Drugs That Prolong the QT Interval
and/or Induce Torsades de Pointes
Raymond L. Woosley, MD, PhD & Klaus Romero, MS, MD
The following drugs are included in one or more of the four lists below. Placement of a drug in these lists is based on a systematic analysis of data and reports in the medical literature, the FDA-approved drug labeling and an analysis of reports submitted to the FDA Adverse Events Reporting System (AERS) MedWatch database.
This website was created by Raymond L. Woosley, MD, PhD, President Emeritus of Critical Path Institute (C-Path). It is maintained by Dr. Woosley and Klaus Romero, MS, MD, Director of Clinical Research for C-Path. To construct these lists, only surveys drugs marketed in the United States (US) are evaluated on a continuing basis. However, drugs marketed in countries other than the US do come to our attention and may be included. Those drugs will be 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 is 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 authors disclaim 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 to be medical advice.
The entire content of this site is protected by International and United States of America copyright laws.
KEY
Risk of TdP |
Substantial evidence supports the conclusion that these drugs prolong the QT interval and have a risk of TdP when used as directed in labeling. |
Possible Risk of TdP
|
Substantial evidence supports the conclusion that these drugs cause QT prolongation but there is insufficient evidence that they, when used as directed in labeling, have a risk of causing TdP. |
|
Substantial evidence supports the conclusion that these drugs prolong QT and have a risk of TdP but only under certain known conditions (e.g. excessive dose, drug interaction, etc.). |
Congenital LQTS Risk
|
Drugs to be avoided, if possible, by patients with Congenital Long QT Syndrome |
Females > Males: |
Substantial evidence indicates that there is a greater risk of TdP in women (usually > two-fold). |
| Generic
Name (Brand Name) |
Drug
Class / Clinical Usage |
Comments |
Risk List |
| Albuterol (Proventil®;Ventolin®) | ß2-receptor agonist/Asthma | Congenital QT Avoid | |
| Alfuzosin (Uroxatral®) | Alpha1-blocker/Benign prostatic hyperplasia | Possible Risk of TdP | |
| Amantadine (Symmetrel®) | Dopaminergic/Anti-viral/Anti-infective/ Parkinson's Disease | Possible Risk of TdP | |
| Amiodarone (Cordarone®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males,TdP risk regarded as low |
Risk of TdP |
| Amiodarone (Pacerone®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males,TdP risk regarded as low |
Risk of TdP |
| Amitriptyline (Elavil®) | Tricyclic Antidepressant/depression | Risk of TdP with overdosage |
Conditional TdP Risk |
| Amphetamine (Dexedrine®) | CNS stimulant/ADHD | This includes dextroamphetamine and amphetamine / dextroamphetamine combinations. |
Congenital QT Avoid |
| Amphetamine (Adderall® ) | CNS stimulant/ADHD | This includes dextroamphetamine and amphetamine / dextroamphetamine combinations. |
Congenital QT Avoid |
| Arsenic trioxide (Trisenox®) | Anti-cancer/Leukemia | Risk of TdP | |
| Astemizole (Hismanal®) | Antihistamine/Allergic rhinitis | No Longer available in U.S. |
Risk of TdP |
| Atazanavir (Reyataz® ) | Protease inhibitor/HIV | Possible Risk of TdP | |
