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Can Abnormal QTc Prolongation Lead To Sudden Cardiac Death?
Question: FOR A US BASED CARDIOLOGIST PLEASE.
There are one or two drugs that I really need to take but can't because I am concerned about the risk they have on your heart. They can cause something called long qt syndrome which can lead to sudden cardiac death. Basically my question is if I have regular ECGs will that completely eliminate the risk of me developing that problem? Or are regular ECGs not enough? Could you simply suffer sudden cardiac death in between the period of times you have ECGs?
There are one or two drugs that I really need to take but can't because I am concerned about the risk they have on your heart. They can cause something called long qt syndrome which can lead to sudden cardiac death. Basically my question is if I have regular ECGs will that completely eliminate the risk of me developing that problem? Or are regular ECGs not enough? Could you simply suffer sudden cardiac death in between the period of times you have ECGs?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that QT prolongation is a common adverse effect of many drugs.
This can lead to an increased risk for cardiac arrhythmia.
This adverse effect is usually dose dependent, which means that it is more frequent when high doses are used.
While in small doses, this adverse effect usually does not occur.
So, I would recommend starting in low doses (the drugs you need to take) and increase slowly up to the desired dose.
Regarding follow ups, periodically scheduled follow ups with resting ECG and some tests (complete blood count, blood electrolytes, kidney and liver function tests) every 1-2 months are more than enough to monitor the situation and check for the occurrence of this adverse effect.
But, if you use an average dose (and avoid maximal daily doses), usually there is nothing to worry about.
Regarding sudden death, I would explain that QT prolongation leads to an increased risk for this disorder, but this is really a rare complication of QT prolongation.
So, you should not worry too much about it.
If you have a normal heart function and structure (in cardiac ultrasound) and a normal ECG, you have really low chances to develop QT prolongation. The chances of sudden cardiac death would be really too low (almost 0%).
With the above follow ups there is really nothing to be concerned of, as they are more than enough to monitor your cardiac situation.
Hope you will find this answer helpful!
If you have any other uncertainties, please don't hesitate to ask me again!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that QT prolongation is a common adverse effect of many drugs.
This can lead to an increased risk for cardiac arrhythmia.
This adverse effect is usually dose dependent, which means that it is more frequent when high doses are used.
While in small doses, this adverse effect usually does not occur.
So, I would recommend starting in low doses (the drugs you need to take) and increase slowly up to the desired dose.
Regarding follow ups, periodically scheduled follow ups with resting ECG and some tests (complete blood count, blood electrolytes, kidney and liver function tests) every 1-2 months are more than enough to monitor the situation and check for the occurrence of this adverse effect.
But, if you use an average dose (and avoid maximal daily doses), usually there is nothing to worry about.
Regarding sudden death, I would explain that QT prolongation leads to an increased risk for this disorder, but this is really a rare complication of QT prolongation.
So, you should not worry too much about it.
If you have a normal heart function and structure (in cardiac ultrasound) and a normal ECG, you have really low chances to develop QT prolongation. The chances of sudden cardiac death would be really too low (almost 0%).
With the above follow ups there is really nothing to be concerned of, as they are more than enough to monitor your cardiac situation.
Hope you will find this answer helpful!
If you have any other uncertainties, please don't hesitate to ask me again!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply, it was very helpful!!
You mentioned that I would also need regular "complete blood count, blood electrolytes, kidney and liver function tests" every 1-2 months, can I ask why this would be necessary? I have not read anywhere that this is necessary for people who need to monitor their heart for long qt syndrome (only ECGs).
I am pleased to hear that sudden cardiac death is a rare complication of long qt syndrome but do you have any statistics on how common sudden cardiac death is through people developing long qt syndrome as a result of drugs they have taken?
And more importantly, if we assume that people whom have died from long qt syndrome and sudden cardiac death as a result of medication they took all took ECGs on a regular basis, can we say with certainty that none of them would have died?
Also, although ecgs are very important, isn't it possible to develop long qt syndrome and torsade de pointes in between ECGs? Or does this only depend on if you increase your level of medication in between ECGs? Or does long qt syndrome take longer to develop than the 1-2 month interval between ECGs (do you know how long long qt syndrome takes to develop)?
