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However, a patient's risk of a fatal ventricular arrhythmia may be reduced with the pharmacist's awareness of nonpharmacologic risk factors, drugs known to cause QT prolongation, and specific drug interactions. QT Interval The QT interval is the length of time required for the heart to repolarize following the onset of depolarization. The unexpected and catastrophic cardiovascular effects of psychotropic drugs are well described albeit uncommon. The list of drugs which have been associated with prolonging QT interval and hence potentially causing Torsades de pointes is Many drugs are associated with QT prolongation and certain patient factors can increase this effect, leading to a significant risk of arrhythmias. This article describes the drug and patient factors that can lead to QT prolongation and discusses how the risks can be reduced. Drugs that prolong the QT interval 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. The heart has an electrical system that allows it to contract in a rhythm. A vital aspect of this electrical system is depolarization and repolarization. The focus of this activity is on the QT interval. It is measured from the Q wave until the T wave, and the QT interval clinically represents the repolarization of the ventricles. Many commonly used medications exhibit QT-prolonging effects Electrocardiogram qt corrected interval prolonged is reported as a side effect among people who take Gabapentin (gabapentin), especially for people who are female, 40-49 old, also take Mirtazapine, and have High blood pressure. Summary: Long qt syndrome is reported as a side effect among people who take Gabapentin (gabapentin), especially for people who are female, 60+ old, also take Aspirin, and have High blood pressure. The phase IV clinical study analyzes which people have Long qt syndrome when taking Gabapentin. The unexpected and catastrophic cardiovascular effects of psychotropic drugs are well described albeit uncommon. The list of drugs which have been associated with prolonging QT interval and hence potentially causing Torsades de pointes is exhaustive. The insight into the plausible mechanisms are largely unclear. However, the practical implications of anticipating and recognizing QT ACTION: ng the QTc interval should be offered an ECG regardless of other risk factors. Cardiology follow up should be sought w Additional ECG monitoring should be considered with any dose increase or the addition of a new risk factor e.g., drug interaction, concomitant use of another potential QTc-prolonging drug, etc. All medicines – both those prescribed by your doctor and any you buy over the counter – must be checked, as some can increase the risk of sudden death. For people with LQTS there are specific medications that can have a serious effect by further prolonging the QT interval. We give a list of these medicines below. Drugs associated with QT Prolongation, QTc prolongation including Antipsychotics, antiarrhythmics, antidepressants, and antihistamines Drugs associated with QT prolongation include (1): tricyclic antidepressants antiarrhythmics: quinidine disopyramide procainamide amiodarone sotalol non-sedative antihistamine toxicity terfenadine astemizole antimalarials especially halofantrine antipsychotics notably droperidol and thioridazine cisapride methadone cocaine has been shown to increase QT intervals acutely (2) citalopram (3 In this population of healthy adults, gabapentin enacarbil at doses of 1200 and 6000 mg was not associated with QT prolongation and was generally well-tolerated. Despite significant changes from baseline in these patients, prolongation of the QT interval exceeded the upper limit of normal in just one patient. Seizure-related oxygen desaturation is also associated with QT interval prolongation [12]. 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. The length of the QT interval represents the time required for ventricular depolarization and repolarization. Prolongation of ventricular repolarization can result in fatal ventricular arrhythmias [3]. Faster heart rates can shorten the QT interval [4], so it is often adjusted for rate and reported as the heart rate corrected (QTc) interval. The typical ventricular action potential is 200 A definitive QT/QTc study of healthy human subjects showed no effect on QTc interval after either a single low dose (1200 mg) or high dose (6000 mg) of oral gabapentin enacarbil (Fig. 1) [17 ••]. Case reports suggest the potential for these drugs to enhance QTc prolongation in patients receiving one or more known QTc–prolonging medications. Keywords: Long QT Syndrome, Torsades de pointes, Anesthesia, QT-prolongation, Anesthetic drugs Core tip: Long QT syndrome 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. Prolongation of the QT interval above 470 ms for men and 480 ms for women should be regarded as abnormal [4]. Several risk factors for QT prolongation have been identified, including female sex, advanced age, drug-drug interactions, genetic predisposition, hypokalemia, hypomagnesemia, heart failure, and bradycardia [5, 6]. Many drug therapies are associated with prolongation of the QT interval. 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'
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