Drugs That Prolong the QT Interval
and/or Induce Torsades de Pointes
Raymond L. Woosley, MD, PhD
The following lists are based on information from the medical literature, the FDA-approved drug labeling and reports submitted to the FDA Adverse Events Reporting System database.
This list is maintained by Raymond L. Woosley, MD, PhD, CEO and President of The Critical Path Institute (C-Path) and Director of the Arizona Center for Education and Research on Therapeutics (AzCERT). To construct these lists, AzCERT only surveys drugs marketed in the United States (US). However, some drugs marketed in countries other than the US come to our attention and are included. Those drugs are designated with an asterisk. Suggested additions, deletions and references are most welcome; the list has benefited immensely from the input of practicing physicians and other researchers in the field. This list will be updated as new information becomes available. The content of this Table is for public use, free of charge and for information only. It is not intended to be used in any other manner. The author disclaims any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, or the use and application of any of the contents of this Table. The information presented on this site is intended as general health information and as an educational tool. It is not intended as medical advice. Only a physician, pharmacist, or other health care professional should advise a patient on medical issues and should do so using a medical history and other factors identified and documented as part of the health professional/patient relationship.
The entire content of this site is protected by International and United States of America copyright laws.
KEY
Drugs with Risk
|
Drugs that are generally accepted by authorities to have a risk of causing torsades de pointes. |
Drugs with Possible Risk
|
Drugs that may prolong the QT interval but at this time lack substantial evidence for causing torsades de pointes. |
Drugs with a Conditional Risk |
Drugs that, in some reports, have been weakly associated with torsades de pointes and/or QT prolongation but that are unlikely to be a risk for torsades de pointes when used in usual recommended dosages and in patients without other risk factors (e.g., concomitant QT prolonging drugs, bradycardia, electrolyte disturbances, congenital long QT syndrome, concomitant drugs that inhibit metabolism). |
Drugs to be Avoided
|
Drugs to be avoided for use in patients with diagnosed or suspected congenital long QT syndrome. (Drugs on Lists 1 and 2 are also included here.) |
Females > Males: |
Substantial evidence indicates a greater risk (usually > two-fold) of TdP in women. |
| Generic
Name (Brand Name) |
Drug
Class / Clinical Usage |
Comments |
List |
| Albuterol (Ventolin®) | Bronchodilator/Asthma | 3 | |
| Albuterol (Proventil®) | Bronchodilator/Asthma | 3 | |
| Alfuzosin (Uroxatral®) | Alpha1-blocker/Benign prostatic hyperplasia | 2 | |
| Amantadine (Symmetrel®) | Dopaminergic/Anti-viral/Anti-infective/ Parkinson's Disease | 2 | |
| Amiodarone (Cordarone®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males,TdP risk regarded as low | 1 |
| Amiodarone (Pacerone®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males,TdP risk regarded as low | 1 |
| Amitriptyline (Elavil®) | Tricyclic Antidepressant/depression | 4 | |
| Amoxapine (Asendin®) | Tricyclic Antidepressant/depression | 4 | |
