Torsades de pointes upon fluconazole administration in a patient with acute myeloblastic leukemia

Abstract

Prolonged QT syndrome often causes torsades de pointes (Tdp), a potentially lethal arrhythmia. A 55-year-old woman with M4Eo who was receiving consolidation chemotherapy had an episode of prolonged QT and Tdp following fluconazole (FCZ) administration. Intravenous supplementation of magnesium sulfate and multiple attempts at electrocardioversion led to recovery from the arrhythmia. FCZ appears to contribute to the development of QT prolongation, in particular with low concentrations of serum potassium or magnesium. Although mechanisms of Tdp development in patients with QT prolongation remain to be determined, it is possible that FCZ administration leads to manifestation of Tdp. Special cautions should be exercised upon the emergence of QT prolongation following FCZ administration. Am. J. Hematol. 81:366-369, 2006. V V C 2006 Wiley-Liss, Inc.

The combination of tamoxifen with amphotericin B, but not with fluconazole, has synergistic activity against the majority of clinical isolates of Cryptococcus neoformans

“…Recognised side effects include thromboembolic disease and retinopathy (although the risk of these is low with short duration treatment) and QT prolongation of the cardiac cycle . QT prolongation might be expected to be a particular risk as doses are increased, especially when combined with fluconazole, which can also cause this conduction abnormality, and disordered serum electrolytes, frequently seen in cryptococcal disease as a consequence of amphotericin therapy and intracranial pathology . Any study would need to pay close attention to these risks, and a trial is underway in Vietnam (Clinicaltrials.gov NCT03112031).…”

Proarrhythmic Potential of Antimicrobial Agents

“…Fluconazole-associated TdP was reported in a patient with acute myeloblastic leukemia on consolidation chemotherapy [45]. Fluconazole caused TdP in a 25-year-old woman with baseline QT interval prolongation, hypokalemia and hypomagnesemia (she was also receiving amiodarone) [46].…”

QTc prolongation during ciprofloxacin and fluconazole combination therapy: prevalence and associated risk factors

“…The actual QTc‐prolonging effect and risk of TdP associated with these drugs have not been studied extensively, apart from several case reports . Furthermore, most studies on drug‐induced QTc prolongation have focused on the risk of QTc prolongation and TdP when using only one QTc‐prolonging drug.…”