Levofloxacin Induced Polymorphic Ventricular Tachycardia with Normal QT Interval

Paltoo, Brendon; O’Donoghue, Susan; Mousavi, M

doi:10.1046/j.1460-9592.2001.00895.x

Cited by 38 publications

(12 citation statements)

References 3 publications

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“…Paltoo et al reported the first case of polymorphic ventricular tachycardia in response to the use of levofloxacin in patients with no risk factors [39]. Patel et al reported that polymorphic ventricular tachycardia occurred in a 91-year-old woman with flu-like symptoms after using levofloxacin [40].…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

Cardiac risks associated with antibiotics: azithromycin and levofloxacin

Zhiqiang

Yuan

et al. 2014

Expert Opinion on Drug Safety

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Introduction Azithromycin and levofloxacin have been shown to be efficacious in treating infections. The adverse drug events associated with azithromycin and levofloxacin were considered rare. However, the US FDA released warnings regarding the possible risk of QT prolongation with azithromycin and levofloxacin. Areas covered Case reports/case series, observational studies and clinical trials assessing cardiovascular risks associated with azithromycin and levofloxacin were critically reviewed, including 15 case reports/series, 5 observational studies and 5 clinical trials that investigated the cardiac risks associated azithromycin and levofloxacin. Expert opinion Results are discordant. Two retrospective studies utilizing large databases demonstrated an increased risk of cardiovascular death with azithromycin, when azithromycin was compared with amoxicillin. Two other retrospective studies found no difference in cardiovascular death associated with azithromycin and other antibiotics. For levofloxacin, the increased risk of cardiovascular death was only found in one retrospective study. Therefore, the risks and benefits of antibacterial therapies should be considered when making prescription decisions. This study should not preclude clinicians from avoiding azithromycin and levofloxacin. If a patient has an indication to receive an antibiotic and if azithromycin or levofloxacin is needed, it may be used, but the potential risks must be understood.

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Section: Cardiovascular Effectsmentioning

confidence: 99%

Cardiac risks associated with antibiotics: azithromycin and levofloxacin

Zhiqiang

Yuan

et al. 2014

Expert Opinion on Drug Safety

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“…Indeed, there are reported cases of TdP in patients with apparently normal QT interval. 92 To further complicate the issue, no standard exists even for QT measurement itself. 3 In collecting and analyzing electrocardiograms, one should consider the guidelines for electrocardiographic evaluation of drug-related QT prolongation and other alterations in ventricular repolarization from the International Society for Holter and Noninvasive Electrocardiology (ISHNE).…”

Section: B Clinical Studiesmentioning

confidence: 99%

QT prolongation through hERG K⁺ channel blockade: Current knowledge and strategies for the early prediction during drug development

Recanatini

Poluzzi

Masetti

et al. 2004

Medicinal Research Reviews

258

116

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Prolongation of the QT interval of the electrocardiogram is a typical effect of Class III antiarrhythmic drugs, achieved through blockade of potassium channels. In the past decade, evidence has accrued that several classes of drugs used for non-cardiovascular indications may prolong the QT interval with the same mechanism (namely, human ether-a-go-go-related gene (hERG) K(+) channel blockade). The great interest in QT prolongation is because of several reasons. First, drug-induced QT prolongation increases the likelihood of a polymorphous ventricular arrhythmia (namely, torsades de pointes, TdP), which may cause syncope and degenerate into ventricular fibrillation and sudden death. Second, the fact that several classes of drugs, such as antihistamines, fluoroquinolones, macrolides, and neuroleptics may cause the long QT syndrome (LQTS) raises the question whether this is a class effect (e.g., shared by all agents of a given pharmacological class) or a specific effect of single agents within a class. There is now consensus that, in most cases, only a few agents within a therapeutic class share the ability to significantly affect hERG K(+) channels. These compounds should be identified as early as possible during drug development. Third, QT prolongation and interaction with hERG K(+) channels have become surrogate markers of cardiotoxicity and have received increasing regulatory attention. This review briefly outlines the mechanisms leading to QT prolongation and the different strategies that can be followed to predict this unwanted effect. In particular, it will focus on the approaches recently proposed for the in silico screening of new compounds.

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“…One case of levofloxacin-associated torsades des pointes in the absence of QTc interval prolongation has also been reported [391]. Grepafloxacin was removed from the market by its manufacturer in October 1999 because of its electrophysiologic adverse event profile.…”

Section: Quinolones and Electrophysiologymentioning

confidence: 99%

Quinolones

Guay¹

2011

Drug Interactions in Infectious Diseases

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Fluoroquinolone (FQ) antimicrobials are among the most commonly used agents in the outpatient and institutional patient care environments. Due to this high frequency of utilization, the potential for deleterious drug-drug interactions with nonantimicrobials is also high. The majority of interactions with the FQs involve deleterious effects on the FQ component. These are also the most clinically-important interactions with these agents. Multivalent cations such as Mg , and other minerals as well as drugs such as sucralfate, lanthanum, sevelamer, and didanosine (the cation-supplemented version of the latter) can substantially reduce FQ bioavailability, leading the subtherapeutic drug concentrations at the infection site and clinical failure. Separation of dose administrations may or may not reduce the magnitude of these interactions. Ciprofloxacin, norfloxacin, and two experimental FQs in clinical trials (pazufloxacin and prulifloxacin) act as moderate cytochrome P450 enzyme inhibitors and may increase serum concentrations of theophylline and caffeine. Warfarin pharmacodynamics are variably affected by the FQs. The pharmacodynamic interactions between NSAIDs and FQs are only relevant if fenbufen is used concurrently with enoxacin or, possibly, prulifloxacin. Caution is warranted if sparfloxacin or moxifloxacin is used concurrently with other medications prolonging the QTc interval or if patients have other risk factors for prolongation of the QTc interval (e.g. abnormal QTc interval pre-treatment, electrolyte abnormalities, use of starvation-liquid diets, or history of heart disease). Fluoroquinolone antimicrobials can be used effectively and safely in the vast majority of patients if the clinician remembers those few drug-drug interactions that are clinically-important.

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Levofloxacin Induced Polymorphic Ventricular Tachycardia with Normal QT Interval

Cited by 38 publications

References 3 publications

Cardiac risks associated with antibiotics: azithromycin and levofloxacin

Cardiac risks associated with antibiotics: azithromycin and levofloxacin

QT prolongation through hERG K⁺ channel blockade: Current knowledge and strategies for the early prediction during drug development

Quinolones

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Levofloxacin Induced Polymorphic Ventricular Tachycardia with Normal QT Interval

Cited by 38 publications

References 3 publications

Cardiac risks associated with antibiotics: azithromycin and levofloxacin

Cardiac risks associated with antibiotics: azithromycin and levofloxacin

QT prolongation through hERG K+ channel blockade: Current knowledge and strategies for the early prediction during drug development

Quinolones

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Product

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About

QT prolongation through hERG K⁺ channel blockade: Current knowledge and strategies for the early prediction during drug development