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

Raymond L. Woosley, MD, PhD

The following lists are based on information from the medical literature, the FDA-approved drug labeling and reports submitted to the FDA Adverse Events Reporting System database.

Drugs on the QT Drug Lists are reviewed on an ongoing basis to assure the evidence is still appropriate for their placement on their respective list.  The most recent modification to the lists was done on March 1, 2006.

This list is maintained by Raymond L. Woosley, MD, PhD, CEO and President of The Critical Path Institute (C-Path) and Director of the Arizona Center for Education and Research on Therapeutics (AzCERT). To construct these lists, AzCERT only surveys drugs marketed in the United States (US). However, some drugs marketed in countries other than the US come to our attention and are included. Those drugs are designated with an asterisk. When the lists were first compiled, they were sent to the larger QTdrugs.org Scientific Advisory Board for comment and suggestions.  Periodically, we again ask the Board about specific drugs and for input about the content of the drug lists. Suggested additions, deletions and references are most welcome; the list has benefited immensely from the input of practicing physicians and other researchers in the field. This list will be updated as new information becomes available. The content of this table is for public use, free of charge and for information only. It is not intended to be used in any other manner. The author disclaims any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, or the use and application of any of the contents of this table. The information presented on this site is intended as general health information and as an educational tool. It is not intended as medical advice. Only a physician, pharmacist, or other health care professional should advise a patient on medical issues and should do so using a medical history and other factors identified and documented as part of the health professional/patient relationship.

The entire content of this site is protected by International and United States of America copyright laws.

 

KEY
Drug List 1:
Drugs that are generally accepted by authorities to have a risk of causing torsades de pointes.
Drug List 2:
Drugs that in some reports may be associated with torsades de pointes but at this time lack substantial evidence for causing torsades de pointes.
Drug List 3:
Drugs to be avoided for use in patients with diagnosed or suspected congenital long QT syndrome. (Drugs on Lists 1, 2 and 4 should also be avoided by patients with QT syndrome.)
Drug List 4:
Drugs that, in some reports, have been weakly associated with torsades de pointes and/or QT prolongation but that are unlikely to be a risk for torsades de pointes when used in usual recommended dosages and in patients without other risk factors (e.g., concomitant QT prolonging drugs, bradycardia, electrolyte disturbances, congenital long QT syndrome, concomitant drugs that inhibit metabolism).
Females>Males: Substantial evidence indicates a greater risk
(usually > two-fold) of TdP in women.

