Long QTc interval and torsade de pointes caused by fluconazole

The Annals of Pharmacotherapy
C Phu PhamWalther Nka van Mook

Abstract

To describe a patient who developed torsade de pointes while being treated with fluconazole. A 33-year-old woman with a 5 year history of systemic lupus erythematosus was admitted to the intensive care unit because of respiratory insufficiency due to Candida albicans pneumonia. Therapy with intravenous fluconazole 200 mg/day, with dose later adjusted according to her renal function, was started. Prolongation of the QTc interval and torsade de pointes occurred. Initially, domperidone, which had been initiated the day before fluconazole, was suspected as the possible cause and was discontinued; ultimately, both drugs were discontinued. However, torsade de pointes recurred several weeks later when the patient was treated with fluconazole for a second time and disappeared again on withdrawal of the drug. According to the Naranjo probability scale, this adverse reaction was highly probable. The risk of torsade de pointes does not correlate in a linear fashion with prolongation of the QTc interval, but an interval beyond 500 msec is considered a significant risk factor. Given that both fluconazole and domperidone are metabolized by the cytochrome P450 system, they may intensify each other's proarrhythmic effects, particularly in pati...Continue Reading

References

Sep 17, 1992·The New England Journal of Medicine·G M VincentM Keating
Aug 17, 1985·Lancet·R J OsborneJ Hamer
Sep 28, 1985·Lancet·N QuinnJ Upward
Jan 12, 1985·British Medical Journal·H A CameronG Lake-Bakaar
May 1, 1982·Lancet·R A JossR L Galeazzi
Dec 8, 1984·British Medical Journal·J B RoussakH Parry
Aug 1, 1981·Clinical Pharmacology and Therapeutics·C A NaranjoD J Greenblatt
Mar 1, 1994·Clinical Physiology·A LindgrenB B Johansson
Jan 1, 1993·European Journal of Clinical Pharmacology·S Pohjola-SintonenP Neuvonen
Dec 1, 1993·JAMA : the Journal of the American Medical Association·R R MakkarM H Lehmann
Mar 1, 1997·Clinical Cardiology·D M Roden
Nov 24, 1999·Lancet·S Viskin
Nov 30, 1999·Annals of Internal Medicine·S WassmannM Böhm
Apr 6, 2000·The American Journal of Emergency Medicine·S T Dorsey, L A Biblo
Jun 15, 2000·European Journal of Clinical Pharmacology·F De PontiN Montanaro
Apr 17, 2001·The Annals of Pharmacotherapy·V N TholakanahalliA D Merliss
Jul 2, 2002·Cardiovascular Drugs and Therapy·Wilhelm HaverkampGünter Breithardt
Dec 24, 2002·Pharmacotherapy·Minou Khazan, A Scott Mathis
Mar 14, 2003·Archives of Neurology·Nazire AfsarJulien Bogousslavsky
Apr 24, 2003·JAMA : the Journal of the American Medical Association·Sana M Al-KhatibRobert M Califf
May 9, 2003·The New England Journal of Medicine·Silvia G PrioriDonata Cappelletti
Dec 23, 2003·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Pritesh J GandhiKarthik Ramaswamy
Mar 5, 2004·The New England Journal of Medicine·Dan M Roden
Apr 13, 2004·Arthritis and Rheumatism·Pietro Enea LazzeriniFranco Laghi-Pasini
Nov 29, 2005·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Raoul BergnerIngeborg Walter-Sack

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Citations

Dec 26, 2009·The Journal of Antimicrobial Chemotherapy·Simon Cronin, Pranatharthi H Chandrasekar
Feb 22, 2011·Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine·UNKNOWN Academy Of Breastfeeding Medicine Protocol Committee
Apr 2, 2015·The American Journal of the Medical Sciences·Arleen OrtizRichard W McCallum
Jul 22, 2015·Nature Reviews. Cardiology·Gerrit Frommeyer, Lars Eckardt
Apr 14, 2007·Dermatologic Clinics·Alexandra Y ZhangBoni E Elewski
May 2, 2008·Pharmacotherapy·John MohrLuis Ostrosky-Zeichner
Nov 26, 2010·Journal of Clinical Pharmacology·Masaharu TsubokuraTsunehiko Komatsu
Jan 23, 2016·Frontiers in Cardiovascular Medicine·Pietro Enea LazzeriniFranco Laghi-Pasini
Nov 26, 2010·International Journal of Cardiology·Salvatore Patanè
Nov 8, 2016·Virulence·Ya-Lin ChangYing-Lien Chen
Dec 18, 2009·Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners·Kenneth R KaufmanRahul Sood
May 18, 2017·Clinical Pharmacology and Therapeutics·H A ChakkeraB Kaplan
Apr 24, 2018·Future Medicinal Chemistry·Kamran MotahariSaeed Emami
Mar 25, 2008·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·James H McMahon, M Lindsay Grayson
Dec 28, 2012·Critical Care Medicine·Juliana BarrUNKNOWN American College of Critical Care Medicine
Sep 23, 2014·Expert Review of Anti-infective Therapy·Matthew L EldridgeGeorge R Thompson
Dec 28, 2019·Renal Failure·Peng LiuGuoliang Li
May 11, 2017·Herzschrittmachertherapie & Elektrophysiologie·Thomas Demming, Hendrik Bonnemeier
Jun 9, 2009·Anaesthesia and Intensive Care·C ChakravartyM K Arora
Dec 14, 2018·Clinical Kidney Journal·Sara AuricchioRenzo Scanziani
Dec 4, 2019·Clinical Pharmacology in Drug Development·Shawn FlanaganTaylor Sandison

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