Case reportCiprofloxacin-induced acquired long QT syndrome
Section snippets
Case 1
A 67-year-old woman with no previous cardiac history was admitted to the hospital for new-onset atrial fibrillation with a rapid ventricular response. She had a recent history of increasing exertional dyspnea and associated malaise and fatigue diagnosed as congestive heart failure. Furosemide and lisinopril therapy were started. On admission, she was given amiodarone 400 mg PO bid, digoxin 0.25 mg/day, and warfarin. An echocardiogram demonstrated global hypokinesis of the left ventricle with an
Commentary
Fluoroquinolones are bactericidal agents that directly inhibit DNA synthesis by inactivating two enzymes. They are being used with increasing frequency because of their wide spectrum of antimicrobial activity against common respiratory, gastrointestinal, and genitourinary pathogens. The cases presented here illustrate ciprofloxacin’s potential to cause proarrhythmia via QTc prolongation. It is interesting that multiple risk factors were present in both cases. However, a clear temporal
References (21)
- et al.
Long QT syndrome caused by noncardiac drugs
Prog Cardiovasc Dis
(2003) - et al.
Effects of sparfloxacin, grepafloxacin, moxifloxacin, and ciprofloxacin on cardiac action potential duration
Eur J Pharmacol
(2000) - et al.
In vivo experimental approach for the risk assessment of fluoroquinolone antibacterial agents-induced long QT syndrome
Eur J Pharmacol
(2004) - et al.
The potential for QT prolongation and proarrhythmia by non-antiarrhythmic drugs: clinical and regulatory implications. Report on a policy conference of the European Society of Cardiology
Eur Heart J
(2000) - et al.
Risk of torsades de pointes with non-cardiac drugs. Doctors need to be aware that many drugs can cause QT prolongation
BMJ
(2000) Acquired long QT syndromes and the risk of proarrhythmia
J Cardiovasc Electrophysiol
(2000)- et al.
A structural basis for drug-induced long QT syndrome
Proc Natl Acad Sci U S A
(2000) Pharmacogenetics and drug-induced arrhythmias
Cardiovasc Res
(2001)- et al.
Drug block of I(kr)model systems and relevance to human arrhythmias
J Cardiovasc Pharmacol
(2001) Genetic polymorphisms, drugs, and proarrhythmia
J Interv Card Electrophysiol
(2003)
Cited by (40)
Antimicrobial agents and torsades de pointes
2022, Torsades de PointesThe risk of cardiac events in patients who received concomitant levofloxacin and amiodarone
2019, International Journal of Infectious DiseasesCitation Excerpt :Although the independent frequencies of developing cardiac events with these medications are low (1% for levofloxacin and 1-to-3% for amiodarone) (Janssen Co., 2018; Wyeth Pharmaceuticals Inc., 2018); we hypothesize that the concomitant usage of levofloxacin and amiodarone may markedly increase the risk of developing pro-arrhythmic effects. Several case reports have been published describing the dangerous pro-arrhythmic characteristics associated with fluoroquinolones and amiodarone (Maxa et al., 2006; Prabhakar and Krahn, 2004; Zeineh, 2010), but no studies have assessed this risk in a real-world clinical setting. The objectives of this study were to estimate the risk of cardiac events in patients receiving levofloxacin with amiodarone, to identify predictors of cardiac events in this population, and to compare the frequency of using EKG to screen patients for QT prolongation.
Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)
2017, Digestive and Liver DiseaseCitation Excerpt :Corticosteroid use, old age and intense physical activity enhance this risk [159]. As QT interval prolongation has been observed in quinolone treatment [160], ciprofloxacin should be avoided in patients with this abnormality or other risk factors for tachyarrhythmia. Finally, a common complication of ciprofloxacin use is mild-to-severe phototoxicity [151,152].
Health Canada Warning on Citalopram and Escitalopram-Its Effects on Prescribing in Consultation-Liaison Psychiatry
2016, PsychosomaticsCitation Excerpt :In addition, at the JGH and JGH C-L service, there had been several grand rounds and other presentations on this topic. A number of cardiac covariates were also examined,9 including age, gender, reason for hospital admission related to cardiac disease, history of cardiovascular comorbidities, antidepressants exposure, antipsychotics exposure, exposure to other QTc-prolonging agents (such as ciprofloxacin),10 and baseline QTc.11 Baseline clinical and demographic characteristics were compared between pre− and post−Health Canada warning groups using Pearson׳s chi-squared and Student׳s t-tests.
Effects of the fluoroquinolone antibacterial drug ciprofloxacin on ventricular repolarization in the halothane-anesthetized guinea pig
2013, Journal of Pharmacological SciencesA case of long QT and torsade des pointes due to ciprofloxacin
2010, Revista Espanola de Cardiologia
Supported by Grant NA3397 from the Heart and Stroke Foundation of Ontario. A.K. is a Research Scholar of the Heart and Stroke Foundation of Ontario.