| Amphetamine (Dexedrine®) | CNS stimulant/ADHD | This includes dextroamphetamine and amphetamine / dextroamphetamine combinations. | 3 |
| Amphetamine (Adderall® ) | CNS stimulant/ADHD | This includes dextroamphetamine and amphetamine / dextroamphetamine combinations. | 3 |
| Arsenic trioxide (Trisenox®) | Anti-cancer/Leukemia | 1 | |
| Astemizole (Hismanal®) | Antihistamine/Allergic rhinitis | No Longer available in U.S. | 1 |
| Atazanavir (Reyataz® ) | Protease inhibitor/HIV | 2 | |
| Atomoxetine (Strattera®) | norepinephrine reuptake inhibitor /ADHD | 3 | |
| Azithromycin (Zithromax®) | Antibiotic/bacterial infection | 2 | |
| Bepridil (Vascor®) | Anti-anginal/heart pain | Females>Males | 1 |
| Chloral hydrate (Noctec®) | Sedative/sedation/ insomnia | 2 | |
| Chloroquine (Aralen®) | Anti-malarial/malaria infection | 1 | |
| Chlorpromazine (Thorazine®) | Anti-psychotic/ Anti-emetic/schizophrenia/ nausea | 1 | |
| Ciprofloxacin (Cipro®) | Antibiotic/bacterial infection | 4 | |
| Cisapride (Propulsid®) | GI stimulant/heartburn | Restricted availability; Females>Males. | 1 |
| Citalopram (Celexa®) | Anti-depressant/depression | 4 | |
| Clarithromycin (Biaxin®) | Antibiotic/bacterial infection | 1 | |
| Clomipramine (Anafranil®) | Tricyclic Antidepressant/depression | 4 | |
| Clozapine (Clozaril®) | Anti-psychotic/schizophrenia | 2 | |
| Cocaine (Cocaine) | Local anesthetic/ | 3 | |
| Desipramine (Pertofrane®) | Tricyclic Antidepressant/depression | 4 | |
| Dexmethylphenidate (Focalin®) | CNS stimulant/ADHD | 3 | |
| Disopyramide (Norpace®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | 1 |
| Dobutamine (Dobutrex®) | Catecholamine/heart failure and shock | 3 | |
| Dofetilide (Tikosyn®) | Anti-arrhythmic/abnormal heart rhythm | 1 | |
| Dolasetron (Anzemet®) | Anti-nausea/nausea, vomiting | 2 | |
| Domperidone (Motilium®) | Anti-nausea/nausea | Not available in the U.S. | 1 |
| Dopamine (Intropine®) | Inotropic agent/heart failure; hypotension; shock | 3 | |
| Doxepin (Sinequan®) | Tricyclic Antidepressant/depression | 4 | |
| Droperidol (Inapsine®) | Sedative;Anti-nausea/anesthesia adjunct, nausea | 1 | |
| Ephedrine (Broncholate®) | Bronchodilator, decongestant/Allergies, sinusitis, asthma | 3 | |
| Ephedrine (Rynatuss®) | Bronchodilator, decongestant/Allergies, sinusitis, asthma | 3 | |
| Epinephrine (Bronkaid®) | catecholamine, vasoconstrictor/anaphylaxis, allergic reactions | 3 | |
| Epinephrine (Primatene®) | catecholamine, vasoconstrictor/anaphylaxis, allergic reactions | 3 | |
| Erythromycin (Erythrocin®) | Antibiotic;GI stimulant/bacterial infection; increase GI motility | Females>Males | 1 |
| Erythromycin (E.E.S.® ) | Antibiotic;GI stimulant/bacterial infection; increase GI motility | Females>Males | 1 |
| Felbamate (Felbatrol®) | Anti-convulsant/seizure | 2 | |
| Fenfluramine (Pondimin®) | Appetite suppressant/dieting, weight loss | 3 | |
| Flecainide (Tambocor®) | Anti-arrhythmic/abnormal heart rhythm | 2 | |
| Fluconazole (Diflucan®) | Anti-fungal/fungal infection | 4 | |
| Fluoxetine (Prozac®) | Anti-depressant/depression | 4 | |
| Fluoxetine (Sarafem®) | Anti-depressant/depression | 4 | |
| Foscarnet (Foscavir®) | Anti-viral/HIV infection | 2 | |
| Fosphenytoin (Cerebyx®) | Anti-convulsant/seizure | 2 | |
| Galantamine (Reminyl®) | Cholinesterase inhibitor/ Dementia, Alzheimer's | 4 | |