You mentioned that I would also need regular "complete blood count, blood electrolytes, kidney and liver function tests" every 1-2 months, can I ask why this would be necessary? I have not read anywhere that this is necessary for people who need to monitor their heart for long qt syndrome (only ECGs).
I am pleased to hear that sudden cardiac death is a rare complication of long qt syndrome but do you have any statistics on how common sudden cardiac death is through people developing long qt syndrome as a result of drugs they have taken?
And more importantly, if we assume that people whom have died from long qt syndrome and sudden cardiac death as a result of medication they took all took ECGs on a regular basis, can we say with certainty that none of them would have died?
Also, although ecgs are very important, isn't it possible to develop long qt syndrome and torsade de pointes in between ECGs? Or does this only depend on if you increase your level of medication in between ECGs? Or does long qt syndrome take longer to develop than the 1-2 month interval between ECGs (do you know how long long qt syndrome takes to develop)?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that QT prolongation is closely related to individual susceptibility, which is related to genetics and cell channel anatomy, which is different in different persons.
The percentage of development of QT prolongation depends on the drug you are using, the dose and other individual characteristics, such as liver and renal function, which are closely related to the drug metabolization and the drug plasma levels.
That is why I recommended you to perform the above mentioned lab tests, in order to be sure that the drug is not deposited abnormally in your body, causing QT prolongation even in low doses.
Regarding QT prolongation and sudden cardiac death, you should know that a borderline QT segment increases the risk of sudden death up to 2 folds, while a severe QT prolongation can increase this risk up to 4 folds, especially in elderly patients (over the age of 60).
There are no studies in young patients like you as this complication is really rare at your age.
The QT prolongation is usually progressive, and can be monitored by repeated ECG. So you shouldn't be concerned of any possible episodes between your follow ups.
The time of developing QT prolongation is not established. It depends on the dose used, the time and individual susceptibility. So, it can take months or even years to develop. That is why, it would be recommendable to repeat ECG periodically.
Hope to have clarified some of your uncertainties!
Feel free to ask me again, whenever you have any other questions!
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that QT prolongation is closely related to individual susceptibility, which is related to genetics and cell channel anatomy, which is different in different persons.
The percentage of development of QT prolongation depends on the drug you are using, the dose and other individual characteristics, such as liver and renal function, which are closely related to the drug metabolization and the drug plasma levels.
That is why I recommended you to perform the above mentioned lab tests, in order to be sure that the drug is not deposited abnormally in your body, causing QT prolongation even in low doses.
Regarding QT prolongation and sudden cardiac death, you should know that a borderline QT segment increases the risk of sudden death up to 2 folds, while a severe QT prolongation can increase this risk up to 4 folds, especially in elderly patients (over the age of 60).
There are no studies in young patients like you as this complication is really rare at your age.
The QT prolongation is usually progressive, and can be monitored by repeated ECG. So you shouldn't be concerned of any possible episodes between your follow ups.
The time of developing QT prolongation is not established. It depends on the dose used, the time and individual susceptibility. So, it can take months or even years to develop. That is why, it would be recommendable to repeat ECG periodically.
Hope to have clarified some of your uncertainties!
Feel free to ask me again, whenever you have any other questions!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply, it was very helpful!!
You mentioned the need for regular "complete blood count, blood electrolytes, kidney and liver function tests" every 1-2 months but would regular ECGs be enough if those things were not possible.
Are there no statistics on how common sudden cardiac death is through people developing long qt syndrome as a result of drugs they have taken?
If we assume that all the people that have died in the past from sudden cardiac death as a result of long qt syndrome had ECGs on a regular basis, can we say with certainty that none of them would have died because the abnormal ECGs would have notified doctors that a patient was in danger of sudden cardiac death before it occured?
You wrote in your answer: “The QT prolongation is usually progressive, and can be monitored by repeated ECG. So you shouldn't be concerned of any possible episodes between your follow ups.” Are you saying that there is a zero per cent chance that I could experience an unexpected sudden cardiac death in between regular ECGs? What about if I had recently increased my level of medication that affects my long qt interval?
But my most important question doctor is this one: if I have regular ECGs will that 100% completely remove the risk of me developing long qt syndrome? Or are regular ECGs not enough? And how regular would I need to have the ECGs?