| Atomoxetine (Strattera®) | norepinephrine reuptake inhibitor /ADHD | Congenital QT Avoid | |
| Azithromycin (Zithromax®) | Antibiotic/bacterial infection | Rare reports |
Possible Risk of TdP |
| Bepridil (Vascor®) | Anti-anginal/heart pain | Females>Males | Risk of TdP |
| Chloral hydrate (Noctec®) | Sedative/sedation/ insomnia | Possible Risk of TdP | |
| Chloroquine (Aralen®) | Anti-malarial/malaria infection | Risk of TdP | |
| Chlorpromazine (Thorazine®) | Anti-psychotic/ Anti-emetic/schizophrenia/ nausea | Risk of TdP | |
| Ciprofloxacin (Cipro®) | Antibiotic/bacterial infection | Drug metabolism inhibitor- Risk for drug interactions |
Conditional TdP Risk |
| Cisapride (Propulsid®) | GI stimulant/heartburn | No longer available in the U.S.; available in Mexico |
Risk of TdP |
| Citalopram (Celexa®) | Anti-depressant/depression | Risk of TdP | |
| Clarithromycin (Biaxin®) | Antibiotic/bacterial infection | Risk of TdP | |
| Clomipramine (Anafranil®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| Clozapine (Clozaril®) | Anti-psychotic/schizophrenia | Possible Risk of TdP | |
| Cocaine (Cocaine) | Local anesthetic/ | Cardiac stimulant |
Congenital QT Avoid |
| Desipramine (Pertofrane®) | Tricyclic Antidepressant/depression | Risk of TdP with overdosage |
Conditional TdP Risk |
| Dexmethylphenidate (Focalin®) | CNS stimulant/ADHD | Congenital QT Avoid | |
| Diphenhydramine (Benadryl®) | Antihistamine/Allergic rhinitis, insomnia | Risk of QT increase/TdP in overdosages |
Conditional TdP Risk |
| Diphenhydramine (Nytol®) | Antihistamine/Allergic rhinitis, insomnia | Risk of QT increase/TdP in overdosages |
Conditional TdP Risk |
| Disopyramide (Norpace®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | Risk of TdP |
| Dobutamine (Dobutrex®) | Catecholamine/heart failure and shock | Congenital QT Avoid | |
| Dofetilide (Tikosyn®) | Anti-arrhythmic/abnormal heart rhythm | Risk of TdP | |
| Dolasetron (Anzemet®) | Anti-nausea/nausea, vomiting | Possible Risk of TdP | |
| Domperidone (Motilium®) | Anti-nausea/nausea | Not available in the U.S. | Risk of TdP |
| Dopamine (Intropine®) | Inotropic agent/heart failure; hypotension; shock | Congenital QT Avoid | |
| Doxepin (Sinequan®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| Dronedarone (Multaq®) | Anti-arrhythmic/Atrial Fibrillation | Possible Risk of TdP | |
| Droperidol (Inapsine®) | Sedative;Anti-nausea/anesthesia adjunct, nausea | Risk of TdP | |
| Ephedrine (Broncholate®) | Bronchodilator, decongestant/Allergies, sinusitis, asthma | Congenital QT Avoid | |
| Ephedrine (Rynatuss®) | Bronchodilator, decongestant/Allergies, sinusitis, asthma | Congenital QT Avoid | |
| Epinephrine (Bronkaid®) | catecholamine, vasoconstrictor/anaphylaxis, allergic reactions | Cardiac stimulant |
Congenital QT Avoid |
| Epinephrine (Primatene®) | catecholamine, vasoconstrictor/anaphylaxis, allergic reactions | Cardiac stimulant |
Congenital QT Avoid |
| Eribulin (Halaven® ) | Anti-cancer/metastatic breast neoplasias | Possible Risk of TdP | |
| Erythromycin (E.E.S.® ) | Antibiotic;GI stimulant/bacterial infection; increase GI motility | Females>Males | Risk of TdP |
| Erythromycin (Erythrocin®) | Antibiotic;GI stimulant/bacterial infection; increase GI motility | Females>Males | Risk of TdP |
