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
Risk of TdP |
Drugs that are generally accepted by authorities to have a risk of causing torsades de pointes. |
Possible Risk of TdP
|
Drugs that may prolong the QT interval but at this time lack substantial evidence for causing torsades de pointes. |
|
Drugs to be avoided for use in patients with diagnosed or suspected congenital long QT syndrome. (Drugs on our other 3 lists are also included here.) |
Conditional TdP 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). |
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 | Congenital QT Avoid | |
| Albuterol (Proventil®) | Bronchodilator/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 (Pacerone®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males,TdP risk regarded as low |
Risk of TdP |
| Amiodarone (Cordarone®) | Anti-arrhythmic/abnormal heart rhythm | Females>Males,TdP risk regarded as low |
Risk of TdP |
| Amitriptyline (Elavil®) | Tricyclic Antidepressant/depression | 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 | 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 | Conditional TdP Risk | |
| Cisapride (Propulsid®) | GI stimulant/heartburn | Restricted availability; Females>Males. | Risk of TdP |
| Citalopram (Celexa®) | Anti-depressant/depression | Conditional TdP Risk | |
| 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/ | Congenital QT Avoid | |
| Desipramine (Pertofrane®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| Dexmethylphenidate (Focalin®) | CNS stimulant/ADHD | Congenital QT Avoid | |
| Diphenhydramine (Benadryl®) | Antihistamine/Allergic rhinitis, insomnia | Conditional TdP Risk | |
| Diphenhydramine (Nytol®) | Antihistamine/Allergic rhinitis, insomnia | 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 (Rynatuss®) | Bronchodilator, decongestant/Allergies, sinusitis, asthma | Congenital QT Avoid | |
| Ephedrine (Broncholate®) | Bronchodilator, decongestant/Allergies, sinusitis, asthma | Congenital QT Avoid | |
| Epinephrine (Bronkaid®) | catecholamine, vasoconstrictor/anaphylaxis, allergic reactions | Congenital QT Avoid | |
| Epinephrine (Primatene®) | catecholamine, vasoconstrictor/anaphylaxis, allergic reactions | Congenital QT Avoid | |
| Erythromycin (Erythrocin®) | Antibiotic;GI stimulant/bacterial infection; increase GI motility | Females>Males | Risk of TdP |
| Erythromycin (E.E.S.® ) | Antibiotic;GI stimulant/bacterial infection; increase GI motility | Females>Males | Risk of TdP |
| Felbamate (Felbatrol®) | Anti-convulsant/seizure | Possible Risk of TdP | |
| Fenfluramine (Pondimin®) | Appetite suppressant/dieting, weight loss | Congenital QT Avoid | |
| Flecainide (Tambocor®) | Anti-arrhythmic/abnormal heart rhythm | Possible Risk of TdP | |
| Fluconazole (Diflucan®) | Anti-fungal/fungal infection | 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 | Conditional TdP Risk | |
| Indapamide (Lozol®) | Diuretic/stimulate urine & salt loss | Possible Risk of TdP | |
| Isoproterenol (Medihaler-Iso®) | Catecholamine/allergic reaction | Congenital QT Avoid | |
| Isoproterenol (Isupres®) | Catecholamine/allergic reaction | Congenital QT Avoid | |
| Isradipine (Dynacirc®) | Anti-hypertensive/high blood pressure | Possible Risk of TdP | |
| Itraconazole (Sporanox®) | Anti-fungal/fungal infection | Conditional TdP Risk | |
| Ketoconazole (Nizoral®) | Anti-fungal/fungal infection | 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 | Risk of TdP | |
| Lisdexamfetamine (Vyvanse® ) | CNS stimulant/ADHD | Congenital QT Avoid | |
| Lithium (Lithobid®) | Anti-mania/bipolar disorder | Possible Risk of TdP | |
| Lithium (Eskalith®) | Anti-mania/bipolar disorder | Possible Risk of TdP | |
| Mesoridazine (Serentil®) | Anti-psychotic/schizophrenia | Risk of TdP | |
| Metaproterenol (Metaprel®) | Bronchodilator/asthma | Congenital QT Avoid | |
| Metaproterenol (Alupent®) | Bronchodilator/asthma | Congenital QT Avoid | |
| Methadone (Methadose®) | Opiate agonist/pain control, narcotic dependence | Females>Males | Risk of TdP |
| Methadone (Dolophine®) | 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 | |
| Mexiletine (Mexitil®) | Anti-arrhythmic/Abnormal heart rhythm | Conditional TdP Risk | |
| 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 | Possible 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 (Dexatrim®) | Decongestant/allergies, sinusitis, asthma | Congenital QT Avoid | |
| Phenylpropanolamine (Acutrim®) | Decongestant/allergies, sinusitis, asthma | 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 (Serlect®) | Antipsychotic, atypical/Anxiety, Schizophrenia | Possible Risk of TdP | |
| Sertindole (Serdolect®) | 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 (Sulfa®) | Antibiotic/bacterial infection | Conditional TdP Risk | |
| Trimethoprim-Sulfa (Bactrim®) | Antibiotic/bacterial infection | Conditional TdP Risk | |
| Trimipramine (Surmontil®) | Tricyclic Antidepressant/depression | Conditional TdP Risk | |
| 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 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: 03/30/2010
Source: www.torsades.org