A Case of Prolonged QT Interval and Torsades de Pointes Due to Ciprofloxacin

Arce, Jorge Salinas; Romero, Rubén; Solorzano, Paula

doi:10.1016/s1885-5857(10)70017-7

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…Another case of prolonged QT internal and tosarde de pointes due to Ciprofloxacin was also reported, which was marked by polymorphic ventricular tachycardia and long QT (QTC 596 ms). After 72 hours of withdrawal of Ciprofloxacin, the disappearance of changes in cardiac repolarization was noted [67]. This agrees with the report of Flanagan et al, (2006) [68] who observed tosarde de pointes, polymorphic ventricular tachycardiac associated with QT internal prolongation caused by intravenous Ciprofloxacin given for pneumonia in a 22-year old healthy marine.…”

Section: Ciprofloxacin Induced Cardiotoxicity In Humans and Animalssupporting

confidence: 90%

Ciprofloxacin Cardiotoxicity and Hepatotoxicity in Humans and Animals

Adikwu¹,

Nelson²

2012

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Ciprofloxacin is generally well tolerated. The most common adverse reactions include gastro intestinal tract, central nervous system and heamatological system. Recently rising cases of Ciprofloxacin associated toxicity have been re-ported. Experiment in animal models and clinical experience show that Ciprofloxacin induces cardiotoxicity marked by increase QT and QTC interval, prolongation of action potential duration. This increases the risk of arrhythmia (tosarde de pointes). Ciprofloxacin induced cardiotoxic effect could be associated with blocking cardiac voltage—gated potassium channels particularly the rapid component (IKr) of the delayed rectifier potassium current. Drug interaction with inhibitors of Cytochrome P450 (CYP) mediated metabolism is one of the underlying mechanisms. Several cases of Ciprofloxacin induced hepatoxicity have been reported. These were characterized by extensive hepatocellular necrosis, mixed inflammatory Infiltrate and abundant esinophils in the liver. Elevated liver enzymes which include serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gramma-glutamyltranferase and prolong prothrobin time were reported. The hepatotoxic effect of Ciprofloxacin as reported could be due to oxidative stress induced in the liver by Ciprofloxacin through the generation of oxidative radicals leading to depletion of protein content in hepatocytes as a consequence of nucleic acids diminution and DNA damage leading to a significant decrease in the number and degeneration in mitochondria which is responsible for energy supply. In conclusion ciprofloxacin induced cardiotoxicity and hepatoxicity is relatively low in humans but patients’ liver and cardiac function should be considered before ciprofloxacin use

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Section: Ciprofloxacin Induced Cardiotoxicity In Humans and Animalssupporting

confidence: 90%

Ciprofloxacin Cardiotoxicity and Hepatotoxicity in Humans and Animals

Adikwu¹,

Nelson²

2012

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“…In patients with LQTS, torsade(s) de pointes may persist despite withdrawal of the drug. Salinas et al [7] reported a patient admitted to ICU due to syncope and loss of consciousness on the 48th hour after initiation of ciprofloxacin with diagnosis of cholangitis. On ECG, tachycardia involving polymorphic QRS was detected and QTc was calculated as 596 ms. As a result, a temporary pacemaker was implemented in addition to withdrawal of ciprofloxacin.…”

Section: Discussionmentioning

confidence: 99%

Clarithromycine-Induced Ventricular Tachycardia in a Geriatric Patient Using Multiple Drugs

Karaören¹

2016

Ann Clin Anal Med

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ÖzetUzun QT sendromu ani kardiak ölüme neden olabilen idiyopatik, iyatrojenik veya konjenital sebeplerle gözlenebilen bir kardiyak repolarizasyon bozukluğudur. İyat-rojenik form daha çok ilaçlara ve elektrolit dengesizliğine bağlıdır. QT aralığı uzaması sıklıkla antiaritmik ilaçlara bağlı olarak görülse de antibiyotikler ve antiepileptikler ile de karşımıza çıkabilir. Yaşlılardaki olumsuz ilaç etkileşimleri; çeşit-li klinikopatolojik formlarda karşımıza çıkabilir. Bu gibi durumlarda tedavide; ilave ilaç uygulamasından önce, kullanılan ilaçların yan etki potansiyellerinin göz önü-ne alınması gerekmektedir. Çalışmamızda; atipik pnömoni sebebiyle yoğun bakı-mımızda Klaritromisin tedavisi başlanan; komorbiditeleri sebebiyle çoklu ilaç kullanımı olan 91 yaşındaki trakeostomili erkek hastada tedavinin 3. gününde gözle-nen QT uzaması ile ventriküler aritmi gelişimini ve sonrasındaki tedavi yaklaşımı-nı sunmayı amaçladık. Anahtar KelimelerKlaritromisin; Uzun QT Sendromu; İlaç Yan Etkisi AbstractLong QT syndrome is a cardiac repolarization disorder, which can be either idiopathic or congenital, and cause sudden cardiac death. The iatrogenic form is generally associated with drugs or electrolyte imbalance. Although prolonged QT interval is frequently seen due to antiarrhythmic agents, it can also be seen with antibiotics or anti-epileptics. Adverse drug interaction can manifest in several clinicopathological forms in elder individuals. In such cases, potential adverse effects of drugs used should be taken into consideration before prescribing additional drugs. Here, we present a case of clarithromycine-induced ventricular arrhythmia accompanied by QT prolongation on the third day of therapy, and the subsequent therapeutic approach, in a 91-year-old man. The patient was taking multiple drugs due to comorbid conditions and was prescribed clarithromycine therapy in the intensive care unit.

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“…In fact, the clinical burden of fluoroquinolones-related CV diseases is strictly related to the co-existent morbidities and pharmacotherapy. As shown by case reports and series, the presence of chronic heart and/or kidney failure, history of cardiomyopathy, rhythm disorders and electrolyte imbalance, use of amiodarone, sotalol, b-blockers and/or digitalis might have exacerbated the risk of TdP [31-33,35-41, [43][44][45][46][47][48][49][50][51][52]. Accordingly, all these covariates had been also taken into account during pharmacovigilance studies [67], which offer a more reliable picture of the 'real' use of these drugs.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and metabolic safety profiles of the fluoroquinolones

Pugi

Bartoloni

et al. 2011

Expert Opinion on Drug Safety

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Cardiac alterations and blood glucose impairments might be associated with any fluoroquinolone. However, the benefit/risk profile of these agents could be stratified for the single compounds. Several predisposing factors, such as diabetes, heart illnesses and their related pharmacotherapies, might exacerbate the risk of potentially serious adverse events. In this context, the opportunity of the more appropriate choice among different fluoroquinolones could be applicable.

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A Case of Prolonged QT Interval and Torsades de Pointes Due to Ciprofloxacin

Cited by 6 publications

References 7 publications

Ciprofloxacin Cardiotoxicity and Hepatotoxicity in Humans and Animals

Ciprofloxacin Cardiotoxicity and Hepatotoxicity in Humans and Animals

Clarithromycine-Induced Ventricular Tachycardia in a Geriatric Patient Using Multiple Drugs

Cardiovascular and metabolic safety profiles of the fluoroquinolones

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