*Drugs to Avoid for Brugada Syndrome

*Drugs That Prolong the QT Interval and/or Induce Torsades de Pointes

The list is maintained by Raymond L. Woosley, MD, PhD,  President, AZCERT and SADS Scientific Advisor.

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New!! Smartphone App for QT Drugs Lists Now Available

Warning: We are aware of another app for QT Drugs that is NOT current and so not useful for LQTS. You should be very careful when looking at lists of QT-prolonging drugs. We only use the Credible Meds list as it is the most accurate and up-to-date.

Recent information from the researchers at Credible Meds (formerly known as Arizona CERT/QT Drugs)

UPDATES are now listed in the News section here. You'll also get emails of any changes when you register.

UPDATE as of 06/14/2016:

• We have evaluated the evidence for Roxithromycin (brand names Rulide®, Xthrocin®, Roxl-150®, Roxo®, Surlid®, Rulide®, Biaxsig®, Roxar®, Roximycinv®, Roxomycin®, Rulid®, Tirabicin® and Coroxin®), an antibiotic marketed outside the US that is now on our Possible Risk List, and found credible evidence of risk of Torsades de Pointes (TdP.  Therefore, we have moved it from the Possible Risk list to the Known Risk list.
• We also evaluated the antipsychotic drugs flupentixol (Depixol® or Fluanxol®) and tiapride(Tiapridal®, Italprid® and several others) also marketed outside the US and found substantial evidence of QT prolongation but only limited evidence of TdP. Therefore, these drugs have been added to the list with Possible Risk of TdP.
• Ranolazine (Ranexa^® or Ranozex^®), a drug approved for the treatment of angina in the US and several other countries, is known to prolong the QT interval and in 2006 was placed on the Possible Risk of TdP list.  We have found conclusive evidence that ranolazine is associated with reports of torsades de pointes (TdP) ventricular arrhythmia when given to patients with hypokalemia, hypomagnesemia or bradycardia or when taken with other drugs that prolong the QT or drugs that block its metabolic breakdown. For this reason, ranolazine has been moved from the Possible Risk list to the Conditional Risk of TdP list. 
• Also, because these four drugs cause QT prolongation, they will also be on the list of Drugs to Avoid (if at all possible) in patients with Congenital Long QT Syndrome.  However, it should be noted that, because of another of its pharmacologic actions, ranolazine is being evaluated as a possible treatment to prevent arrhythmias for one particular genetic subset of patients with the congenital Long QT syndrome.

UPDATE as of 12/17/2015:

• We have evaluated the available evidence for the anti-cancer drug oxaliplatin (Eloxatin®) and found substantial evidence that it is associated with torsades de pointes (TdP) ventricular arrhythmia. Therefore, oxaliplatin has been added to the list of drugs with Known Risk of TdP.
• We have also reviewed the available evidence for asenapine (Saphris®,Sycrest®), an antipsychotic drug, and found convincing evidence that it can prolong the QT interval. Furthermore, the extended release forms of the opiate pain reliever hydrocodone (Hysingla ER and Zohydro ER) have been found to produce QT prolongation.
• Therefore, asenapine and the sustained release form of hydrocodone have been added to the list of drugs with Possible Risk of TdP.   We are not aware of any relevant studies of the immediate release form of hydrocodone but we suggest caution as we continue to monitor the evidence. At this time, our listing for hydrocodone specifies only the extended release formulation.
• All three drugs have been added to the list of Drugs to Avoid in patients with Congenital Long QT Syndrome if at all possible.

UPDATE as of 11/17/2015:

• We have evaluated the available evidence for levomepromazine, an antipsychotic marketed in the EU and several other countries (brand names: Nosinan®, Nozinan®, Levoprome®), and found substantial evidence that the drug is associated with TdP. Therefore, we have added it to the list of drugs with Known Risk of TdP.
• We have also reviewed the available evidence for the anti-tuberculosis drug delamanid (Deltyba®) and found convincing evidence that it can prolong the QT interval. Since we have not yet found convincing evidence of TdP, we have added it to the list of drugs with Possible Risk of TdP. 
• We have also found convincing evidence in the published literature that the very old drug papaverine HCl is associated with TdP when given by infusion as part of tests to measure blood flow to the heart.  Therefore, we have added papaverine, when administered by this route, to the list of drugs with Known Risk of TdP.

