Drugs to be avoided in patients with long QT syndrome: Focus on the anaesthesiological management

Table 1 Drugs that prolong the QT interval and/or induce torsades de pointes

Drugs to be avoided in patients with c-long QT syndrome
Class	Generic name
Anesthetic	Sevoflurane
Anti-anginal	Ranolazine, Bepridil
Anti-arrhythmic	Sotalol, Quinidine, Amiodarone, Ibutilide, Disopyramide, Procainamide, Flecainide, Dofetilide, Dronedarone
Antibiotic	Moxifloxacin, Clarithromycin, Ciprofloxacin, Gemifloxacin, Ofloxacin Telithromycin, Levofloxacin, Roxithromycin, Trimethoprim-Sulfa, Gatifloxacin, Sparfloxacin, Azithromycin Erythromycin
Anti-cancer	Tamoxifen, Lapatinib, Nilotinib, Arsenic trioxide, Eribulin, Sunitinib
	Vandetanib
Anti-convulsivant	Fosphenytoin, Felbamate
Anti-depressant	Mirtazapine, Citalopram, Venlafaxine, Paroxetine, Fluoxetine, Sertraline, Trazodone, Escitalopram, Clomipramine, Amitriptyline, Imipramine, Nortriptyline, Desipramine, Doxepin, Trimipramine, Protriptyline
Anti-fungal	Voriconazole, Fluconazole, Ketoconazole, Itraconazole
Antihistamine	Astemizole, Terfenadine, Diphenhydramine, Diphenhydramine
Anti-hypertensive	Nicardipine, Isradipine, Moexipril/HCTZ
Anti-infective	Pentamidine
Antilipemic	Probucol
Anti-malarial	Artenimol + piperaquine, Chloroquine, Halofantrine
Anti-mania	Lithium
Anti-nausea/antiemetic	Granisetron, Dolasetron, Ondansetron
Anti-psychotic	Clozapine, Ziprasidone, Thioridazine, Risperidone, Mesoridazine, Quetiapine, Haloperidol, Pimozide, Amisulpride, Sertindole, Sertindole, Iloperidone, Paliperidone, Chlorpromazine
Anti-viral	Foscarnet, Ritonavir, Atazanavir
Appetite suppressant	Phentermine, Fenfluramine, Sibutramine
Bladder Antispasmodic	Tolterodine
α1-blocker	Alfuzosin
Bronchodilator/decongestant	Albuterol, Salmeterol, Metaproterenol, Terbutaline, Metaproterenol, Levalbuterol, Ephedrine, Phenylpropanolamine, Pseudoephedrine
Cholinesterase inhibitor	Galantamine
CNS stimulant	Amphetamine
	Methylphenidate
	Amphetamine
	Dexmethylphenidate
	Methylphenidate
	Lisdexamfetamine
Diuretic	Indapamide
Dopaminergic/anti-viral/anti-infective/	Amantadine
Endocrine	Ocreotide
GI stimulant	Cisapride
H2-receptor antagonist	Famotidine
Imaging contrast agent	Perflutren lipid microspheres
Immunosuppressant	Tacrolimus, Fingolimod
Inotropic agent/vasconstrictor	Dopamine, Isoproterenol, Dobutamine, Epinephrine, Norepinephrine, Phenylephrine
Local anesthetic	Cocaine
Muscarinic receptor anatagonist	Solifenacin
Muscle relaxant	Tizanidine
norepinephrine reuptake inhibitor	Atomoxetine
Opiate agonist	Methadone, Levomethadyl
Oxytocic	Oxytocin
phosphodiesterase inhibitor/vasodilator	Vardenafil
Sedative	Chloral hydrate
Sedative; Anti-nausea/anesthesia adjunct	Droperidol
Uterine relaxant	Ritodrine
Vasconstrictor	Midodrine

A continuously updated list of these drugs is available at http://www.torsades.org (accessed December 16, 2012). CNS: Central Nervous System.

Table 2 Normal QT corrected using the Bazzet’s formula duration by age and gender

QT corrected using the Bazzet’s formula
QTc value (s)	Children (1-15 yr)	Male ( > 15 yr)	Female ( > 15 yr)
Normal	< 0.44	< 0.43	< 0.45
Borderline	0.44-0.46	0.43-0.45	0.45-0.46
Prolonged	> 0.46	> 0.45	> 0.46

QTc: QT corrected using the Bazzet’s formula.

Table 3 Electrocardiograph pattern in long QT syndrome

ECG in LQTS
LQT1	Prolonged QT, T wave normal or with increased amplitude with a wide base
LQT2	Prolonged QT, T wave with low amplitude and often bifid
LQT3	Late onset of the T wave, prolonged isoelectric segment

ECG: Electrocardiography; LQTS : Long QT syndrome.