Geneesmiddelgeinduceerde QTverlenging: adviezen voor de praktijk

Many drugs are associated with QT prolongation on the electrocardiogram and may increase the risk of torsade de pointes (TdP). QT prolonging drugs are prescribed frequently, but the incidence of death due to TdP is estimated to be around 10 per million person years. There is discussion about the management of these risks. For each individual patient risks should be weighed against benefits. We performed a literature review to identify potential risk factors for QT prolongation. High risk factors include hypokalemia, hypocalcemia, heart failure, a history of ventricular arrhythmias, a history of QT prolongation and age above 70 years. Drugs with a high potential for QT prolongation include amiodarone, erythromycin (at doses above 1000 mg per day), quinidine, and sotalol. Drugs that are listed as QT prolonging drugs but probably have a low risk include ciprofloxacin, clarithromycin, domperidone (< 30 mg/day), haloperidol (< 5 mg/day), and oral ondansetron.