UPDATE as of 9/24/2015:

• We have evaluated the available evidence for changes to two drugs used to treat psychosis, quetiapine (Seroquel®) and ziprasidone (Geodon and Zeldox®) that we have had on our list of drugs with Possible Risk of TdP and found substantial evidence that they are associated with reports of TdP but, in almost all cases, only under certain conditions (e.g. overdose, concomitant drug with TdP risk, hypokalemia, etc.). Therefore, we have moved these two drugs from the list of drugs with Possible Risk of TdP to the list of drugs with Conditional Risk of TdP.
• We have also reviewed the available evidence for and changes to the antibiotic gatifloxacin (Tequin®) that is now on our list of drugs with Possible Risk of TdP. Gatifloxacin has a strong signal for TdP in the FDA's adverse event database and has been withdrawn from the US market due to reports of TdP. Because it is currently being tested as an investigational drug for tuberculosis, we believe it should remain on our lists but be moved to the list of drugs with Known Risk of TdP.

UPDATE as of 4/14/2014:

• Nelfinavir (Viracept®) is a drug used for the treatment of HIV/AIDS that has been added to the list of medicines with Conditional Risk of Torsades de Pointes (TdP).  There is substantial evidence that nelfinavir is associated with TdP when taken with other medicines that prolong the QT interval or drugs that block the metabolic breakdown of nelfinavir.
• Ivabradine (Procoralan®, Coralan®, Corlentor®, Coraxan®, Ivabid®, Bradia®) is a medicine approved in many countries o utside the US for treatment of angina pectoris (heart pain).  It has been added to the list of drugs with Conditional Risk of Torsades de Pointes.  There is substantial evidence that ivabradine is associated with TdP when taken with other medicines that prolong the QT interval, diuretics or drugs that block the metabolic breakdown of ivabradine, or electrolyte abnormalities (low potassium or low magnesium), which may be induced by co-administration of diuretics.

UPDATE as of 3/19/2014:

• Aripiprazole (Abilify®, Aripiprex®) is a drug used for the treatment of psychosis or as an adjunct when added to antidepressants for patients with major depression.  Aripiprazole has been added to the list of medicines with Possible Risk of Torsades de Pointes.
• Pentamidine inhalation formulation (Nebupent®) h as been removed from the list of drugs with risk of torsades de pointes.  The intravenous formulation of pentamidine remains on the list of drugs with Risk of Torsades de Pointes.

UPDATE as of 12/12/2013:

• Apomorphine (Apokyn®, Ixense®, Spontane®, Uprima®), an injectable dopamine agonist for Parkinson’s disease – added to list of drugs with Possible Risk of TdP.

• Arformoterol (Brovana®) an inhaled bronchodilator for chronic obstructive lung disease – added to the list of drugs to be avoided, if at all possible, by patients with congenital long QT.
• Formoterol (Foradil® and many others including combination products such as Symbicort®), an inhaled bronchodilator for asthma – added to the list of drugs to be avoided, if at all possible, by patients with congenital long QT.
• Mifepristone (Korlym® and Mifeprex®), an oral progesterone antagonist for termination of pregnancy – added to list of drugs with Possible Risk of TdP.
• Mirabegron (Myrbetriq®), an oral beta3 adrenergic agonist for overactive bladder – added to the list of drugs with Possible Risk of TdP.
• Sulpiride (not marketed in US) (Dogmatil® and others), an oral anti-psychotic for schizophrenia – added to the list of drugs with Known Risk of TdP.
• Telaprevir (Incivek® and Incivo®), an oral anti-viral for hepatitis C – added to the list of drugs with Conditional Risk of TdP because it blocks the metabolism of many drugs that prolong the QT interval.
• Tetrabenazine (Nitoman®, Xenazine®), an oral monoamine transporter inhibitor marketed in the US as an orphan drug for chorea in Huntington’s disease and around the world for other illnesses – added to the list of drugs with Possible Risk of TdP

UPDATE as of 11/4/2013:

