Clinical characteristics of patients with drug-induced QT interval prolongation and torsade de pointes: identification of risk factors

Letsas, Κonstantinos P.; Efremidis, Michalis; Kounas, Stavros P.; Pappas, Loukas K.; Gavrielatos, Gerasimos; Alexanian, Ioannis; Dimopoulos, Nikolaos; Filippatos, Gerasimos; Sideris, Antonios; Kardaras, Fotios

doi:10.1007/s00392-008-0741-y

Cited by 71 publications

(46 citation statements)

References 20 publications

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“…(2,6) There is an increasing concern with drugs that have the property of prolonging the QT interval, because of the risk of cardiotoxicity with torsade de points and cardiac arrest. (11) These adverse events may be determined by potential pharmacokinetic interactions that inhibit the metabolism of drugs with this property or pharmacodynamic synergism. The potential interactions between amidorane + metronidazole, fluconazole + sulfamethoxazole / trimethoprim, fluconazole + haloperidol, haloperidol + amiodarone detected in this study may produce the adverse events cited.…”

Section: Discussionmentioning

confidence: 99%

Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil

et al. 2013

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Objective: To determine the prevalence of drug interactions in intensive care units and to analyze the clinical significance of interactions identified. Methods: A multicenter, retrospective and cross sectional study conducted with 1124 patients in the seven intensive care units of teaching hospitals in Brazil. Information on drugs administered at 24 hours and 120 hours of hospitalization was obtained from the prescriptions. Results: Within 24 hours, 70.6% of patients had at least one drug interaction; the number at 24h was 2299, at 120 h it was 2619. Midazolam, fentanyl, phenytoin and omeprazole were the drugs with higher frequency of drug interactions. Conclusion: In this sample, moderate and severe drug interactions were more prevalent. In light of these findings, all actions of health professionals who provide care to these patients must be integrated in order to identify and prevent possible drug events. ResumoObjetivo: Determinar a prevalência de interações medicamentosas em Unidades de Terapia Intensiva-UTI brasileiras e analisar seu significado clínico. Métodos: Estudo multicêntrico, retrospectivo, desenvolvido com 1.124 prontuários em sete UTI de hospitais de ensino brasileiros. As informações sobre os medicamentos prescritos e administrados em pacientes com 24 horas e 120 horas de internação foram obtidas baseadas nas prescrições. Resultados: Em 24 horas, 70,6% dos pacientes de UTI tinham, pelo menos uma interação medicamentosa. O número total de interações detectadas foi de 2.299 em 24 horas, e 2.619 em 120 horas. Midazolam, Fentanyl, Phenytoin e Omeprazole foram os medicamentos que apresentaram maior frequência de interação medicamentosa. Conclusão: Na amostra estudada, as interações medicamentosas graves e moderadas foram mais prevalentes. Neste sentido, todas as ações dos profissionais de saúde que prestam cuidados a esses pacientes devem ser integradas no intuito de identificar e prevenir possíveis eventos com medicamentos.

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Section: Discussionmentioning

confidence: 99%

Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil

et al. 2013

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“…anifestations and outcomes of disease, including cardiovascular conditions, [1][2][3][4] immune disease, 5,6 respiratory illness [6][7][8] and mental health conditions, 9,10 have long been known to differ between men and women. These differences relate to sex (molecular, cellular and epigenetic mechanisms of male and female physiology) and gender (adopted or imposed social norms, behaviours, identities and expectations).…”

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confidence: 99%

Sex and gender considerations in Canadian clinical practice guidelines: a systematic review

et al. 2017

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Background:The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender considerations. Methods:We searched the Canadian Medical Association's CPG Infobase, PubMed, all provincial/territorial websites and websites of professional organizations for English-and French-language Canadian clinical practice guidelines published between January 2013 and June 2015 on selected conditions identified as priorities by policy-makers and practitioners. Citations and text were searched electronically using keyword terms related to sex and gender. Three investigators independently analyzed and categorized the content of text-positive clinical practice guidelines based on clinical relevance for practitioners. Results:Of the 118 clinical practice guidelines that met the inclusion criteria, 79 (66.9%) were text-positive for sex and/or gender keywords; 8 (10%) of the 79 used the keywords only in relation to pregnancy. Of the remaining 71 guidelines, 25 (35%) contained sex-related diagnostic or management recommendations. An additional 5 (7%) contained recommendations for sex-specific laboratory reference values, 29 (41%) referred to differences in epidemiologic features or risk factors only, and 12 (17%) contained nonrelevant mentions of search keywords. Twenty-five (35%) of the text-positive guidelines used the terms "sex" and/or "gender" correctly. higher in women than in men, with increased risk of driving impairment. 19 Rochon and colleagues 20 discovered that, in Ontario, men with dementia who were prescribed antipsychotic drugs had significantly higher risks for hospital admission and death than did women with dementia. Similarly, social risk factors are associated with higher rates of suicide in older men, which suggests that more aggressive screening and treatment may be required. [21][22][23] The extent to which evidence about sex and gender is integrated into clinical practice guidelines for diagnosis and management of diseases remains unknown. We conducted a systematic review to investigate the integration of sex and gender evidence into Canadian clinical practice guidelines published between 2013 and 2015 for noncommunicable health conditions. Methods Data sources and inclusion criteriaProtocols for this review are posted on Open Science Framework and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines (www.prisma-statement.org/). The review search focused on selected health conditions identified as priorities by policymakers and practitioners [24][25][26][27][28][29][30] (Box 1). We considered only 2 cancers, lung and colorectal, because they are among the leading causes of death from cancer for both females and males, 31 and important sex and/or gender differences in prevalence, risk and screening, path...

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“…A higher incidence of prolonged QT interval and Tdp has been shown repeatedly in women [77][78][79][80][81]. This is true for congenital variants of LQTS as well as for a drug-induced prolongation of the QT interval [77].…”

Section: Considerations For Risk Assessmentmentioning

confidence: 98%

Drug-induced QT interval prolongation in cancer patients

Becker

Yeung

2010

Oncol Rev

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Cancer patients are at an increased risk for QT interval prolongation and subsequent potentially fatal Torsade de pointes tachycardia due to the multiple drugs used for treatment of malignancies and the associated symptoms and complications. Based on a systematic review of the literature, this article analyzes the risk for prolongation of the QT interval with antineoplastic agents and commonly used concomitant drugs. This includes anthracyclines, fluorouracil, alkylating agents, and new molecularly targeted therapeutics, such as vascular disruption agents. Medications used in the supportive care can also prolong QT intervals, such as methadone, 5-HT 3 -antagonists and antihistamines, some antibiotics, antifungals, and antivirals. We describe the presumed mechanism of QT interval prolongation, drug-specific considerations, as well as important clinical interactions. Multiple risk factors and drug-drug interactions increase this risk for dangerous arrhythmias. We propose a systematic approach to evaluate cancer patients for the risk of QT interval prolongation and how to prevent adverse effects.

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Clinical characteristics of patients with drug-induced QT interval prolongation and torsade de pointes: identification of risk factors

Cited by 71 publications

References 20 publications

Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil

Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil

Sex and gender considerations in Canadian clinical practice guidelines: a systematic review

Drug-induced QT interval prolongation in cancer patients

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