Cited by 48Cardiac electrophysiology and arrhythmiasPharmaceutical Practices and Patient OutcomesPharmacovigilance and Adverse Drug Reactions

Pharmacoepidemiology of QT‐interval prolonging drug administration in critically ill patients

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Freeman, Bradley D., Dixon, David J., Coopersmith, Craig M., Zehnbauer, Barbara A., Buchman, Timothy G.·2008·Pharmacoepidemiology and Drug Safety

Abstract

Purpose: Commonly prescribed medications produce QT‐prolongation and are associated with torsades de pointes in non‐acutely ill patients. We examined patterns of QT‐prolonging drug use in critically ill individuals. Methods: An administrative critical care database was utilized to identify patients receiving drugs associated with QT‐interval prolongation or torsades de pointes for ≥ 24 hours. Results: Data from 212 016 individuals collected over a 63‐month period was examined to identify 6125 patients (2.9%) receiving QT‐interval prolonging drugs. These individuals had a mean (±SE) age of 63.0 (±0.2) years, were predominately male (55.4%) and Caucasian (84.4%), and were exposed to QT‐interval prolonging agents for a mean (±SE) 53.1 (±0.4)% of their ICU length of stay. Respiratory and cardiovascular illnesses were the most common reasons for ICU admission (17.2, 12.0%, respectively). The most frequently administered agents were amiodarone (23.5%), haloperidol (19.8%), and levofloxacin (19.7%); no other single agent accounted for more than 10% of QT‐interval prolonging drugs prescribed. Coadministration of QT‐prolonging drugs occurred in 1139 patients (18.6%). These patients had higher ICU mortality rate and longer ICU lengths of stay, compared to patients not receiving coadministered drugs (p < 0.001 for both). For patients receiving coadministered drugs, overlap occurred for 71.4 (±0.8)% of the time that the drugs were given. Amiodarone coadministration with antibiotics, haloperidol coadministration with antibiotics, and haloperidol coadministration with amiodarone, comprised 15.2, 13.7, and 9.4%, of all coadministered agents, respectively. Conclusions: QT‐prolonging drugs were used in a minority of critically ill patients. Prospective evaluation in the ICU environment is necessary to determine whether administration of these agents is associated with adverse cardiac events comparable to those reported in ambulatory patients. Copyright © 2008 John Wiley & Sons, Ltd.

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  • Haloperidol has a number of side effects, the most problematic of which is prolongation of the corrected QT interval.

    “Haloperidol has, however, a number of side effects, the most problematic of which is prolongation of the corrected QT interval [33].”

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Authors
Freeman, B. D., Dixon, D. J., Coopersmith, C. M., Zehnbauer, B. A., & Buchman, T. G.
Affiliations
Washington University in St. Louis (US)
Corresponding author
Freeman, Bradley D.
Venue
Pharmacoepidemiology and Drug Safety
Publisher
Wiley
Published
2008-08-11
Volume
17
Issue
10
Pages
971-981
ISSN
  • 1053-8569 (ISSN-L)
  • 1099-1557
OpenAlex
W2014113885
Cited by
48
References
33
Citations by year
2025: 2 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 12 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 1 · 2013: 5 · 2012: 2
FWCI
2.92
Type
journal article
Language
en
Open access
Locations
  • Pharmacoepidemiology and Drug Safety (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of General Medical Sciences (K08GM000691, GM00601)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
QT prolongation, torsades de pointes, critically ill patients, amiodarone, haloperidol, levofloxacin, drug-drug interactions, co-administration, ICU mortality, ICU length of stay, adverse cardiac events
MeSH terms
Cardiovascular Agents, Female, Humans, Long QT Syndrome, Male, Middle Aged, Torsades de Pointes, Databases, Factual, Critical Illness, Pharmacoepidemiology

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