The following changes have been made to the lists:

• Dabrafenib (Tafinlar®), a kinase inhibitor for melanoma – added to Possible Risk of TdP list
• Dexmedetomidine (Precedex®, Dexdor®, Dexdomitor®) an iv sedative – added to Possible Risk of TdP list
• Posaconazole (Noxafil®, Posanol®), an anti-fungal drug – added to Conditional Risk of TdP list
• Hydrochlorothiazide (Hydrodiuril® and many others), a diuretic for edema – added to Conditional Risk of TdP list

• Furosemide (Lasix® and many others), a diuretic for edema – added to Conditional Risk of TdP list
• Indapamide (Lozol® and others), a diuretic for edema – moved from Possible Risk to Conditional Risk of TdP list

UPDATE as of 8/21/2013:

The following two changes have been made to the lists: 

1. Anagrelide (Agrylin® or Xagrid®), a drug for the treatment of thrombocythemia (excess platelets in blood), has been added to the list of drugs with “Risk of torsades de pointes”.
2. Norfloxacin (Noroxin® or Ambigram®), a drug for the treatment of bacterial infections, has been added to the list of drugs with “Possible risk of torsades de pointes”.

UPDATE as of 7/1/2013:

Added to "Possible risk of torsades de pointes":

1. Pasireotide (Signifor®): is a new drug approved for the treatment of Cushing's Disease. The FDA recommends obtaining a baseline ECG before administering the drug
2. Telavancin (brand name Vibativ®), an intravenous antibiotic
3. Rilpivirine (Brand name Edurant®), also marketed in the combination products Complera® and Eviplera®, as oral antiviral therapy for patients with HIV/AIDS.
4. Vorinostat (Zolinza®) for the treatment of cutaneous Tcell lymphoma

Added to "Risk of torsades de pointes".

1. Ondansetron (Zofran® and others),

   a drug for the treatment or prevention of nausea and vomiting
2. Dronedarone (Multaq®), a drug for the treatment of arrhythmias

 

UPDATE as of 6/7/2013:

Pasireotide (Signifor®): Pasireotide is a new drug approved for the treatment of Cushing’s Disease that has been found to prolong the QT interval at usual clinical dosages. The FDA recommends obtaining a baseline ECG before administering the drug.

Action: Added pasireotide to the “possible risk” list and the “Drugs to Avoid in cLQTS” list.

UPDATE as of 3/19/2013:

Based upon our analysis of emerging evidence reporting QT prolongation and cases of Torsades de pointes (TdP) in certain clinical conditions, quinine sulfate has been added to the list of drugs with “conditional risk of torsades de pointes”. The brand name in the US is Qualaquin®. The reported cases of TdP were in patients who took large overdoses of quinine sulfate or those who took it with other drugs that prolong QT.  Cases were also reported for patients who had reduced ability to metabolize quinine because of other drugs they took or because they took it with grapefruit juice.

UPDATE as of 1/20/2013:

On December 30, 2012, the FDA approved a new drug for the treatment of multi-drug resistant tuberculosis, bedaquiline (Brand name Sirturo^®). Because the FDA-approved label includes a black box warning that it can cause QT prolongation, we have added it to the list of drugs with "possible risk of torsades de pointes". 

 

Based upon our analysis of emerging evidence reporting QT prolongation, olanzapine has been added to the list of drugs with "possible risk of torsades de pointes".  The most common brand name is Zyprexa®, but others include Zidis®, Relprevv®, Olzapin®, Zalasta®, Zolafren®, Zypradhera®, and Oferta®.

 

For patients with congenital long QT syndrome (CLQTS), we recommend that, unless no other option is feasible, drugs on any of the QTdrugs lists should be avoided.  For this reason, bedaquiline and olanzapine will also be included on the list of Drugs to be Avoided by CLQTS Patients.

Notes about the Lists:

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. This means that you must look up each ingredient of the drug to see if it is on this list.

The list is sorted into four groups based on the risk for people with LQTS. It is recommended that those with inherited long QT syndrome not take any of the drugs on these lists. It is also recommended that people with LQTS avoid any herbal medicines/remedies as these may contain ingredients that could cause an event.