Pain medication and long QT syndrome

Klivinyi, Christoph; Bornemann‐Cimenti, Helmar

doi:10.3344/kjp.2018.31.1.3

Cited by 12 publications

(8 citation statements)

References 69 publications

(71 reference statements)

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“…Drug-induced QT interval prolongation is a critical issue [18]. Drugs leading to fatal heart rhythm disorders should be prescribed with caution because life-saving drugs can also lead to life-threatening complications.…”

Section: Discussionmentioning

confidence: 99%

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QT interval prolongation: Life-threatening consequences of life saving drugs

Shah¹

2018

Pharm Drug Dev Ther

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Acquired long QT syndrome is a frequent phenomenon in clinical practice. QT interval prolongation can lead to fatal ventricular arrhythmias and even sudden cardiac death. Adverse effect from pharmaceuticals is the most common reason for QT interval prolongation and also for withdrawal of marketed drugs. Critically ill hospitalized patients often receive multiple drugs with proarrhythmogenic properties making them susceptible to QT interval prolongation. Seropositive patients are also very susceptible to QT interval prolongation because of concurrent use of protease inhibitors with proarrhythmogenic properties. Hepatic and renal dysfunctions are major contributing factors for QT interval prolongation. Reduced drug metabolism due to hepatic dysfunction and reduced drug clearance due to renal functional impairment can propel electrocardiographic abnormalities. Other contributing factors are advanced age, female sex, occult genetic predisposition for long QT syndrome, electrolyte imbalance, and underlying cardiovascular disorders. Patients at high-risk of developing QT interval prolongation should be approached with caution. While in certain situations it is mandatory to administer drugs with proarrhythmogenic properties, it is also important to continuously monitor the high-risk patients with EKG to prevent worsening of QT interval prolongation.

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Section: Discussionmentioning

confidence: 99%

“…Other risk factors implicated in acquired LQTS are female sex, age > 65 years and occult genetic predisposition for LQTS [18]. Risk factor that can be modulated to prevent QT interval prolongation is electrolyte imbalance including hypokalemia, hypomagnesemia, and hypocalcemia.…”

Section: Contributing Factorsmentioning

confidence: 99%

QT interval prolongation: Life-threatening consequences of life saving drugs

Shah¹

2018

Pharm Drug Dev Ther

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“… 23 Pharmacodynamic drug interactions between medications commonly prescribed for pain and related comorbidities may increase risk of respiratory sedation and death (eg, benzodiazepines, gabapentinoids, opioids), 24 , 25 serotonin syndrome (eg, antidepressants, certain opioids, triptans), 26 excessive anticholinergic effects (eg, tricyclic antidepressants, opioids, muscle relaxants) 27 or QT interval prolongation (eg, methadone, antidepressants, NSAIDs, muscle relaxants). 28 Patients may be seeing both primary care teams and specialists to manage their physical and mental health conditions, with the pharmacist and the pharmacy as the common convergence point. As such, pharmacists are essential in assessing the medication regimen in its totality.…”

Section: Role In Medication Managementmentioning

confidence: 99%

The Role of the Pharmacist in the Care of Patients with Chronic Pain

Murphy

Ng²,

Isaac

et al. 2021

IPRP

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Pharmacists across the healthcare continuum are well positioned to collaborate with patients to effectively manage their chronic pain. Evidence supports positive outcomes when pharmacists undertake these roles; however, there are barriers preventing uptake across the profession. This paper aims to expand awareness of the breadth of these roles, including pharmaceutical care provision, interprofessional collaboration, pain and medication education, support for patients in self-management and acceptance of responsibility to be culturally responsive and decrease stigma. Pharmacists are accessible healthcare professionals and can improve the care of patients with chronic pain.

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“…Prucalopride is a serotonin receptor agonist with a selective high-affinity for intestinal 5-hydroxy tryptamine 4 (5-HT4) receptors, which have prokinetic effects, promoting peristalsis and defecation. At therapeutic doses, it does not inhibit human ether-a-go-go-related gene (hERG) potassium channels, (which are known to play a pivotal role in long-QT syndrome) and has no proarrhythmic effect, unlike the structurally related cisapride (which has been withdrawn from the market) [55,56]. While one placebo-controlled study failed to show a statistically significant increase in spontaneous bowel movements, even as 52% of participants reported adverse reactions [57], another trial reported significant improvement of OIC with prucalopride [58].…”

Section: Main Bodymentioning

confidence: 99%

Opioid-induced constipation: a narrative review of therapeutic options in clinical management

Lang-Illievich

Bornemann‐Cimenti

2019

Korean J Pain

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Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not suffice, the next step for persistent OIC is the administration of laxatives. If these are ineffective as well, treatment with peripherally active μ-opioid receptor antagonists should be considered. Enemas and irrigation are emergency measures, often used as a last resort.

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Pain medication and long QT syndrome

Cited by 12 publications

References 69 publications

QT interval prolongation: Life-threatening consequences of life saving drugs

QT interval prolongation: Life-threatening consequences of life saving drugs

The Role of the Pharmacist in the Care of Patients with Chronic Pain

Opioid-induced constipation: a narrative review of therapeutic options in clinical management

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