| Escitalopram (Cipralex®) | Anti-depressant/Major depression/ Anxiety disorders | Possible Risk of TdP | |
| Escitalopram (Lexapro®) | Anti-depressant/Major depression/ Anxiety disorders | Possible Risk of TdP | |
| Famotidine (Pepcid®) | H2-receptor antagonist/Peptic ulcer/ GERD | Possible Risk of TdP | |
| Felbamate (Felbatrol®) | Anti-convulsant/seizure | Possible Risk of TdP | |
| Fenfluramine (Pondimin®) | Appetite suppressant/dieting, weight loss | Congenital QT Avoid | |
| Fingolimod (Gilenya®) | Immunosuppressant/Multiple Sclerosis | Possible Risk of TdP | |
| Flecainide (Tambocor®) | Anti-arrhythmic/abnormal heart rhythm | Risk of TdP | |
| Fluconazole (Diflucan®) | Anti-fungal/fungal infection | Drug metabolism inhibitor- Risk for drug interactions |
Conditional TdP Risk |
| Fluoxetine (Prozac®) | Anti-depressant/depression | Conditional TdP Risk | |
| Fluoxetine (Sarafem®) | Anti-depressant/depression | Conditional TdP Risk | |
| Foscarnet (Foscavir®) | Anti-viral/HIV infection | Possible Risk of TdP | |
| Fosphenytoin (Cerebyx®) | Anti-convulsant/seizure | Possible Risk of TdP | |
| Galantamine (Reminyl®) | Cholinesterase inhibitor/ Dementia, Alzheimer's | Conditional TdP Risk | |
| Gatifloxacin (Tequin®) | Antibiotic/bacterial infection | Possible Risk of TdP | |
| Gemifloxacin (Factive®) | Antibiotic/bacterial infection | Possible Risk of TdP | |
| Granisetron (Kytril®) | Anti-nausea/nausea and vomiting | Possible Risk of TdP | |
| Halofantrine (Halfan®) | Anti-malarial/malaria infection | Females>Males | Risk of TdP |
| Haloperidol (Haldol®) | Anti-psychotic/schizophrenia, agitation | When given intravenously or at higher-than- recommended doses, risk of sudden death, QT prolongation and torsades increases. | Risk of TdP |
| Ibutilide (Corvert®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | Risk of TdP |
| Imipramine (Norfranil®) | Tricyclic Antidepressant/depression | Risk of TdP in overdosage |
Conditional TdP Risk |
| Indapamide (Lozol®) | Diuretic/stimulate urine & salt loss | Possible Risk of TdP | |
| Isoproterenol (Isupres®) | Catecholamine/allergic reaction | Congenital QT Avoid | |
| Isoproterenol (Medihaler-Iso®) | Catecholamine/allergic reaction | Congenital QT Avoid | |
| Isradipine (Dynacirc®) | Anti-hypertensive/high blood pressure | Possible Risk of TdP | |
| Itraconazole (Sporanox®) | Anti-fungal/fungal infection | Drug metabolism inhibitor- Risk for drug interactions |
Conditional TdP Risk |
| Ketoconazole (Nizoral®) | Anti-fungal/fungal infection | Drug metabolism inhibitor |
Conditional TdP Risk |
| Lapatinib (Tykerb®) | Anti-cancer/breast cancer, metastatic | Possible Risk of TdP | |
| Lapatinib (Tyverb®) | Anti-cancer/breast cancer, metastatic | Possible Risk of TdP | |
| Levalbuterol (Xopenex® ) | Bronchodilator/asthma | Congenital QT Avoid | |
| Levofloxacin (Levaquin®) | Antibiotic/bacterial infection | Possible Risk of TdP | |
| Levomethadyl (Orlaam®) | Opiate agonist/pain control, narcotic dependence | Not available in the U.S. |
Risk of TdP |
| Lisdexamfetamine (Vyvanse® ) | CNS stimulant/ADHD | Congenital QT Avoid | |
| Lithium (Eskalith®) | Anti-mania/bipolar disorder | Possible Risk of TdP | |
