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Drugs which may prolong QTc interval

The following is a list of some drugs that may be associated with QTc interval prolongation. This list is not exhaustive.

Class Drugs (in therapeutic doses)
Antiarrhythmics amiodarone, disopyramide, dofetilide*, procainamide, quinidine, sotalol
Antipsychotics amisulpride, chlorpromazine, clozapine, droperidol, fluphenazine, haloperidol, pimozide*, risperidone, sertindole*, thioridiazine*, ziprasidone
Antidepressants citalopram, escitalopram, fluoxetine, lithium, moclobemide, tricyclic antidepressants (e.g. amitriptyline, clomipramine, dosulepin (doxepin), dothiepin, imipramine)
Antibiotics azithromycin, clarithromycin, erythromycin, metronidazole (with alcohol), moxifloxacin, pentamidine, roxithromycin, sparfloxacin*
Antifungals fluconazole, ketoconazole, voriconazole
Antivirals atazanavir, lopinavir, nelfinavir
Antimalarials chloroquine, mefloquine, quinine
Antineoplastics anagrelide, arsenic trioxide, cabozantinib, ceritinib, crizotinib, dabrafenib, dasatinib, degarelix, eribulin, goserelin, lapatinib, lenvatinib, leuprorelin, nilotinib, osimertinib, oxaliplatin, pazopanib, ribociclib, romidepsin, sorafenib, sunitinib, toremifene, triptorelin, vandetanib, vemurafenib
Miscellaneous 5HT3 antagonists (e.g. dolasetron, ondansetron), astemizole*, cisapride, cocaine, dextropropoxyphene, domperidone, fingolimod*, methadone, pasireotide, probucol*, solifenacin, tacrolimus, terfenadine*, tetrabenazine, vardenafil

* not readily available in Australia

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Bibliography

Australian Medicines Handbook 2019 (online). Adelaide: Australian Medicines Handbook Pty Ltd. Available from : https://amhonline.amh.net.au.acs.hcn.com.au/ [Accessed 26 February 2019]
Jayasinghe, R., P. Kovoor. 2002 "Drugs and the QTc Interval." Australian Prescriber 25(3): 63-65.

Many commonly used drugs can prolong the QTc interval, especially if used in combination with other substances which affect their metabolism. Prolongation of the QTc interval can cause life-threatening polymorphic ventricular tachycardia also known as torsade de pointes. Women and certain susceptible people are more prone to prolongation of the QTc interval. This predisposition could be congenital or due to conditions such as hypokalaemia, hypomagnesaemia, renal failure or cardiac failure. Susceptible patients need an electrocardiogram before and after starting drugs that can prolong the QTc interval. If a drug prolongs the QTc interval beyond normal limits, the benefits of continuing the drug should be weighed against the relatively rare risk of potentially life-threatening arrhythmias.

NPS MedicineWise. “Fatal arrhythmias — drugs and the QT” Published in Health News and Evidence, 17 April 2013. http://www.nps.org.au/publications/health-professional/health-news-evidence/2013/drugs-QT-invterval
MIMS Point of Care Online, CMPMedica Australia Pty Ltd 2019.

Version 3

Date Summary of changes

31/05/2017

Transferred to new eviQ website.

Previous website ID: 193
05/03/2019 Updated with new drugs: anagrelide, cabozantinib, ceritinib, eribulin, lenvatinib, osimertinib, ribociclib, romidepsin. Doxepin updated to dosulepin (doxepin). Version increased to V.3. Review in 2 years.

While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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01 Mar 2021