You mentioned the need for regular "complete blood count, blood electrolytes, kidney and liver function tests" every 1-2 months but would regular ECGs be enough if those things were not possible.
Are there no statistics on how common sudden cardiac death is through people developing long qt syndrome as a result of drugs they have taken?
If we assume that all the people that have died in the past from sudden cardiac death as a result of long qt syndrome had ECGs on a regular basis, can we say with certainty that none of them would have died because the abnormal ECGs would have notified doctors that a patient was in danger of sudden cardiac death before it occured?
You wrote in your answer: “The QT prolongation is usually progressive, and can be monitored by repeated ECG. So you shouldn't be concerned of any possible episodes between your follow ups.” Are you saying that there is a zero per cent chance that I could experience an unexpected sudden cardiac death in between regular ECGs? What about if I had recently increased my level of medication that affects my long qt interval?
But my most important question doctor is this one: if I have regular ECGs will that 100% completely remove the risk of me developing long qt syndrome? Or are regular ECGs not enough? And how regular would I need to have the ECGs?
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
There are different studies, which show that the QT prolongation is proportional to the risk of developing sudden cardiac death.
So, the more prolonged the QT interval, higher the risk of sudden cardiac death.
Some studies have shown that a borderline QT interval leads to a low risk of developing sudden cardiac death (the risk is compared to normal persons, which have a normal QT interval).
While patients with a prominent QT prolongation have a risk up to 60% higher compared to normal patients and those with borderline QT interval.
So, repeated ECG are necessary to notice any possible prolongation in QT interval.
If this is noticed (comparing new and old ECG), the drug should be stopped, or switched to another drug.
So, in my opinions, repeated ECG are quite safe to remove the risk of QT syndrome.
I would recommend performing them every month, in order to be sure that nothing wrong is going on.
Regarding sudden cardiac death, I would not say that the risk is 0%, but it is just like the risk of every other healthy person, while your repeated ECG are normal (which means almost 0).
You are not at any increased risk of sudden cardiac death in the intervals between normal ECG. You should consider yourself a normal and healthy person in these periods. You shouldn't be afraid of anything.
So, relax and don't worry about it!
Hope to have clarified some of your uncertainties!
Kind regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
There are different studies, which show that the QT prolongation is proportional to the risk of developing sudden cardiac death.
So, the more prolonged the QT interval, higher the risk of sudden cardiac death.
Some studies have shown that a borderline QT interval leads to a low risk of developing sudden cardiac death (the risk is compared to normal persons, which have a normal QT interval).
While patients with a prominent QT prolongation have a risk up to 60% higher compared to normal patients and those with borderline QT interval.
So, repeated ECG are necessary to notice any possible prolongation in QT interval.
If this is noticed (comparing new and old ECG), the drug should be stopped, or switched to another drug.
So, in my opinions, repeated ECG are quite safe to remove the risk of QT syndrome.
I would recommend performing them every month, in order to be sure that nothing wrong is going on.
Regarding sudden cardiac death, I would not say that the risk is 0%, but it is just like the risk of every other healthy person, while your repeated ECG are normal (which means almost 0).
You are not at any increased risk of sudden cardiac death in the intervals between normal ECG. You should consider yourself a normal and healthy person in these periods. You shouldn't be afraid of anything.
So, relax and don't worry about it!
Hope to have clarified some of your uncertainties!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks for your reply, it is much appreciated!!
You answered most of my questions but I believe you may have missed one or two. Please can you read over my questions below again and try to answer each of them individually for me please?
Are there no statistics on how common sudden cardiac death is through people developing long qt syndrome as a result of drugs they have taken?
If we assume that all the people that have died in the past from sudden cardiac death as a result of long qt syndrome had ECGs on a regular basis, can we say with certainty that none of them would have died because the abnormal ECGs would have notified doctors that a patient was in danger of sudden cardiac death before it occured?
I understand that after an ECG my risk of developing long qt syndrome and or sudden cardiac death is very low however what about if I were to increase my level of medication which can affect my long qt interval? Wouldn’t that then increase my risk of developing long qt syndrome in between ECGs?
Can you also please tell me if there have ever been any documented incidents of an individual with a normal healthy heart experiencing long qt syndrome and sudden cardiac death through taking a first generation antipsychotic drug? And the same question again please for the drug lisdexamfetamine (or any other stimulant type drug)? Also when these incidents have occured in the past, do they get recorded properly and accurately or are they unfortunately under reported (in which case we do not know exactly how common they are)?
