Medicamente care prelungesc intervalul QT

Prelungirea intervalului QT este asociata cu un risc crescut de aritmii ventriculare maligne (torsada vârfurilor, try fibrilatie ventriculara). Sindromul QT lung de origine medicamentoasa apare mai frecvent la femei, sildenafil la vârstnici, la pacienti cu insuficienta cardiaca congestiva si bradicardie severa si poate fi precipitat de hipomagnezemie, hipopotasemie, hipocalcemie, disfunctii hepatorenale sau inanitie. Asocierea de medicamente care prelungesc intervalul QT are efect aditiv.

Risc crescut de torsada vârfurilor: amiodarona (antiaritmic), astemizol (antihistaminic), cholochina (antimalaric), clorpromazina (antipsihotic, antiemetic), cisaprida (prokinetic), chinidina (antiaritmic), claritromicina (antibiotic), disopiramida (antiaritmic), dofetilid (antiaritmic), domperidon (antiemetic), droperidol (sedativ, antiemetic), eritromicina (antibiotic), haloperidol (antipsihotic), ibutilid (antiaritmic) trioxid de arsen (anticanceros), metadona (agonist opioid), pentamidina (antiinfectios), pimozida (antipsihotic), procainamida (antiaritmic), sotalol (antiaritmic), sparfloxacin (antibiotic), tioridazina (antipsihotic).

Risc posibil de torsada vârfurilor: alfuzosin (alfa-1 blocant), amantadina (antiviral, agent dopaminergic), atazanavir (inhibitor de proteaza), azitromicina (antibiotic), clozapina (antipsihotic), dolasetron (antiemetic), felbamat (anticonvulsivant), flecainida (antiaritmic), foscarnet (antiviral), fenotoina (anticonvulsivant, antiaritmic), gatifloxacin (antibiotic), gemifloxacin (antibiotic), granisetron (antiemetic), indapamida (diuretic), isradipina (antihipertensiv), lapatinib (anticanceros), levofloxacin (antibiotic), litiu (antimaniacal), moxifloxacin (antibiotic), nicardipina (antihipertensiv), nilotinib (anticanceros), octreotid (analog de somatostatina), ofloxacin (antibiotic), ondansetron (antiemetic), oxitocina (ocitocic), risperidona (antipsihotic), sunitinib (anticanceros), tacrolimus (imunosupresor), tamoxifen (anticanceros), telitromicina (antibiotic), vardenafil (inhibitor de fosfodiesteraza), voriconazol (antifungic), ziprasidona (antipsihotic).

Risc de torsada vârfurilor conditionat de prezenta sindromului de QT lung congenital, supradozaj medicamentos sau co-administrare de alte medicamente: amitriptilina (antidepresiv triciclic), ciprofloxacin (antibiotic), citalopram (antidepresiv), desipramina (antidepresiv triciclic), fluconazol (antifungic), fluoxetina (antidepresiv), imipramina (antidepresiv triciclic), itraconazol (antifungic), ketoconazol (antifungic), mexiletina (antiaritmic), nortriptilina (antidepresiv triciclic), sertralina (antidepresiv), trimethoprim-sulfamethoxazol (antibiotic).

Riscul este mai crescut la femei decât la barbati pentru urmatoarele medicamente: amiodarona, cisaprida, disopiramida, eritromicina, ibutilida, pentamidina, sotalol, chinidina, metadona, pimozida.

Sursa:

www.qtdrugs.org

www.azcert.org/medical-pros/drug-lists/bycategory.cfm

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