<i>Torsades de pointes</i>following clarithromycin treatment

Gysel, Michael; Vieweg, W. Victor R.; Hasnain, Mehrul; Hancox, Jules C.; Kunanithy, Vitharani; Baranchuk, Adrián

doi:10.1586/14779072.2013.840535

Cited by 13 publications

(8 citation statements)

References 36 publications

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“…Comparison with clarithromycin and azithromycin Whilst the present study is limited to the evaluation of 29 case reports with erythromycin, there is good concordance between its findings and the results of recent analyses of case reports with other macrolide agents (azithromycin and clarithromycin) that we have conducted Vieweg et al 2013a;Gysel et al 2013]. For both azithromycin and clarithromycin there was no significant correlation between administered drug dose and QTc interval of the cases examined, whilst female sex, old age and heart disease were identified as major risk factors Vieweg et al 2013a].…”

Section: Limitations and Strengths Of Approachsupporting

confidence: 70%

Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity

Hancox¹,

Hasnain

Vieweg

et al. 2014

Therapeutic Advances in Infection

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Abstract:Objectives: Erythromycin is a macrolide antibiotic that is widely used for various infections of the upper respiratory tract, skin, and soft tissue. Similar to other macrolides (clarithromycin, azithromycin), erythromycin has been linked to QTc interval prolongation and torsade de pointes (TdP) arrhythmia. We sought to identify factors that link to erythromycin-induced/ associated QTc interval prolongation and TdP. Methods and Results: In a critical evaluation of case reports, we found 29 cases: 22 women and 7 men (age range 1895 years). With both oral and intravenous erythromycin administration, there was no significant relationship between dose and QTc interval duration in these cases. Notably, all patients had severe illness. Other risk factors included female sex, older age, presence of heart disease, concomitant administration of either other QTc prolonging drugs or agents that were substrates for or inhibitors of CYP3A4. Most patients had at least two risk factors. Conclusions: On the basis of case report evaluation, we believe that major risk factors for erythromycin-associated TdP are female sex, heart disease and old age, particularly against a background of severe illness. Coadministration of erythromycin with other drugs that inhibit or are metabolized by CYP3A4 or with QTc prolonging drugs should be avoided in this setting.

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Section: Limitations and Strengths Of Approachsupporting

confidence: 70%

Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity

Hancox¹,

Hasnain

Vieweg

et al. 2014

Therapeutic Advances in Infection

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“…[57][58][59] Progression of QT prolongation to more serious cardiac events commonly occurs when many of these clinical risk factors are present together. Older women with heart disease are at particularly higher risk.…”

Section: Discussionmentioning

confidence: 99%

Macrolide antibiotics and the risk of ventricular arrhythmia in older adults

Trac

McArthur

Jandoc

et al. 2016

CMAJ

119

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“…The use as of QT as surrogate for TdP has also been challenged [37,38]. Instead the presence of one or often two or more additional risk factors, such as old age, female gender, and heart disease, seems to be more important for the development of TdP [23,35,36]. In our study in older at-risk individuals, we thoroughly adjusted for comorbidity, concurrent drug use and several other confounders (see Table in the online version).…”

Section: Figurementioning

confidence: 99%

Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Danielsson¹,

Collin²,

Bergman³

et al. 2016

Brit J Clinical Pharma

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AIMThe aim of the study was to examine mortality risk associated with use of antidepressants and antipsychotics classified with torsades de pointes (TdP) risk in elderly. METHODSA matched case-control register study was conducted in people 65 years and older dying outside hospital from 2008-2013 (n = 286 092) and matched controls (n = 1 430 460). The association between prescription of antidepressants and antipsychotics with various TdP risk according to CredibleMeds (www.crediblemeds.org) and all-cause mortality was studied by multivariate conditional logistic regression adjusted for comorbidity and several other confounders. RESULTSUse of antidepressants classified with known or possible TdP risk, was associated with higher adjusted risk for mortality (OR 1.53, 95% CI 1.51, 1.56 and OR 1.63, 95% CI 1.61, 1.67, respectively) compared with antidepressants classified with conditional TdP risk (OR 1.25, 95% CI 1.22, 1.28) or without TdP classification (OR 0.99, 95% CI 0.94, 1.05). Antipsychotics classified with known TdP risk were associated with higher risk (OR 4.57, 95% CI 4.37, 4.78) than antipsychotics with possible risk (OR 2.58, 95% CI 2.52, 2.64) or without TdP classification (OR 2.14, 95% CI 2.03, 2.65). The following risk ranking was observed for commonly used antidepressants: mirtazapine > citalopram > sertraline > amitriptyline and for antipsychotics: haloperidol > risperidone >olanzapine > quetiapine. CONCLUSIONThe CredibleMeds system predicted drug-associated risk for mortality in the elderly at the risk class level. Among antipsychotics, haloperidol, and among antidepressants, mirtazapine and citalopram, were associated with the highest risks. The results suggest that the TdP risk with

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Torsades de pointesfollowing clarithromycin treatment

Cited by 13 publications

References 36 publications

Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity

Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity

Macrolide antibiotics and the risk of ventricular arrhythmia in older adults

Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

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