Also how accurate are ECGs at identifying long qt syndrome? Please try to provide a percentage out of 100 if you can.
And just to clarify, are you saying that regular complete blood count, blood electrolytes, kidney and liver function tests every few months are useful but not essential for long qt sydrome? And if regular ECGs are enough to monitor long qt syndrome why are they necessary at all?
And I am trying to become less of a hypochondriac!
You answered most of my questions but I believe you may have missed one or two. Please can you read over my questions below again and try to answer each of them individually for me please?
Are there no statistics on how common sudden cardiac death is through people developing long qt syndrome as a result of drugs they have taken?
If we assume that all the people that have died in the past from sudden cardiac death as a result of long qt syndrome had ECGs on a regular basis, can we say with certainty that none of them would have died because the abnormal ECGs would have notified doctors that a patient was in danger of sudden cardiac death before it occured?
I understand that after an ECG my risk of developing long qt syndrome and or sudden cardiac death is very low however what about if I were to increase my level of medication which can affect my long qt interval? Wouldn’t that then increase my risk of developing long qt syndrome in between ECGs?
Can you also please tell me if there have ever been any documented incidents of an individual with a normal healthy heart experiencing long qt syndrome and sudden cardiac death through taking a first generation antipsychotic drug? And the same question again please for the drug lisdexamfetamine (or any other stimulant type drug)? Also when these incidents have occured in the past, do they get recorded properly and accurately or are they unfortunately under reported (in which case we do not know exactly how common they are)?
Also how accurate are ECGs at identifying long qt syndrome? Please try to provide a percentage out of 100 if you can.
And just to clarify, are you saying that regular complete blood count, blood electrolytes, kidney and liver function tests every few months are useful but not essential for long qt sydrome? And if regular ECGs are enough to monitor long qt syndrome why are they necessary at all?
And I am trying to become less of a hypochondriac!
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Here are my answers to your questions:
1- There are no statistics on the possibility of developing cardiac death in QT prolongation, as this is a really rare disorder. But, the QT prolongation depends on the drug used (some of them influence more the QT interval than others) and the dose (high doses lead to a higher risk for QT prolongation and thus sudden cardiac death). But, it is well-known that when the QT prolongation is prominent this lead to a doubled risk for sudden cardiac death.
2- QT prolongation is not the only cause of sudden cardiac death. Other problems can lead to this events (severe electrolyte imbalance, a congenital heart disorder, drug toxicity, etc). So, we can not say for sure that between the ECG you there is no riks of sudden cardiac death. But this risk is not related to QT interval, but to other causes (related to individual susceptibility, heart problems, electrolyte balances, or other causes). In a few words, I would say that the risk is almost 0, in your case, considering the fact that you will regularly check your blood electrolytes, kidney and liver function tests (in order to be sure that the drugs you are taking are well metabolised and not accumulated in your blood). That is why I recommended to periodically check these blood lab tests besides ECG.
3- Regarding the psychotics with a higher risk for QT prolongation, based on the medical literature, I would mention: clozapine, paliperidone, lurasidone, quetiapine, olanzapine and risperidone. But this risk is higher when high doses are used and especially when there is concomitant use of other drugs which influence the QT interval.
4- Regarding high doses, they increase the risk for QT prolongation. But if this is noticed in repeated ECG, changes to the therapy are made (reduce the dose or switch to another drug.
5-Lisdexampfetamine does not influence QT interval. It is not related to QT interval prolongation. It can lead to palpitations and cardiomyopathy, if used in high doses and for a long time. But these adverse effects are seen in less than 1% of the patients. But there is nothing to be concerned about QT prolongation.
Hope to have clarified your uncertainties!
Regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Here are my answers to your questions:
1- There are no statistics on the possibility of developing cardiac death in QT prolongation, as this is a really rare disorder. But, the QT prolongation depends on the drug used (some of them influence more the QT interval than others) and the dose (high doses lead to a higher risk for QT prolongation and thus sudden cardiac death). But, it is well-known that when the QT prolongation is prominent this lead to a doubled risk for sudden cardiac death.
