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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.


Congenital QT Avoid

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.

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.

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Revised: 03/30/2010
Source: www.torsades.org