09/03/2002

www.Torsades.org

Drugs That Prolong the QT Interval

and/or Induce Torsades de Pointes
www.Torsades.org

Raymond L. Woosley, MD, PhD

www.ArizonaCERT.org
Information from the FDA-approved drug labeling and the medical literature.
This list is maintained by Raymond L. Woosley, MD, PhD, Vice President for
Health Sciences at University of Arizona Health Sciences Center,
(woosleyr@u.arizona.edu). 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:

QT: Prolongation is mentioned in the FDA-approved labeling as a known action of the

drug.
TdP: The FDA-approved labeling includes mention of cases or a risk of Torsades de
Pointes (TdP).
Cases in Lit: There are case reports of TdP in the medical literature.
F>M (Females>Males): Substantial evidence indicates a greater risk (usually > twofold) of TdP in women.
Off Market: This drug has been removed from the US market because of druginduced TdP.

Drugs that prolong the QT interval and/or induce

Torsades De Pointes
QT TdP Comments

Drug (Brand Names)

Drug Class (Clinical Usage)

Amiodarone
(Cordarone,Pacerone)

Anti-arrhythmic/abnormal heart rhythm QT TdP F>M,

Arsenic trioxide (Trisenox)

Anti-cancer/Leukemia

QT TdP Cases in Lit,

Bepridil (Vascor)

Anti-anginal/heart pain

QT TdP F>M,

Chlorpromazine (Thorazine)

Anti-psychotic/ Antiemetic/schizophrenia/ nausea

Cisapride(Propulsid)

GI stimulant/heartburn

QT TdP F>M,

Clarithromycin(Biaxin)

Antibiotic/bacterial infection

Cases in Lit,

Disopyramide (Norpace)

Anti-arrhythmic/abnormal heart rhythm QT TdP F>M,

Dofetilide (Tikosyn)

Anti-arrhythmic/abnormal heart rhythm QT TdP

Dolasetron(Anzemet)

Anti-nausea/nausea, vomiting

QT

Droperidol (Inapsine)

Sedative;Anti-nausea/anesthesia
adjunct, nausea

QT TdP Cases in Lit,

Erythromycin (E.E.S.
,Erythrocin)

Antibiotic;GI stimulant/bacterial
infection; increase GI motility

QT TdP F>M,

Felbamate (Felbatrol)

Anti-convulsant/seizure

Flecainide(Tambocor)

Anti-arrhythmic/abnormal heart rhythm QT TdP

Association not
clear

Fluoxetine
(Prozac,Sarafem)

Anti-depressant/depression

QT TdP

Association not
clear

Foscarnet (Foscavir)

Anti-viral/HIV infection

QT

Fosphenytoin(Cerebyx)

Anti-convulsant/seizure

QT

Gatifloxacin(Tequin)

Antibiotic/bacterial infection

Halofantrine (Halfan)

Anti-malarial/malaria infection

Haloperidol (Haldol)

Anti-psychotic/schizophrenia, agitation QT TdP

Ibutilide(Corvert)

Anti-arrhythmic/abnormal heart rhythm QT TdP F>M,

Indapamide(Lozol)

Diuretic/stimulate urine & salt loss

QT

Isradipine(Dynacirc)

Anti-hypertensive/high blood pressure

QT

Levofloxacin(Levaquin)

Antibiotic/bacterial infection

Levomethadyl(Orlaam)

Opiate agonist/pain control, narcotic

dependence

QT

Mesoridazine(Serentil)

Anti-psychotic/schizophrenia

QT TdP

Moexipril/HCTZ (Uniretic)

Anti-hypertensive/high blood pressure

QT

Moxifloxacin (Avelox)

Antibiotic/bacterial infection

QT

Naratriptan (Amerge)

Serotonin receptor agonist/Migraine

treatment

QT

Nicardipine (Cardene)

Anti-hypertensive/high blood pressure

QT

Octreotide (Sandostatin)

Endocrine/acromegaly, carcinoid
diarrhea

QT

Paroxetine(Paxil)

Anti-depressant/depression

Pentamidine
(NebuPent,Pentam)

Anti-infective/pneumocystis pneumonia QT TdP F>M,

Pimozide(Orap )

Anti-psychotic/Tourette's tics

Procainamide (Procan
,Pronestyl)

Anti-arrhythmic/abnormal heart rhythm QT TdP

Quetiapine (Seroquel )

Anti-psychotic/schizophrenia

TdP

QT TdP F>M,

Cases in Lit,

TdP

Association not
clear

TdP

QT

QT

F>M, Cases in
Lit,

Quinidine(Cardioquin
,Quiniglute)

Anti-arrhythmic/abnormal heart rhythm QT TdP F>M,

Risperidone (Risperdal )