2- QT prolongation is not the only cause of sudden cardiac death. Other problems can lead to this events (severe electrolyte imbalance, a congenital heart disorder, drug toxicity, etc). So, we can not say for sure that between the ECG you there is no riks of sudden cardiac death. But this risk is not related to QT interval, but to other causes (related to individual susceptibility, heart problems, electrolyte balances, or other causes). In a few words, I would say that the risk is almost 0, in your case, considering the fact that you will regularly check your blood electrolytes, kidney and liver function tests (in order to be sure that the drugs you are taking are well metabolised and not accumulated in your blood). That is why I recommended to periodically check these blood lab tests besides ECG.
3- Regarding the psychotics with a higher risk for QT prolongation, based on the medical literature, I would mention: clozapine, paliperidone, lurasidone, quetiapine, olanzapine and risperidone. But this risk is higher when high doses are used and especially when there is concomitant use of other drugs which influence the QT interval.
4- Regarding high doses, they increase the risk for QT prolongation. But if this is noticed in repeated ECG, changes to the therapy are made (reduce the dose or switch to another drug.
5-Lisdexampfetamine does not influence QT interval. It is not related to QT interval prolongation. It can lead to palpitations and cardiomyopathy, if used in high doses and for a long time. But these adverse effects are seen in less than 1% of the patients. But there is nothing to be concerned about QT prolongation.
Hope to have clarified your uncertainties!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks for your answers, it is very much appreciated!!
I have numbered my questions this time to make answering them easier for you. Here they are:
1. You mentioned in your answer that some of the newer antipsychotics such as quetiapine can cause long qt syndrome but I was under the impression that the older ones and the ones that I was considering taking (such as haloperidol or chlorpromazine) were the ones that posed the greatest risk to your heart, is this not correct?
2. Am I correct in believing that there have been cases of sudden cardiac death in individuals with normal healthy hearts when they have taken first generation antipsychotics such as haloperidol?
3. How accurate are ECGs at identifying long qt syndrome? Please try to provide a percentage out of 100 if you can.
4. Thank you for telling me about the risk of cardiomyopathy with lisdexamfetamine, I was not aware of that. Should you have regular ECGs or other tests to regularly check for that, and if so how often should you have these tests?
5. When it comes to heart problems that can cause death such as long qt syndrome, cardiomyopathy etc, do these problems develop slowly over many months and years, allowing them to be detected by periodic ECGs and other tests before they become fatal, or can they develop very quickly in a few weeks and kill before periodic tests can detect them?
My apologies for all these questions!
I have numbered my questions this time to make answering them easier for you. Here they are:
1. You mentioned in your answer that some of the newer antipsychotics such as quetiapine can cause long qt syndrome but I was under the impression that the older ones and the ones that I was considering taking (such as haloperidol or chlorpromazine) were the ones that posed the greatest risk to your heart, is this not correct?
2. Am I correct in believing that there have been cases of sudden cardiac death in individuals with normal healthy hearts when they have taken first generation antipsychotics such as haloperidol?
3. How accurate are ECGs at identifying long qt syndrome? Please try to provide a percentage out of 100 if you can.
4. Thank you for telling me about the risk of cardiomyopathy with lisdexamfetamine, I was not aware of that. Should you have regular ECGs or other tests to regularly check for that, and if so how often should you have these tests?
5. When it comes to heart problems that can cause death such as long qt syndrome, cardiomyopathy etc, do these problems develop slowly over many months and years, allowing them to be detected by periodic ECGs and other tests before they become fatal, or can they develop very quickly in a few weeks and kill before periodic tests can detect them?
My apologies for all these questions!
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Here are my answers to your questions:
1- I agree with you that the old antipsychotics have much more influence on QT interval. Haloperidol and chlorpromazine can cause prolonged QT interval and also extrapiramidal symptoms (like tardive dyskinesia, parkinson like syndrome and dystonia). That is why they are not much preferred in young patients.
2- Yes, there have been causes of sudden cardiac death in patients taking haloperidol, but they are too rare. Most of deaths from haloperidol are caused by malignant neuroleptic syndrome, which is a more frequent complications compared to QT prolongation and sudden cardiac death.
3- The ECG monitoring every 1-2 months is a really accurate follow up in detecting possible QT prolongation. It helps in more than 95% of the cases. In fact there is no other cardiac test for this purpose in every day clinical practice.