| Lithium (Lithobid®) | Anti-mania/bipolar disorder | Possible Risk of TdP | |
| Mesoridazine (Serentil®) | Anti-psychotic/schizophrenia | Risk of TdP | |
| Metaproterenol (Alupent®) | Bronchodilator/asthma | Congenital QT Avoid | |
| Metaproterenol (Metaprel®) | Bronchodilator/asthma | Congenital QT Avoid | |
| Methadone (Dolophine®) | Opiate agonist/pain control, narcotic dependence | Females>Males | Risk of TdP |
| Methadone (Methadose®) | Opiate agonist/pain control, narcotic dependence | Females>Males | Risk of TdP |
| Methylphenidate (Ritalin®) | CNS stimulant/ADHD | Congenital QT Avoid | |
| Methylphenidate (Concerta® ) | CNS stimulant/ADHD | Congenital QT Avoid | |
| Midodrine (ProAmatine®) | Vasoconstrictor/low blood pressure, fainting | Congenital QT Avoid | |
| Moexipril/HCTZ (Uniretic®) | Anti-hypertensive/high blood pressure | Possible Risk of TdP | |
| Moxifloxacin (Avelox®) | Antibiotic/bacterial infection | Risk of TdP | |
| Nicardipine (Cardene®) | Anti-hypertensive/high blood pressure | Possible Risk of TdP | |
| Nilotinib (Tasigna® ) | Anti-cancer/Leukemia | Possible Risk of TdP | |
| Norepinephrine (Levophed®) | Vasconstrictor, Inotrope/shock, low blood pressure | Congenital QT Avoid | |
| Nortriptyline (Pamelor®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| Octreotide (Sandostatin®) | Endocrine/acromegaly, carcinoid diarrhea | Possible Risk of TdP | |
| Ofloxacin (Floxin®) | Antibiotic/bacterial infection | Possible Risk of TdP | |
| Ondansetron (Zofran®) | Anti-emetic/nausea and vomiting | Possible Risk of TdP | |
| Oxytocin (Pitocin®) | Oxytocic/Labor stimulation | Possible Risk of TdP | |
| Paliperidone (Invega®) | Antipsychotic, atypical/Schizophrenia | Possible Risk of TdP | |
| Paroxetine (Paxil®) | Anti-depressant/depression | Conditional TdP Risk | |
| Pentamidine (NebuPent®) | Anti-infective/pneumocystis pneumonia | Females>Males | Risk of TdP |
| Pentamidine (Pentam®) | Anti-infective/pneumocystis pneumonia | Females>Males | Risk of TdP |
| Perflutren lipid microspheres (Definity® ) | Imaging contrast agent/Echocardiography | Possible Risk of TdP | |
| Phentermine (Fastin®) | Appetite suppressant/dieting, weight loss | Congenital QT Avoid | |
| Phentermine (Adipex®) | Appetite suppressant/dieting, weight loss | Congenital QT Avoid | |
| Phenylephrine (Neosynephrine®) | Vasoconstrictor, decongestant/low blood pressure, allergies, sinusitis, asthma | Congenital QT Avoid | |
| Phenylpropanolamine (Acutrim®) | Decongestant/allergies, sinusitis, asthma | No longer available in the U.S. |
Congenital QT Avoid |
| Phenylpropanolamine (Dexatrim®) | Decongestant/allergies, sinusitis, asthma | No longer available in the U.S. |
Congenital QT Avoid |
| Pimozide (Orap® ) | Anti-psychotic/Tourette's tics | Females>Males | Risk of TdP |
| Probucol (Lorelco®) | Antilipemic/Hypercholesterolemia | No longer available in U.S. |
Risk of TdP |
| Procainamide (Pronestyl®) | Anti-arrhythmic/abnormal heart rhythm | Risk of TdP | |
| Procainamide (Procan® ) | Anti-arrhythmic/abnormal heart rhythm | Risk of TdP | |
| Protriptyline (Vivactil®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| Pseudoephedrine (PediaCare®) | Decongestant/allergies, sinusitis, asthma | Congenital QT Avoid | |
