP). Women are at greater risk for the development of drug-induced TdP. To determine whether this may be the result of gender-specific differences in the effect of quinidine on cardiac repolarization, we compared the degree of quinidineinduced QT interval lengthening in young, healthy volunteers. Subjects and Methods: Twelve women and 12 men each received a single intravenous dose of quinidine (4 mg/kg) or placebo in a single-blinded, randomized crossover trial. Total plasma concentrations of quinidine were measured, and QT and corrected QT intervals were analyzed. Results: As expected, the mean QTc interval at baseline was longer for women than for men (443.6±26.9 vs 402.1±31.3 msec, respectively, p=0.037). The mean value of the maximal ΔQTc after quinidine infusion was higher in women (134.4±46.4 vs 117.5±37.7 msec, respectively, p=0.029), and the mean value of the minimal ΔQTc for 1 hour after quinidine infusion was also higher in the female group (47.6±15.7 vs 83.7±25.4 msec, p=0.034). However, there were no significant differences in the time courses of the changes in the quinidine-induced QTc and ΔQTc interval between the two groups (p=0.092, and p=0.305, respectively). Conclusion: Quinidine causes greater QT prolongation in women at equivalent serum concentrations. This difference may contribute to the greater incidence of drug-induced TdP observed in women taking quinidine, and has implications for other cardiac and noncardiac drugs that prolong the QTc interval.

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A Case of Torsade de Pointes after Treatment with Terfenadine and Ketoconazole

Cited by 2 publications

References 10 publications

Torsade de pointes induced by systemic antifungal agents: lessons from a retrospective analysis of published case reports

Torsade de pointes induced by systemic antifungal agents: lessons from a retrospective analysis of published case reports

Quinidine-Induced QTc Interval Prolongation and Gender Differences in Healthy Korean Subjects

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