What other drug classes are associated with torsade de pointes?

Updated: Jan 31, 2017
  • Author: Jatin Dave, MD, MPH; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

Answer

Other drug classes associated with torsade include the following:

  • Antibiotics - Erythromycin, clarithromycin, azithromycin, levofloxacin, moxifloxacin, gatifloxacin, trimethoprim-sulfamethoxazole, clindamycin, pentamidine, chloroquine

  • Antifungals - Ketoconazole, itraconazole

  • Antivirals – Amantadine

  • Antipsychotics - Haloperidol, phenothiazines, thioridazine, trifluoperazine, sertindole, zimeldine, ziprasidone [7]

  • Tricyclic and tetracyclic antidepressants

  • Antihistamines (histamine1-receptor antagonists) - Terfenadine, astemizole, diphenhydramine, hydroxyzine [8]

  • Cholinergic antagonists - Cisapride, organophosphates (pesticides)

  • Diuretics - Indapamide, hydrochlorothiazide, furosemide

  • Antihypertensives - Bepridil, lidoflazine, prenylamine, ketanserin

  • Lithium

  • Anticonvulsants - phenytoin, carbamazepine (possible)

  • Oral hypoglycemic

  • Citrate (massive blood transfusions)

  • Cocaine

  • Vasopressin (possible)

  • Fluoxetine (possible)

  • Anesthetics - dexmedetomidine, [9]  propofol [10]

  • Loperamide - This antidiarrheal agent has been associated with torsade, even in patients without predisposing genetic or cardiac abnomalities, typically as a result of misuse or abuse [11, 12]

Some drugs (eg, amiodarone) routinely prolong QT but are less commonly associated with clinical consequences of long QT.


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