 
Drugs that prolong the QT interval and/or induce Torsades De Pointes
 
Albuterol (Ventolin®) Bronchodilator/Asthma 3
Albuterol (Proventil®) Bronchodilator/Asthma 3
Alfuzosin (Uroxatral®) Alpha1-blocker/Benign prostatic hyperplasia 2
Amantadine (Symmetrel®) Dopaminergic/Anti-viral/Anti-infective/ Parkinson's Disease 2
Amiodarone (Pacerone®) Anti-arrhythmic/abnormal heart rhythm Females>Males,TdP risk regarded as low 1
Amiodarone (Cordarone®) Anti-arrhythmic/abnormal heart rhythm Females>Males,TdP risk regarded as low 1
Amitriptyline (Elavil®) Tricyclic Antidepressant/depression 4
Amoxapine (Asendin®) Tricyclic Antidepressant/depression 4
Amphetamine (Adderall® ) CNS stimulant/ADHD This includes dextroamphetamine and amphetamine / dextroamphetamine combinations. 3
Amphetamine (Dexadrine®) CNS stimulant/ADHD This includes dextroamphetamine and amphetamine / dextroamphetamine combinations. 3
Arsenic trioxide (Trisenox®) Anti-cancer/Leukemia 1
Atomoxetine (Strattera®) norepinephrine reuptake inhibitor /ADHD 3
Azithromycin (Zithromax®) Antibiotic/bacterial infection 2
Bepridil (Vascor®) Anti-anginal/heart pain Females>Males 1
Chloral hydrate (Noctec®) Sedative/sedation/ insomnia 2
Chloroquine (Arelan®) Anti-malarial/malaria infection 1
Chlorpromazine (Thorazine®) Anti-psychotic/ Anti-emetic/schizophrenia/ nausea 1
Ciprofloxacin (Cipro®) Antibiotic/bacterial infection 4
Cisapride (Propulsid®) GI stimulant/heartburn Restricted availability; Females>Males. 1
Citalopram (Celexa®) Anti-depressant/depression 4
Clarithromycin (Biaxin®) Antibiotic/bacterial infection 1
Clomipramine (Anafranil®) Tricyclic Antidepressant/depression 4
Clozapine (Clozaril®) Anti-psychotic/schizophrenia 2
Cocaine (Cocaine) Local anesthetic/ 3
Desipramine (Pertofrane®) Tricyclic Antidepressant/depression 4
Dexmethylphenidate (Focalin®) CNS stimulant/ADHD 3
Disopyramide (Norpace®) Anti-arrhythmic/abnormal heart rhythm Females>Males 1
Dobutamine (Dobutrex®) Catecholamine/heart failure and shock 3
Dofetilide (Tikosyn®) Anti-arrhythmic/abnormal heart rhythm 1
Dolasetron (Anzemet®) Anti-nausea/nausea, vomiting 2
Domperidone* (Motilium®) Anti-nausea/nausea not available in the United States 1
Dopamine (Intropine®) Anti-arrhythmic/abnormal heart rhythm 3
Doxepin (Sinequan®) Tricyclic Antidepressant/depression 4
Droperidol (Inapsine®) Sedative;Anti-nausea/anesthesia adjunct, nausea 1
Ephedrine (Broncholate®) Bronchodilator, decongestant/Allergies, sinusitis, asthma 3
Ephedrine (Rynatuss®) Bronchodilator, decongestant/Allergies, sinusitis, asthma 3
Epinephrine (Primatene®) catecholamine, vasoconstrictor/anaphylaxis, allergic reactions 3
Epinephrine (Bronkaid®) catecholamine, vasoconstrictor/anaphylaxis, allergic reactions 3
Erythromycin (Erythrocin®) Antibiotic;GI stimulant/bacterial infection; increase GI motility Females>Males 1
Erythromycin (E.E.S.® ) Antibiotic;GI stimulant/bacterial infection; increase GI motility Females>Males 1
Felbamate (Felbatrol®) Anti-convulsant/seizure 2
Fenfluramine (Pondimin®) Appetite suppressant/dieting, weight loss 3
Flecainide (Tambocor®) Anti-arrhythmic/abnormal heart rhythm 2
Fluconazole (Diflucan®) Anti-fungal/fungal infection 4
Fluoxetine (Sarafem®) Anti-depressant/depression 4
Fluoxetine (Prozac®) Anti-depressant/depression 4
Foscarnet (Foscavir®) Anti-viral/HIV infection 2
Fosphenytoin (Cerebyx®) Anti-convulsant/seizure 2
Galantamine (Reminyl®) Cholinesterase inhibitor/ Dementia, Alzheimer's 4
Gatifloxacin (Tequin®) Antibiotic/bacterial infection 2
Gemifloxacin (Factive®) Antibiotic/bacterial infection 2
Granisetron (Kytril®) Anti-nausea/nausea and vomiting 2
Halofantrine (Halfan®) Anti-malarial/malaria infection Females>Males 1
Haloperidol (Haldol®) Anti-psychotic/schizophrenia, agitation 1
Ibutilide (Corvert®) Anti-arrhythmic/abnormal heart rhythm Females>Males 1
Imipramine (Norfranil®) Tricyclic Antidepressant/depression 4
Indapamide (Lozol®) Diuretic/stimulate urine & salt loss 2
Isoproterenol (Isupres®) Catecholamine/allergic reaction 3
Isoproterenol (Medihaler-Iso®) Catecholamine/allergic reaction 3
Isradipine (Dynacirc®) Anti-hypertensive/high blood pressure 2
Itraconazole (Sporanox®) Anti-fungal/fungal infection 4
