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The QT interval
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Drug-induced QT interval prolongation is associated with an increased risk of torsades de pointes (Chapter 8), which can lead to ventricular fibrillation and sudden cardiac death. Awareness of the risk of drug-induced QT prolongation is therefore important, particularly when managing individuals with increased susceptibility to such effects. This includes those with: Simultaneous treatment with more than one QT-prolonging drugOverdose with a QT-prolonging drugPre-existing QT interval prolongationElectrolyte abnormalitiesUnderlying cardiovascular disease
Regulation of Human CYP2D6
Published in Shufeng Zhou, Cytochrome P450 2D6, 2018
Gender may affect CYP enzyme activity owing to endogenous hormonal fluctuations with the menstrual cycle, which are altered by oral contraceptives (Anderson 2002; Franconi and Campesi 2014; Harris et al. 1995; Scandlyn et al. 2008; Waxman and Holloway 2009). For example, the activity of CYP3A4 appears to be higher in females (Cotreau et al. 2005; Cummins et al. 2002; Waxman and Holloway 2009), whereas males seem to have a higher CYP2E1 and 1A2 activity (Gleiter and Gundert-Remy 1996; Landi et al. 1999; Scandlyn et al. 2008). Women are reported to experience more ADRs than men (Drici and Clement 2001). For example, women are more likely to experience drug-induced QT prolongation and torsade de pointes than men (Wenzel-Seifert et al. 2011).
Drug-specific risk of severe QT prolongation following acute drug overdose
Published in Clinical Toxicology, 2020
Sharan L. Campleman, Jeffery Brent, Anthony F. Pizon, Joshua Shulman, Paul Wax, Alex F. Manini
In this large prospective US cohort, we have comprehensively identified specific drugs with the highest risk of SQTP following acute drug overdose. Drug classes most commonly associated with SQTP were class III antidysrhythmics, sodium channel blockers, antidepressants, and antipsychotics. These findings should be used by clinicians to guide the clinical management of patients with acute drug overdose, as heightened awareness of the need for electrocardiographic monitoring may be required. Timing and duration of electrocardiographic monitoring, as well as implications for prescribing practices to prevent drug-induced QT prolongation, both require further study.
Guidelines for reporting case studies and series on drug-induced QT interval prolongation and its complications following acute overdose
Published in Clinical Toxicology, 2020
Ingrid Berling, Benjamin W. Hatten, Robert S. Hoffman, Rittirak Othong, Darren M. Roberts, Reem A. Mustafa, Christopher Yates, Monique Cormier, Sophie Gosselin
When possible, the drug concentration(s) should also be reported. When a dose-response relationship is observed this increases the degree of certainty for drug-induced QT prolongation. For example, in isolation, a case report of QT prolongation and TdP after an overdose of eperisone and triazolam in a patient also taking nifedipine is noteworthy [46], but subsequent data demonstrating a correlation between eperisone drug concentrations and QT interval duration [47] further increases the degree of certainty that eperisone causes drug-induced QT prolongation in overdose.
Utility of QT interval corrected by Rautaharju method to predict drug-induced torsade de pointes
Published in Clinical Toxicology, 2019
Rittirak Othong, Suttisak Wattanasansomboon, Thanakorn Kruutsaha, Douglas Chesson, Sakda Arj-Ong Vallibhakara, Ziad Kazzi
Evaluation of QT intervals on the 12-lead electrocardiogram (ECG) is of value for drug-induced QT prolongation. One of the worst outcomes in those with QT prolongation is the occurrence of torsade de pointes (TdP) [1]. Because the QT interval varies with the heart rate, it is recommended that clinicians use corrected QT intervals (QTc) instead [2]. The Bazett formula (QTcBZT) is the most widely used correction method worldwide [3] although it has been criticized for causing both over-correction and under-correction at faster and slower heart rates, respectively [4].