Drugs associated with QT Prolongation, QTc prolongation including Antipsychotics, antiarrhythmics, antidepressants, and antihistamines Prolongation of the QT interval can lead to a life threatening ventricular arrhythmia known as torsades de pointes which can result in sudden cardiac death. The risk of torsades de pointes depends on patient factors and current medication. A safe drug in one patient may be potentially harmful in another. Che cos’è il tratto QT, il QTc e perchè va considerato quando si trattano dei pazienti con farmaci antidepressivi e antipsicotici. QTc, Torsione di Punta e psicofarmaci: nel corso degli ultimi anni, in parte per ragioni oggettive ed in parte per ragioni di strumentalizzazione di questo pericolo, si sta portando molto attenzione alla possibilità che farmaci antidepressivi ed antipsicotici Gabapentin enacarbil, a prodrug of gabapentin, had no effect on cardiac repolarization in healthy volunteers [29,30]. In rabbits, therapeutic doses of pregabalin significantly prolonged the QT interval [ 31 ]. Among the mood stabilizers, lithium has a moderate risk of QTc prolongation while the antiepileptics used for this purpose such as carbamazepine, oxcarbazepine, topiramate, valproate, pregabalin, gabapentin, and lamotrigine are reported to be safe with a low risk of QTc prolongation. Anxiolytic drugs and sedatives Pregabalin use has been associated with QTc prolongation in patients taking other QTc–prolonging agents, although the relative contributions of pregabalin to QTc prolongation may be minimal. Pregabalin and gabapentin have been associated with a dose-related increased risk of atrial fibrillation. This may increase the risk of Torsades de Pointes (TdP), a potentially life-threatening cardiac arrhythmia. As the QT interval varies with a change in heart rate, various formulae can adjust for this, producing a 'corrected QT' (QTc) value. Normal QTc intervals are typically <450 ms for men and <460 ms for women. Sull’ECG sono indicati i valori di QT e QTc, cioè corretto per la frequenza cardiaca. Nella pratica clinica il rischio viene definito dal QTc. Sono considerati ad alto rischio di TdP e morte improvvisa soggetti il cui intervallo QTc è superiore a 500 msec, o >60 msec rispetto a un ECG precedente. La sindrome del QT lungo è di solito Several drugs have been withdrawn from the U.S. market or have received black box warnings due to their potential to cause QT interval prolongation that leads to fatal ventricular arrhythmias and sudden cardiac death. 1,2 Predicting the risks involved with most of these drugs is difficult, since they are often structurally and pharmacologically Say goodbye to nerve pain and hello to a pain-free life with Gabapentin e qtc! How does Gabapentin achieve fewer side effects? When it comes to managing pain, Gabapentin offers an effective solution that can greatly improve your quality of life. A comprehensive list of conditions and drugs that may prolong the QT interval, and cause torsade de pointes (TdP) and long QT syndrome (LQTS) is presented below. With regards to drugs, the risk of QT prolongation and TdP varies markedly across the list but tends to be rather similar within a drug class. Funk, Margo C., et al. "QTc prolongation and psychotropic medications." American Journal of Psychiatry 177.3 (2020): 273-274. Tisdale, James E. "Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management." La somministrazione concomitante di gabapentin e contraccettivi orali contenenti noretindrone e/o etinilestradiolo non modifica la farmacocinetica allo steady-state dei due componenti. La somministrazione concomitante di gabapentin e antiacidi contenenti alluminio e magnesio, riduce la biodisponibilità di gabapentin fino al 24%. Si raccomanda As part of the overall safety evaluation of gabapentin enacarbil, the present definitive QT/QTc study was conducted to assess the effects of gabapentin enacarbil on cardiac repolarization in accordance with the International Conference on Harmonization E14 guidance. A QT–concentration relationship was reported with moxifloxacin. Gabapentin exposures were dose-proportional with gabapentin enacarbil doses of 1200 and 6000 mg. The most commonly reported adverse events with gabapentin enacarbil 6000 mg were dizziness and somnolence (60.0% and 54.0%, respectively). Long QT syndrome (LQTS) is a cardiac conduction disorder characterized by prolongation and increased dispersion of ventricular repolarization, manifested by lengthening of the QT interval on the surface electrocardiography (ECG). The effects of gabapentin enacarbil (GBPe), a prodrug of gabapentin (GBP), on cardiac repolarization were investigated in a single-center, double-blind, randomized, placebo-controlled, escalating-dose, crossover trial in 32 healthy volunteers who received single doses of either GBPe 2400 mg, 3600 mg, 4800 mg, 6000 mg, or placebo [34]. A QT-concentration relationship was reported with moxifloxacin. Gabapentin exposures were dose-proportional with gabapentin enacarbil doses of 1200 and 6000 mg. The most commonly reported adverse events with gabapentin enacarbil 6000 mg were dizziness and somnolence (60.0% and 54.0%, respectively). e.g. diuretics can interact with QT prolonging drugs by causing hypokalaemia. What is a normal QT interval? The QT interval varies with heart rate. A number of formulas are used to correct the QT interval for heart rate. Once corrected it is expressed as the QTc interval. The QTc interval is reported on the ECG printout. Normal QTc Interval <440 ms For calculating the QTc interval, most commonly Bazett's square root formula (QTc = QT/RR 0.5) is used and is recommended for relatively low heart rates (60–80 bpm). The Fridericia cube root formula (QTc = QT/RR 0.33) is suitable for higher heart rates. Isbister's QT–heart rate nomogram (QT nomogram) may also be used for this purpose.
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