When Should QT Prolongation Be Considered in Antiemetic Use?
Antiemetic medications are commonly prescribed in the acute care setting. Most carry a warning for QTc interval prolongation, which may devolve into potentially fatal arrhythmias. Ondansetron, the most commonly prescribed antiemetic, increases the QTc interval by 6–20 ms, which is not sufficient to cause cardiac arrhythmias in most patients. The risk of significant QTc prolongation after receiving an antiemetic drug is significantly associated with preexisting QTc prolongation, electrolyte abnormalities, and organ failure. Patients who are known to have underlying risk factors should have a screening electrocardiogram performed prior to medication administration. Other patients can safely receive a single dose of an antiemetic without any preceding tests.
KeywordsAntiemetics QTc prolongation Arrhythmia
- 6.Center for Drug Evaluation and Research. Drug Safety and Availability – FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran) [Internet]. U S Food and Drug Administration Home Page. Center for Drug Evaluation and Research; 2012 [cited 26 Oct 2017]; Available from: https://www.fda.gov/Drugs/DrugSafety/ucm310190.htm
- 7.Hafermann MJ, Namdar R, Seibold GE, Page RL 2nd. Effect of intravenous ondansetron on QT interval prolongation in patients with cardiovascular disease and additional risk factors for torsades: a prospective, observational study. Drug Healthc Patient Saf. 2011;3:53–8. https://doi.org/10.2147/DHPS.S25623.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Goy J-J, Stauffer J-C, Schlaepfer J, Christeler P, editors. Electrolyte disturbances and QT interval abnormalities. In:Electrocardiography (ECG) [Internet]: Bentham Science Publishers; 2013. p. 133–41. [cited 15 Nov 2017]. Available from: http://www.eurekaselect.com/node/112318.
- 15.Smith HS, Cox LR, Smith BR. Dopamine receptor antagonists. Ann Palliat Med. 2012;1(2). [Internet]. [cited 1 Jan 2012]; Available from: http://apm.amegroups.com/article/view/1039