Report cases of drug-induced QTc prolongation with or without TdP
Report cases of drug-induced QTc prolongation with or without TdP

Many drugs are known to prolong QTc (heart rate corrected QT) interval. A prolonged QTc interval ((≥450 msec for men and ≥470 msec for women) is used as a surrogate marker of torsade de pointes (TdP), a potentially fatal arrhythmia. Most patients with prolonged QTc do not develop TdP and predicting TdP based only on prolonged QTc interval is very unreliable. Based on extensive review of literature by our group (1-4), at least for psychotropic drugs, TdP mostly occurs in the setting of prolonged QTc when one or more risk factors are present. Major risk factors include electrolyte disturbances, underlying cardiac disease, concomitant use of QTc prolonging drugs, and metabolic inhibition of the drug due to liver impairment or drug-drug interaction. Also, as TdP is a rare complication of prolonged QTc, studying there association using conventional statistics may be flawed. We believe case-report or case-series format will better identify risk factors underlying the association, allowing more systematic analysis as data accumulate. This website is dedicated to publishing such case-reports or case-series online only. Authors will retain copyright of their publication(s). .Click here for author guidelines


Thank you.


Mehrul Hasnain, MD

Editor-in-Chief


References:


1. Vieweg WVR, Hasnain M, Howland RH, Clausen T, Koneru JN, Kogut C et al. Methadone, QTc interval prolongation and torsade de pointes: Case reports offer the best understanding of this problem. Ther Adv Psychopharmacol. In press 2013


2. Vieweg WV, Hasnain M, Howland RH, Hettema JM, Kogut C, Wood MA, Pandurangi AK. Citalopram, QTc interval prolongation, and torsade de pointes. How should we apply the recent FDA ruling? Am J Med. 2012 Sep;125(9):859-68.


3. Vieweg WV, Wood MA, Fernandez A, Beatty-Brooks M, Hasnain M, Pandurangi AK. Proarrhythmic risk with antipsychotic and antidepressant drugs: implications in the elderly. Drugs Aging. 2009;26(12):997-1012


4. Vieweg WV. New Generation Antipsychotic Drugs and QTc Interval Prolongation. Prim Care Companion J Clin Psychiatry. 2003 Oct;5(5):205-215.