| Pseudoephedrine (Sudafed®) | Decongestant/allergies, sinusitis, asthma | Congenital QT Avoid | |
| Quetiapine (Seroquel® ) | Anti-psychotic/schizophrenia | Possible Risk of TdP | |
| Quinidine (Quinaglute®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | Risk of TdP |
| Quinidine (Cardioquin® ) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | Risk of TdP |
| Ranolazine (Ranexa® ) | Anti-anginal/chronic angina | Possible Risk of TdP | |
| Risperidone (Risperdal® ) | Anti-psychotic/schizophrenia | Possible Risk of TdP | |
| Ritodrine (Yutopar®) | Uterine relaxant/prevent premature labor | Congenital QT Avoid | |
| Ritonavir (Norvir®) | Protease inhibitor/HIV | Conditional TdP Risk | |
| Roxithromycin* (Rulide®) | Antibiotic/bacterial infection | *not available in the United States | Possible Risk of TdP |
| Salmeterol (Serevent® ) | Sympathomimetic/asthma, COPD | Congenital QT Avoid | |
| Sertindole (Serdolect®) | Antipsychotic, atypical/Anxiety, Schizophrenia | Possible Risk of TdP | |
| Sertindole (Serlect®) | Antipsychotic, atypical/Anxiety, Schizophrenia | Possible Risk of TdP | |
| Sertraline (Zoloft®) | Anti-depressant/depression | Conditional TdP Risk | |
| Sibutramine (Meridia®) | Appetitie suppressant/dieting, weight loss | Congenital QT Avoid | |
| Solifenacin (VESIcare®) | muscarinic receptor anatagonist/treatment of overactive bladder | Conditional TdP Risk | |
| Sotalol (Betapace® ) | Anti-arrhythmic/abnormal heart rhythm | Females>Males | Risk of TdP |
| Sparfloxacin (Zagam® ) | Antibiotic/bacterial infection | Risk of TdP | |
| Sunitinib (Sutent®) | Anti-cancer/RCC, GIST | Possible Risk of TdP | |
| Tacrolimus (Prograf®) | Immunosuppressant/Immune suppression | Possible Risk of TdP | |
| Tamoxifen (Nolvadex® ) | Anti-cancer/breast cancer | Possible Risk of TdP | |
| Telithromycin (Ketek®) | Antibiotic/bacterial infection | Possible Risk of TdP | |
| Terbutaline (Brethine®) | Bronchodilator/asthma | Congenital QT Avoid | |
| Terfenadine (Seldane®) | Antihistamine/Allergic rhinitis | No longer available in U.S. |
Risk of TdP |
| Thioridazine (Mellaril® ) | Anti-psychotic/schizophrenia | Risk of TdP | |
| Tizanidine (Zanaflex® ) | Muscle relaxant/ | Possible Risk of TdP | |
| Tolterodine (Detrol®) | Bladder Antispasmodic/ | Congenital QT Avoid | |
| Tolterodine (Detrol LA®) | Bladder Antispasmodic/ | Congenital QT Avoid | |
| Trazodone (Desyrel®) | Anti-depressant/Depression, insomnia | Conditional TdP Risk | |
| Trimethoprim-Sulfa (Bactrim®) | Antibiotic/bacterial infection | Conditional TdP Risk | |
| Trimethoprim-Sulfa (Sulfa®) | Antibiotic/bacterial infection | Conditional TdP Risk | |
| Trimipramine (Surmontil®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| Vandetanib (Caprelsa®) | Anti-cancer/Thyroid cancer | Risk of TdP | |
| Vardenafil (Levitra® ) | phosphodiesterase inhibitor/vasodilator | Possible Risk of TdP | |
| Venlafaxine (Effexor® ) | Anti-depressant/depression | Possible Risk of TdP | |
| Voriconazole (VFend® ) | Anti-fungal/anti-fungal | Possible Risk of TdP | |
| Ziprasidone (Geodon® ) | Anti-psychotic/schizophrenia | Possible Risk of TdP |
A note about Brand Names: Drugs often have more than one brand name. For these lists, only the 2 most common brand names are included.
Revised: 03/02/2012
Source: www.torsades.org