|Metabolic disorders |
|Other factors ||Androgen deprivation therapy |
Diuretic therapy via electrolyte disorders particularly hypokalemia and hypomagnesemiaHerbs
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AV: atrioventricular; IV: intravenous; QTc: rate-corrected QT interval on the electrocardiogram.
* Classifications provided by Lexicomp according to US Food & Drug Administration guidance: Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythic Potential for Non-Antiarrhythmic Drugs – Questions and Answers; Guidance for Industry US Food and Drug Administration, June 2017 (revision 2) available at: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM073161.pdf as updated August 8, 2023 (https://www.fda.gov/media/170814/download) with additional data from CredibleMeds QT drugs list[1,2]. The use of other classification criteria may lead to some agents being classified differently by other sources.
¶ Not available in the United States.
Δ In contrast with other class III antiarrhythmic drugs, amiodarone is rarely associated with torsades de pointes; refer to accompanying text within UpToDate topic reviews of acquired long QT syndrome.
◊ Withdrawn from market in most countries due to adverse cardiovascular effects.
§ IV amisulpride antiemetic use is associated with less QTc prolongation than the higher doses administered orally as an antipsychotic.
¥ Some other cyclic antidepressants (ie, amoxapine, maprotiline, protriptyline, trimipramine) may also prolong the QT interval, but data are insufficient to identify level of risk with confidence; refer to UpToDate content on cyclic antidepressant pharmacology, administration, and side effects.
‡ The "low risk" category includes drugs with limited evidence of clinically significant QTc prolongation or TdP risk; many of these drugs have label warnings regarding possible QTc effects or recommendations to avoid use or increase ECG monitoring when combined with other QTc prolonging drugs.
† Rarely associated with significant QTc prolongation at usual doses for treatment of opioid use disorder, making buprenorphine a suitable alternative for patients with methadone-associated QTc prolongation. Refer to UpToDate clinical topic reviews.
** The United States FDA labeling for the sublingual preparation of dexmedetomidine warns against use in patients at elevated risk for QTc prolongation. Both intravenous (ie, sedative) and sublingual formulations of dexmedetomidine have a low risk of QTc prolongation and have not been implicated in TdP.
¶¶ Over-the-counter; available without a prescription.ΔΔ Not associated with significant QTc prolongation in healthy persons. Refer to UpToDate clinical topic for potential adverse cardiovascular (CV) effects in patients with CV disease.
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