| Gatifloxacin (Tequin®) | Antibiotic/bacterial infection | 2 | |
| Gemifloxacin (Factive®) | Antibiotic/bacterial infection | 2 | |
| Granisetron (Kytril®) | Anti-nausea/nausea and vomiting | 2 | |
| Halofantrine (Halfan®) | Anti-malarial/malaria infection | Females>Males | 1 |
| Haloperidol (Haldol®) | Anti-psychotic/schizophrenia, agitation | When given intravenously or at higher-than- recommended doses, risk of sudden death, QT prolongation and torsades increases. | 1 |
| Ibutilide (Corvert®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | 1 |
| Imipramine (Norfranil®) | Tricyclic Antidepressant/depression | 4 | |
| Indapamide (Lozol®) | Diuretic/stimulate urine & salt loss | 2 | |
| Isoproterenol (Medihaler-Iso®) | Catecholamine/allergic reaction | 3 | |
| Isoproterenol (Isupres®) | Catecholamine/allergic reaction | 3 | |
| Isradipine (Dynacirc®) | Anti-hypertensive/high blood pressure | 2 | |
| Itraconazole (Sporanox®) | Anti-fungal/fungal infection | 4 | |
| Ketoconazole (Nizoral®) | Anti-fungal/fungal infection | 4 | |
| Lapatinib (Tykerb®) | Anti-cancer/breast cancer, metastatic | 2 | |
| Lapatinib (Tyverb®) | Anti-cancer/breast cancer, metastatic | 2 | |
| Levalbuterol (Xopenex® ) | Bronchodilator/asthma | 3 | |
| Levofloxacin (Levaquin®) | Antibiotic/bacterial infection | 2 | |
| Levomethadyl (Orlaam®) | Opiate agonist/pain control, narcotic dependence | 1 | |
| Lisdexamfetamine (Vyvanse® ) | CNS stimulant/ADHD | 3 | |
| Lithium (Lithobid®) | Anti-mania/bipolar disorder | 2 | |
| Lithium (Eskalith®) | Anti-mania/bipolar disorder | 2 | |
| Mesoridazine (Serentil®) | Anti-psychotic/schizophrenia | 1 | |
| Metaproterenol (Metaprel®) | Bronchodilator/asthma | 3 | |
| Metaproterenol (Alupent®) | Bronchodilator/asthma | 3 | |
| Methadone (Methadose®) | Opiate agonist/pain control, narcotic dependence | Females>Males | 1 |
| Methadone (Dolophine®) | Opiate agonist/pain control, narcotic dependence | Females>Males | 1 |
| Methylphenidate (Ritalin®) | CNS stimulant/ADHD | 3 | |
| Methylphenidate (Concerta® ) | CNS stimulant/ADHD | 3 | |
| Mexiletine (Mexitil®) | Anti-arrhythmic/Abnormal heart rhythm | 4 | |
| Midodrine (ProAmatine®) | Vasoconstrictor/low blood pressure, fainting | 3 | |
| Moexipril/HCTZ (Uniretic®) | Anti-hypertensive/high blood pressure | 2 | |
| Moxifloxacin (Avelox®) | Antibiotic/bacterial infection | 2 | |
| Nicardipine (Cardene®) | Anti-hypertensive/high blood pressure | 2 | |
| Nilotinib (Tasigna® ) | Anti-cancer/Leukemia | 2 | |
| Norepinephrine (Levophed®) | Vasconstrictor, Inotrope/shock, low blood pressure | 3 | |
| Nortriptyline (Pamelor®) | Tricyclic Antidepressant/depression | 4 | |
| Octreotide (Sandostatin®) | Endocrine/acromegaly, carcinoid diarrhea | 2 | |
| Ofloxacin (Floxin®) | Antibiotic/bacterial infection | 2 | |
| Ondansetron (Zofran®) | Anti-emetic/nausea and vomiting | 2 | |
| Oxytocin (Pitocin®) | Oxytocic/Labor stimulation | 2 | |
| Paliperidone (Invega®) | Antipsychotic, atypical/Schizophrenia | 2 | |
| Paroxetine (Paxil®) | Anti-depressant/depression | 4 | |
| Pentamidine (NebuPent®) | Anti-infective/pneumocystis pneumonia | Females>Males | 1 |
| Pentamidine (Pentam®) | Anti-infective/pneumocystis pneumonia | Females>Males | 1 |
| Perflutren lipid microspheres (Definity® ) | Imaging contrast agent/Echocardiography | 2 | |
| Phentermine (Fastin®) | Appetite suppressant/dieting, weight loss | 3 | |
