Medications to be avoided

Jackie Crawford
Cardiac Inherited Disease Co-ordinator
C/- Paediatric Cardiology; Level 3
Starship; Auckland City Hospital
Private Bag 92024; Auckland
Cardiac Inherited Disease Group
Phone: (09) 3074949 ext 23634
www.cidg.org
Fax: (09) 6309877
Email: [email protected]
Medications to be avoided, or requiring special caution, in people with Long QT syndrome
This list includes medications which prolong the QT interval and is meant as a guide for people with Long QT syndrome, or acquired long QT interval from heart muscle disease, and their parents or guardians. It should not be seen as all inclusive. Those prescribing any medication to someone with Long QT syndrome should always check the drug specifications and contra-indications. The list has been compiled by review of publications and/or drug advice sheets provided with medications. Check also www.SADS.org and www.Torsades.org. Antibiotics
Erythromycin, Clarithromycin, Gatifloxacin, levofloxacin, Moxifloxacin Sulfamethoxazole-trimethoprim (Septrin/Bactrim),
Spiramycin, Pentamidine
Antihistamines
Terfenadine, Astemizole, Diphenhydramine, (These are particularly to be avoided (even in normal subjects) in combination
with Erythromycin or grapefruit juice or the antifungals ketoconazole, miconazole, fluconazole or itraconazole)
[Antihistamines that may be used safely are loratidine, cetirizine and fexofenadine, and phenergan]
Appetite suppressants
Fenfluramine, phentermine, Sibutramine
Asthma treatments
The Beta-2 agonists (e.g. Terbutaline, Salbutamol, Salmeterol) both work against the B-Blockers given to subjects with long
QT and lower blood potassium levels and therefore should be given only in hospital with careful monitoring. Inhaled steroids
(e.g. Becotide/Flixotide) and Ipatropium (Atrovent) are safer.
Decongestants
Ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine
Psychotropics/Antidepressants/ Anticonvulsants
The antipsychotics (including Thioridazine, Haloperidol Mesoridazine, chlorpromazine), the antidepressants (including
Maptiline, Amitriptyline, imiprmaine, fluoxetine, desipramine, paroxetine) and anticonvulsants Felbamate and Fosphenytoin
are to be avoided.
Vasodilators (used to dilate blood vessels in treatment of heart failure angina or high blood pressure)
Prenylamine Lidoflazine, Fenoxedil, Bepridil
Antiarrhythmics- (Pure Beta Blockers are safe! (e.g. Nadolol, Propranolol, Atenolol))
The others are not safe e.g.
Type IA Quinidine (particularly dangerous), Procainamide, Disopyramide
Type IC Encainide, Flecainide
Type III Ibutilide, Amiodarone, Sotalol, Sematilide
Liquorice
This lowers potassium level even in small doses, and is dangerous in big doses (more than one liquorice twist) or over long
periods. Is present as Glycyrrhizinic acid (GZA), found in many sweets including Stimorol and Ben Bits Coolmint chewing
gum, Fisherman’s Friend, turkish Pepper and herbal medicines for gastric ulcer treatments. Drinks include Belgian beers,
Pastis, Raki, Ouzo and Pernod.
Miscellaneous
Adrenaline (epinephrine), Amantadine (antiviral and Parkinson’s disease agent), Chloral hydrate (sedative), Cortocosteroids,
diuretics (via electrolyte disturbance-low potassium, magnesium, calcium: Frusemide and other loop diuretics particularly
dangerous), Chloroquine (antimalarial), Cocaine, Dopamine, dobutamine (used in intensive care), Dolasetron (anti-emetic),
Droperidol (sedative), Foscarnet (antiviral), Halofantrine (antimalarial), Isoproterenol (adrenaline like substance),
Levomethadyl (narcotic dependance), 1Midodrine (to treat low blood pressure), Suxamethonium and Atropine (anaesthetic
agents), Ritodrine, Vasopressin, Cisapride (for oesophageal reflux- indigestion), Tacrolimus (to suppress immune responses),
liquid protein diets. Your dentist should use local anaesthetic WITHOUT ADRENALIN.
Dr. Jon Skinner, [email protected] List created on 25/07/2002. Paediatric Cardiology/Electrophysiology, Green Lane Hospital, Auckland, New Zealand

Source: http://www.cidg.org/webcontent/Portals/1/Clinicians/Medications%20to%20be%20avoided.pdf