Anti-psychotic/schizophrenia

QT

Salmeterol (Serevent )

Sympathomimetic/asthma, COPD

QT

Sertraline(Zoloft)

Anti-depressant/depression

QT TdP

Sotalol (Betapace )

Anti-arrhythmic/abnormal heart rhythm QT TdP F>M,

Sparfloxacin (Zagam )

Antibiotic/bacterial infection

QT TdP

Sumatriptan(Imitrex )

Serotonin receptor agonist/Migraine

treatment

QT

Tacrolimus (Prograf)

Immunosuppressant/Immune
suppression

Tamoxifen (Nolvadex )

Anti-cancer/breast cancer

QT

Thioridazine(Mellaril )

Anti-psychotic/schizophrenia

QT TdP

Tizanidine (Zanaflex )

Muscle relaxant/

QT

Venlafaxine (Effexor )

Anti-depressant/depression

QT

Ziprasidone(Geodon )

Anti-psychotic/schizophrenia

QT

Zolmitriptan (Zomig )

Migraine treatment/

QT

Association not
clear

Cases in Lit,

We have compiled a list of drugs to avoid in patients with congenital Long QT syndrome. See below
for the full table.
The drugs listed here are potential triggers for Torsades de Pointes (Polymorphic Ventricular Tachycardia) or Ventricular
Fibrillation in the presence of a long QT interval. People who have a long QT interval, due either to congenital long QT
syndrome or due to a QT-prolonging effect of medications or certain heart muscle diseases, are generally advised to avoid use
of these medications if possible. In addition to these drugs, patients with a long QT interval should also avoid drugs that
prolong the QT interval, as listed in www.Torsades.org.

Chemical Name of
Drug

Brand Names of
Drug

Drug Class

Albuterol

Proventil, Ventolin, Bronchodilator

Volmax, Xopenex

Amantadine

Symmetrel

Cocaine
Dobutamine

In asthma: relieves wheezing /

bronchospasm

Dopaminergic / Parkinsons disease,

Anti-viral
Viral infections
Local
anesthetic

Dobutrex

Clinical Use

In surgery, to numb tissues

Catecholamine Heart failure and shock

Dopamine

Catecholamine Heart failure and shock

Ephedrine

Broncholate, Kie,
Marax, DF syrup,
Rynatuss

Bronchodilator, Allergies, sinusitis, asthma

Decongestant

Epinephrine

Adrenalin, Ana-Kit, Catecholamine, Treatment of anaphylaxis, other

Bronitin, Bronkaid, Vasoconstrictor allergic reactions.
Epifin,
Epinal,Epipen,
Can be combined with local
Epitrate, Eppy/N,
anesthetic to prolong their
Glaucon,
actions (e.g., Xylocaine,
Medihaler-Epi,
Sensorcaine)
Primatene, SusPhrine

Fenfluramine

Pondimin

Isoproterenol

Isuprel, Medihaler- Catecholamine Allergic reactions

Iso

Metaproterenol

Alupent, Metaprel, Bronchodilator

Metaproterenol

Midodrine

ProAmatine

Vasoconstrictor Prevent low blood pressure and

fainting (syncope)

Norepinephrine

Levophed

Vasoconstrictor Treatment for shock or low blood

Inotrope
pressure (BP).

Phentermine

Appetite
Adipex, Fastin,
Ionamin, Obenix, suppressant
Obephen,
Obermine,Obestin,
T-Diet

Phenylephrine

Neosynephrine

Appetite
suppressant

To aid dieting and weight loss

In asthma: relieves wheezing /

bronchospasm

To aid dieting and weight loss

Vasoconstrictor To raise blood pressure.

Decongestant
Allergies, sinusitis, asthma

Phenylpropanolamine Acutrim, Dexatrim, Decongestant

Phenoxine,
Phenyldrine,
Propagest,
Phindecon

Allergies, sinusitis, asthma

Pseudoephedrine

Novafed, PediaCare, Sudafed

Decongestant

Allergies, sinusitis, asthma

Ritodrine

Yutopar

Uterine
relaxant

Used to prevent premature labor

Salmeterol

Serevent

Bronchodilator

In asthma: relieves wheezing /

bronchospasm

Sibutramine

Meridia

Appetite
suppressant

To aid dieting and weight loss

Terbutaline

Brethaire,
Bronchodilator
Brethine, BrethineSC, Bricanyl

In asthma: relieves wheezing /

bronchospasm

Note: Certain herbal supplements including ephedra and ma huang contain compounds with similar
properties as the drugs listed here and should be avoided in patients with the long QT syndrome.
This list is maintained by Raymond L. Woosley, MD, PhD, Vice President for Health Sciences, University of Arizona Health
Sciences Center and Director, University of Arizona CERT (woosleyr@u.arizona.edu). 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 page 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.