| Phentermine (Adipex®) | Appetite suppressant/dieting, weight loss | 3 | |
| Phenylephrine (Neosynephrine®) | Vasoconstrictor, decongestant/low blood pressure, allergies, sinusitis, asthma | 3 | |
| Phenylpropanolamine (Dexatrim®) | Decongestant/allergies, sinusitis, asthma | 3 | |
| Phenylpropanolamine (Acutrim®) | Decongestant/allergies, sinusitis, asthma | 3 | |
| Pimozide (Orap® ) | Anti-psychotic/Tourette's tics | Females>Males | 1 |
| Probucol (Lorelco®) | Antilipemic/Hypercholesterolemia | No longer available in U.S. | 1 |
| Procainamide (Pronestyl®) | Anti-arrhythmic/abnormal heart rhythm | 1 | |
| Procainamide (Procan® ) | Anti-arrhythmic/abnormal heart rhythm | 1 | |
| Protriptyline (Vivactil®) | Tricyclic Antidepressant/depression | 4 | |
| Pseudoephedrine (PediaCare®) | Decongestant/allergies, sinusitis, asthma | 3 | |
| Pseudoephedrine (Sudafed®) | Decongestant/allergies, sinusitis, asthma | 3 | |
| Quetiapine (Seroquel® ) | Anti-psychotic/schizophrenia | 2 | |
| Quinidine (Quinaglute®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | 1 |
| Quinidine (Cardioquin® ) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | 1 |
| Ranolazine (Ranexa® ) | Anti-anginal/chronic angina | 2 | |
| Risperidone (Risperdal® ) | Anti-psychotic/schizophrenia | 2 | |
| Ritodrine (Yutopar®) | Uterine relaxant/prevent premature labor | 3 | |
| Roxithromycin* (Rulide®) | Antibiotic/bacterial infection | *not available in the United States | 2 |
| Salmeterol (Serevent® ) | Sympathomimetic/asthma, COPD | 3 | |
| Sertraline (Zoloft®) | Anti-depressant/depression | 4 | |
| Sibutramine (Meridia®) | Appetitie suppressant/dieting, weight loss | 3 | |
| Solifenacin (VESIcare®) | muscarinic receptor anatagonist/treatment of overactive bladder | 4 | |
| Sotalol (Betapace® ) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | 1 |
| Sparfloxacin (Zagam® ) | Antibiotic/bacterial infection | 1 | |
| Sunitinib (Sutent®) | Anti-cancer/RCC, GIST | 2 | |
| Tacrolimus (Prograf®) | Immunosuppressant/Immune suppression | 2 | |
| Tamoxifen (Nolvadex® ) | Anti-cancer/breast cancer | 2 | |
| Telithromycin (Ketek®) | Antibiotic/bacterial infection | 2 | |
| Terbutaline (Brethine®) | Bronchodilator/asthma | 3 | |
| Terfenadine (Seldane®) | Antihistamine/Allergic rhinitis | No longer available in U.S. | 1 |
| Thioridazine (Mellaril® ) | Anti-psychotic/schizophrenia | 1 | |
| Tizanidine (Zanaflex® ) | Muscle relaxant/ | 2 | |
| Tolterodine (Detrol®) | Bladder Antispasmodic/ | 3 | |
| Tolterodine (Detrol LA®) | Bladder Antispasmodic/ | 3 | |
| Trimethoprim-Sulfa (Bactrim®) | Antibiotic/bacterial infection | 4 | |
| Trimethoprim-Sulfa (Sulfa®) | Antibiotic/bacterial infection | 4 | |
| Trimipramine (Surmontil®) | Tricyclic Antidepressant/depression | 4 | |
| Vardenafil (Levitra® ) | phosphodiesterase inhibitor/vasodilator | 2 | |
| Venlafaxine (Effexor® ) | Anti-depressant/depression | 2 | |
| Voriconazole (VFend® ) | Anti-fungal/anti-fungal | 2 | |
| Ziprasidone (Geodon® ) | Anti-psychotic/schizophrenia | 2 |
A note about Brand Names: Drugs are listed with up to 2 common brand names. There are many more brand names for some of the common drugs, such as pseudoephedrine and erythromycin. It is also important to look at the list of active drugs in medicines that contain a combination of drugs such as Zyrtec-D®, which contains pseudoephedrine.
Revised: 11/25/2008
Source: www.torsades.org