Practice Based Learning: Anti-emetic use in patients with Long QT Syndrome

Neelima Marupudi, MD

Presented by Neelima Marupudi, MD
Resident, Department of Pediatrics
Emory University

Key Points:

  • Though droperidol comes with the black box warning, most commonly prescribed anti-emetics have the ability to prolong the QT interval – Zofran and Chlorpromazine (known/high risk), Phenergan (possible/modest risk), and Benadryl (conditional/low risk).
  • If giving low-dose ondansetron to patients with LQT syndrome, continuous telemetry is recommended for at least 2 hours following administration.
  • Less commonly used for nausea/vomiting, benzodiazepines (lorazepam, midazolam) do not pose a known risk for prolonging the QT interval. 

References:

Charbit B, Albaladejo P, Funck-Brentano C, Legrand M, Samain E, Marty J. Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology. 2005 Jun;102(6):1094-100.

Curran ME, Splawski I, Timothy KW, Vincent GM, Green ED, Keating MT. molecular basis for cardiac arrhythmia: HERG mutations cause long QT syndrome. Cell. 1995 Mar 10;80(5):795-803.

Gupta SD, Pal R, Sarkar A, Mukherjee S, Mitra K, Roy S, Sarbapalli D, Kundu KK, Zaman FA, Kar S. Evaluation of Ondansetron-induced QT interval prolongation in the prophylaxis of postoperative emesis. J Nat Sci Biol Med. 2011 Jan;2(1):119-24.

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.

Suzuki Y, Watanabe J, Ono S, Fukui N, Sugai T, Tsuneyama N, Someya T. Increase in the risk of chlorpromazine-induced QT prolongation during nighttime: is a short-period ECG during daytime sufficient? Prog Neuropsychopharmacol Biol Psychiatry. 2010 Aug 16;34(6):1122-3.

Toyoda T, Terao Y, Oji M, Okada M, Fukusaki M, Sumikawa K. The interaction of antiemetic dose of droperidol with propofol on QT interval during anesthetic induction. J Anesth. 2013 May 10. [Epub ahead of print]

U.S. Food and Drug Administration. (20130). FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran). Retrieved on Nov. 1, 2013 from: http://www.fda.gov/Drugs/DrugSafety/ucm310190.htm

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