4- Regarding lisdexamphetamine, regular ECG are helpful for this purpose. I would also recommend cardiac ultrasound every 6 months for this purpose.
5- Usually these changes occur for a long time (as they are more possible to occur when these drugs are used for a long time), so they can be detected during periodic follow ups (as above recommended). There is no reason to worry too much.
Hope to have clarified your uncertainties!
Wishing all the best,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Here are my answers to your questions:
1- I agree with you that the old antipsychotics have much more influence on QT interval. Haloperidol and chlorpromazine can cause prolonged QT interval and also extrapiramidal symptoms (like tardive dyskinesia, parkinson like syndrome and dystonia). That is why they are not much preferred in young patients.
2- Yes, there have been causes of sudden cardiac death in patients taking haloperidol, but they are too rare. Most of deaths from haloperidol are caused by malignant neuroleptic syndrome, which is a more frequent complications compared to QT prolongation and sudden cardiac death.
3- The ECG monitoring every 1-2 months is a really accurate follow up in detecting possible QT prolongation. It helps in more than 95% of the cases. In fact there is no other cardiac test for this purpose in every day clinical practice.
4- Regarding lisdexamphetamine, regular ECG are helpful for this purpose. I would also recommend cardiac ultrasound every 6 months for this purpose.
5- Usually these changes occur for a long time (as they are more possible to occur when these drugs are used for a long time), so they can be detected during periodic follow ups (as above recommended). There is no reason to worry too much.
Hope to have clarified your uncertainties!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks for those answers again, much appreciated!!
If I may I would like to clarify something you said in an earlier answer to me. You said that the drug lisdexamfetamine does not influence the qt interval. I am very confused by this because I have read on numerous websites online that it is one of the drugs that does. For example please see table 1 in this website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
I have also read that many antidepressants can cause the syndrome, is this not correct?
Also is domperidone a drug that can cause long qt syndrome? Does it only have a potentially dangerous effect on the heart when it is taken on a regular basis? If taken occasionally is there any risk of it causing long qt syndrome?
If I may I would like to clarify something you said in an earlier answer to me. You said that the drug lisdexamfetamine does not influence the qt interval. I am very confused by this because I have read on numerous websites online that it is one of the drugs that does. For example please see table 1 in this website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
I have also read that many antidepressants can cause the syndrome, is this not correct?
Also is domperidone a drug that can cause long qt syndrome? Does it only have a potentially dangerous effect on the heart when it is taken on a regular basis? If taken occasionally is there any risk of it causing long qt syndrome?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for the link!
I read the article and would explain that it is referred to persons suffering from long QT interval (which is a medical disorder, not drug induced, but related to genetic characteristics).
All CNS stimulants like lisdexamphetamine can cause cardiac arrhythmia, by stimulating the sympathetic nervous system. When there is a high suscepibility of cardiac arrhythmia (like in patients with long QT syndrome), these drugs, may exacerbate the situation. That is why they are not indicated in these patients, because they lower the threshold of cardiac arrhythmia, which can lead to sudden cardiac death.
I agree with you that all the antidepressants (present also in the article table) can cause QT prolongation.
Regarding domperidone, I would explain that when taken regularly it can cause QT prolongation. That is why I would recommend taking it only occasionally, especially when you are taking other drugs that can cause QT prolongation.
Hope to have clarified some of your uncertainties!
Wishing good health,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for the link!
I read the article and would explain that it is referred to persons suffering from long QT interval (which is a medical disorder, not drug induced, but related to genetic characteristics).
All CNS stimulants like lisdexamphetamine can cause cardiac arrhythmia, by stimulating the sympathetic nervous system. When there is a high suscepibility of cardiac arrhythmia (like in patients with long QT syndrome), these drugs, may exacerbate the situation. That is why they are not indicated in these patients, because they lower the threshold of cardiac arrhythmia, which can lead to sudden cardiac death.
I agree with you that all the antidepressants (present also in the article table) can cause QT prolongation.
Regarding domperidone, I would explain that when taken regularly it can cause QT prolongation. That is why I would recommend taking it only occasionally, especially when you are taking other drugs that can cause QT prolongation.
Hope to have clarified some of your uncertainties!
Wishing good health,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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