Ketoconazole (Nizoral®) Anti-fungal/fungal infection 4
Levalbuterol (Xopenex® ) Bronchodilator/asthma 3
Levofloxacin (Levaquin®) Antibiotic/bacterial infection 2
Levomethadyl (Orlaam®) Opiate agonist/pain control, narcotic dependence 1
Lithium (Eskalith®) Anti-mania/bipolar disorder 2
Lithium (Lithobid®) Anti-mania/bipolar disorder 2
Mesoridazine (Serentil®) Anti-psychotic/schizophrenia 1
Metaproterenol (Alupent®) Bronchodilator/asthma 3
Metaproterenol (Metaprel®) Bronchodilator/asthma 3
Methadone (Dolophine®) Opiate agonist/pain control, narcotic dependence Females>Males 1
Methadone (Methadose®) Opiate agonist/pain control, narcotic dependence Females>Males 1
Methylphenidate (Ritalin®) CNS stimulant/ADHD 3
Methylphenidate (Concerta® ) CNS stimulant/ADHD 3
Mexiletine (Mexitil®) Anti-arrhythmic/Abnormal heart rhythm 4
Midodrine (ProAmatine®) Vasoconstrictor/low blood pressure, fainting 3
Moexipril/HCTZ (Uniretic®) Anti-hypertensive/high blood pressure 2
Moxifloxacin (Avelox®) Antibiotic/bacterial infection 2
Nicardipine (Cardene®) Anti-hypertensive/high blood pressure 2
Norepinephrine (Levophed®) Vasconstrictor, Inotrope/shock, low blood pressure 3
Nortriptyline (Pamelor®) Tricyclic Antidepressant/depression 4
Octreotide (Sandostatin®) Endocrine/acromegaly, carcinoid diarrhea 2
Ofloxacin (Floxin®) Antibiotic/bacterial infection 2
Ondansetron (Zofran®) Anti-emetic/nausea and vomiting 2
Paroxetine (Paxil®) Anti-depressant/depression 4
Pentamidine (NebuPent®) Anti-infective/pneumocystis pneumonia Females>Males 1
Pentamidine (Pentam®) Anti-infective/pneumocystis pneumonia Females>Males 1
Phentermine (Fastin®) Appetite suppressant/dieting, weight loss 3
Phentermine (Adipex®) Appetite suppressant/dieting, weight loss 3
Phenylephrine (Neosynephrine®) Vasoconstrictor, decongestant/low blood pressure, allergies, sinusitis, asthma 3
Phenylpropanolamine (Acutrim®) Decongestant/allergies, sinusitis, asthma 3
Phenylpropanolamine (Dexatrim®) Decongestant/allergies, sinusitis, asthma 3
Pimozide (Orap® ) Anti-psychotic/Tourette's tics Females>Males 1
Procainamide (Pronestyl®) Anti-arrhythmic/abnormal heart rhythm 1
Procainamide (Procan® ) Anti-arrhythmic/abnormal heart rhythm 1
Protriptyline (Vivactil®) Tricyclic Antidepressant/depression 4
Pseudoephedrine (PediaCare®) Decongestant/allergies, sinusitis, asthma 3
Pseudoephedrine (Sudafed®) Decongestant/allergies, sinusitis, asthma 3
Quetiapine (Seroquel® ) Anti-psychotic/schizophrenia 2
Quinidine (Quinaglute®) Anti-arrhythmic/abnormal heart rhythm Females>Males 1
Quinidine (Cardioquin® ) Anti-arrhythmic/abnormal heart rhythm Females>Males 1
Ranolazine (Ranexa® ) Anti-anginal/chronic angina 2
Risperidone (Risperdal® ) Anti-psychotic/schizophrenia 2
Ritodrine (Yutopar®) Uterine relaxant/prevent premature labor 3
Roxithromycin* (Rulide®) Antibiotic/bacterial infection *not available in the United States 2
Salmeterol (Serevent® ) Sympathomimetic/asthma, COPD 3
Sertraline (Zoloft®) Anti-depressant/depression 4
Sibutramine (Meridia®) Appetitie suppressant/dieting, weight loss 3
Solifenacin (VESIcare®) muscarinic receptor anatagonist/treatment of overactive bladder 4
Sotalol (Betapace® ) Anti-arrhythmic/abnormal heart rhythm Females>Males 1
Sparfloxacin (Zagam® ) Antibiotic/bacterial infection 1
Tacrolimus (Prograf®) Immunosuppressant/Immune suppression 2
Tamoxifen (Nolvadex® ) Anti-cancer/breast cancer 2
Telithromycin (Ketek®) Antibiotic/bacterial infection 2
Terbutaline (Brethine®) Bronchodilator/asthma 3
Thioridazine (Mellaril® ) Anti-psychotic/schizophrenia 1
Tizanidine (Zanaflex® ) Muscle relaxant/ 2
Tolterodine (Detrol®) Bladder Antispasmodic/ 3
Tolterodine (Detrol LA®) Bladder Antispasmodic/ 3
Trimethoprim-Sulfa (Sulfa®) Antibiotic/bacterial infection 4
Trimethoprim-Sulfa (Bactrim®) Antibiotic/bacterial infection 4
Trimipramine (Surmontil®) Tricyclic Antidepressant/depression 4
Vardenafil (Levitra® ) phosphodiesterase inhibitor/vasodilator 2
Venlafaxine (Effexor® ) Anti-depressant/depression 2
Voriconazole (VFend® ) Anti-fungal/anti-fungal 2
Ziprasidone (Geodon® ) Anti-psychotic/schizophrenia 2
 
  A note about Brand Names: 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.
   
  Revised:03/01/2006
Source:www.QTdrugs.org