Ciprofloxacin-induced acquired long QT syndrome

Prabhakar, Manu; Krahn, Andrew D.

doi:10.1016/j.hrthm.2004.06.020

Cited by 38 publications

(19 citation statements)

References 18 publications

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“…A single case of TdP has been reported to occur in association with ciprofloxacin administration [43]. When moxifloxacin, levofloxacin, or gemifloxacin are used, class Ia and III antiarrhythmic agents should be avoided.…”

Section: Clinical Studies Examining the Effect Of Fluoroquinolones Onmentioning

confidence: 99%

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

Briasoulis¹,

Agarwal²,

Pierce

2011

Cardiology

124

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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 I_Kr, expressed by HERG (the human ether-a-go-go-related gene). According to the available case reports and clinical studies, moxifloxacin carries the greatest risk of QT prolongation from all available quinolones in clinical practice and it should be used with caution in patients with predisposing factors for Torsades de pointes (TdP). Although gemifloxacin, levofloxacin, and ofloxacin are associated with a lower risk of QT prolongation compared with moxifloxacin, they should also be used with caution in patients at risk for QT prolongation. Ciprofloxacin appears to be associated with the lowest risk for QT prolongation and the lowest TdP rate. The overall risk of TdP is small with the use of fluoroquinolones. Clinicians can minimize that risk by avoiding prescriptions of multiple medications associated with QT-interval prolongation, especially in high-risk patients.

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Section: Clinical Studies Examining the Effect Of Fluoroquinolones Onmentioning

confidence: 99%

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

Briasoulis¹,

Agarwal²,

Pierce

2011

Cardiology

124

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“…Ciprofloxacin is believed to be safer than other quinolones but in some patients with reduced ''repolarization reserve'' (presence of several risk factors) it also provoked QT interval prolongation and TdP [33]. Ciprofloxacin has been shown to prolong cardiac repolarization by blocking IKr current in a dose-dependent manner [34].…”

Section: Fluoroquinolonesmentioning

confidence: 99%

Proarrhythmic Potential of Antimicrobial Agents

et al. 2008

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Several antiarrhythmic and non-cardiovascular drug therapies including antimicrobial agents have been implicated as the causes for QT interval prolongation, torsades de pointes (TdP) ventricular tachycardia and sudden cardiac death. Most of the drugs that have been associated with the lengthening of the QT interval or development of TdP can also block the rapidly activating component of the delayed rectifier potassium current (IKr) in the ventricular cardiomyocytes. This article presents a review of the current literature on the QT interval prolonging effect of antimicrobials based on the results of the in vitro, in vivo studies and case reports. Our observations were derived from currently available Medline database. As we found, the most frequently QT interval prolonging antimicrobials are erythromycin, clarithromycin, fluoroquinolones, halofantrine, and pentamidine. Almost every antimicrobial-associated QT interval prolongation occurs in patients with multiple risk factors of the following: drug interactions, female gender, advanced age, structural heart disease, genetic predisposition, and electrolyte abnormalities. In conclusion, physicians should avoid prescribing antimicrobials having QT prolonging potential for patients with multiple risk factors. Recognition and appropriate treatment of TdP are also indispensable.

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“…Only a few case reports have associated ciprofloxacin therapy with QT prolongation or episodes of Tdp. Two cases were female patients who previously received sotalol or amiodarone for supraventricular arrhythmia [23]. Another case was a 76-year-old male patient with acute renal failure, hypocalcaemia and QT interval prolongation who received ciprofloxacin treatment and developed Tdp triggered by haemodialysis [24].…”

Section: Effect Of Various Fluoroquinolones On Qt Prolongationmentioning

confidence: 99%