Faculty Collaboration Database

QTc Prolongation in Poison Center Exposures to CredibleMeds List of Substances with "Known Risk of Torsades de Pointes". Cardiovasc Toxicol 2022 Sep;22(9):866-877

Date

08/06/2022

Pubmed ID

35930218

DOI

10.1007/s12012-022-09764-4

Scopus ID

2-s2.0-85135527018 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

Many drugs carry some risk of QT interval prolongation, which can lead to life-threatening dysrhythmias including Torsades de Pointes (TdP). CredibleMeds.org identifies medications categorized as "Known Risk of TdP" but does not stratify risk in acute supratherapeutic ingestions. We sought to determine the proportion of cases exhibiting QTc prolongation and life-threatening dysrhythmias including ventricular tachycardia (VT)/ventricular fibrillation (VF), TdP, and asystole in patients exposed to these substances. Retrospective chart review of cases reported to our Regional Poison Center from 2014 to 2019 of exposures to one or more of the "Known Risk" substances was performed. Demographics, therapies, clinical effects, and medical outcome for each case were analyzed. There were 1125 exposures, of which 760 had a documented QTc interval. QTc ≥ 500 ms was reported in 138 (18.2%) of the 760 cases. The most common "Known Risk" substances were citalopram, escitalopram and cocaine. Although not in the "Known Risk" category, mirtazapine, amitriptyline, diphenhydramine, and trazodone had a statistically significant association with QTc > 500 ms. Life-threatening dysrhythmias occurred in 13 cases, with VT/VF in 6 of the 760 (0.8%) cases, and one case of TdP. Flecainide (OR 11.1, 95% CI 2.2-55.8) and methadone (OR 7.1, 95% CI 2.1-23.4) were associated with increased risk of all life-threatening dysrhythmias. Exposures to medications on the Credible Meds list of "Known Risk of TdP" QTc prolongation is common, but life-threatening dysrhythmias are rare. Mirtazapine, amitriptyline, diphenhydramine, and trazodone were associated with prolonged QTc. Flecainide and methadone had the highest associated risk of life-threatening dysrhythmias.

Author List

Ryan K, Benz P, Zosel A, Farkas A, Theobald J

Authors

Andrew N. Farkas MD Associate Professor in the Emergency Medicine department at Medical College of Wisconsin
Jillian Lee Theobald MD, PhD Associate Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Amitriptyline
Arrhythmias, Cardiac
Diphenhydramine
Electrocardiography
Flecainide
Humans
Long QT Syndrome
Methadone
Poison Control Centers
Retrospective Studies
Risk Factors
Tachycardia, Ventricular
Torsades de Pointes
Trazodone
Ventricular Fibrillation