Drug-induced QT interval prolongation after ciprofloxacin administration in a patient receiving olanzapine

Letsas, Κonstantinos P.; Sideris, Antonios; Kounas, Stavros P.; Efremidis, Michalis; Korantzopoulos, Panagiotis; Kardaras, Fotios

doi:10.1016/j.ijcard.2005.04.031

Cited by 43 publications

(26 citation statements)

References 10 publications

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“…This cellular mechanism leads into prolongation of the QT interval (Kaźmierczak et al 2007). Ciprofloxacin, like other quinolones, has been shown to prolong cardiac repolarization by direct blockade of the (IKr) current in a dose dependent manner (Letsas et al 2006). However, ciprofloxacin has a minimal effect on IKr channels or action potential duration in humans.…”

Section: Discussionmentioning

confidence: 99%

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The effects of intravenous ciprofloxacin on the electrocardiogram of healthy dogs

Ghaffari

Parsamehr

2009

Vet Res Commun

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The purpose of this study was to evaluate the electrocardiographic effects of single intravenous dose of ciprofloxacin in dogs. Ten adult cross-breed dogs of both sexes were selected as the sample population. Baseline electrocardiographic values were recorded just before drug administration. Then the dogs received intravenous infusion of ciprofloxacin (10 mg/kg) over the fifteen minutes. The ECGs recorded at 15, 30, 60 and 120 minutes after ciprofloxacin administration. The ECG measurements of heart rate, PR interval, QRS interval, ST segment, T-wave amplitude and QT interval were taken from lead II. There was a small but significant increase in the longest QT intervals over baseline at T₆₀ (P = 0.041). The mean PR intervals, QTc intervals, JT intervals, ST segment, T-wave amplitude did not differ significantly before and after ciprofloxacin except for JT intervals at T₆₀ (P = 0.041). At this measurement point, there was an increased QT interval value of 0.02 second or 9.51% in comparison to the baseline. In Conclusions, Only minor QT intervals changes were observed after ciprofloxacin injection. Despite the occurrence of ECG changes following intravenous ciprofloxacin administration neither dangerous rhythm disturbances nor serious ECG changes were seen in this study.

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Section: Discussionmentioning

confidence: 99%

“…A significant number of non-antiarrhythmic drugs including antibiotic and antipsychotic agents have shown to prolong cardiac repolarization (QT interval) (Letsas et al 2006). QT interval prolongation can trigger the life threatening polymorphic ventricular tachycardia called torsades de pointes (Harada et al 2005).…”

Section: Introductionmentioning

confidence: 99%

The effects of intravenous ciprofloxacin on the electrocardiogram of healthy dogs

Ghaffari

Parsamehr

2009

Vet Res Commun

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“…Sparfloxacin, grepafloxacin, levofloxacin, ciprofloxacin, gatifloxacin, and moxifloxacin have been associated with prolongation of the QTc interval on the electrocardiogram, which in a few cases has been associated with the development of polymorphous ventricular tachycardia (torsades des pointes), which in turn can degenerate into ventricular fibrillation [372][373][374][375][376][377][378][379][380][381][382][383][384][385][386][387][388][389][390]. One case of levofloxacin-associated torsades des pointes in the absence of QTc interval prolongation has also been reported [391].…”

Section: Quinolones and Electrophysiologymentioning

confidence: 99%

Quinolones

Guay¹

2011

Drug Interactions in Infectious Diseases

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Fluoroquinolone (FQ) antimicrobials are among the most commonly used agents in the outpatient and institutional patient care environments. Due to this high frequency of utilization, the potential for deleterious drug-drug interactions with nonantimicrobials is also high. The majority of interactions with the FQs involve deleterious effects on the FQ component. These are also the most clinically-important interactions with these agents. Multivalent cations such as Mg , and other minerals as well as drugs such as sucralfate, lanthanum, sevelamer, and didanosine (the cation-supplemented version of the latter) can substantially reduce FQ bioavailability, leading the subtherapeutic drug concentrations at the infection site and clinical failure. Separation of dose administrations may or may not reduce the magnitude of these interactions. Ciprofloxacin, norfloxacin, and two experimental FQs in clinical trials (pazufloxacin and prulifloxacin) act as moderate cytochrome P450 enzyme inhibitors and may increase serum concentrations of theophylline and caffeine. Warfarin pharmacodynamics are variably affected by the FQs. The pharmacodynamic interactions between NSAIDs and FQs are only relevant if fenbufen is used concurrently with enoxacin or, possibly, prulifloxacin. Caution is warranted if sparfloxacin or moxifloxacin is used concurrently with other medications prolonging the QTc interval or if patients have other risk factors for prolongation of the QTc interval (e.g. abnormal QTc interval pre-treatment, electrolyte abnormalities, use of starvation-liquid diets, or history of heart disease). Fluoroquinolone antimicrobials can be used effectively and safely in the vast majority of patients if the clinician remembers those few drug-drug interactions that are clinically-important.

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“…Several non-antiarrhythmic drugs [2] including antibiotic [3] and antipsychotic agents [4] have been shown to prolong cardiac repolarization predisposing to torsade de pointes ventricular tachycardia. Blockade of the delayed rectifier (repolarising) potassium current and drug interactions with inhibitors of the CYP-mediated metabolism are the most common underlying mechanisms [5]. Many drugs, including sotalol, have been also implicated in prolonging QT interval and triggering torsades de pointes, especially during chronic therapy or in case of acute high dose toxicity [6].…”

Section: Case Reportmentioning

confidence: 99%