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Reckless administration of QT interval-prolonging agents in elderly patients with drug-induced torsade de pointes

Riskante Gabe von QT-Intervall-verlängernden Wirkstoffen bei älteren Patienten mit arzneimittelinduzierter Torsade de pointes

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Abstract

A systematic review was conducted for all published case reports on drug-induced torsade de pointes (TdP) in elderly (≥80 years) patients to study if the administration of the offending agent was reckless. Overall, 61 reports on drug-induced TdP in patients aged 80–97 years were included in the analysis. Non-modifiable risk factors for drug-induced TdP (e.g. acute coronary syndrome, female gender and congestive heart failure), modifiable risk factors (e.g. hypokalemia, severe hypomagnesemia and digitalis toxicity) and reckless administration of a QT interval-prolonging agent (e.g. despite a known QT interval prolongation or a history of TdP, together with other QT interval prolonging agents in higher than recommended doses) were recorded in each case. Overall, 54 (88.5%) patients had non-modifiable risk factors for drug-induced TdP and 21 (34.4%) patients had modifiable risk factors. The administration of the offending agent was reckless in one half (n = 31; 50.8%) of the patients. The most prevalent reckless administration of a QT interval-prolonging agent was together with other QT interval-prolonging agents (n = 16; 51.6%) or despite QT interval prolongation (n = 8; 25.8%). In conclusion, although risk factors for drug-induced TdP are prevalent in elderly patients with drug-induced TdP, in approximately 50% of patients it appeared following a reckless administration of a QT interval-prolonging agent. In this population physicians should particularly avoid administration of two or more QT interval-prolonging agents simultaneously or administration of a QT interval-prolonging agent despite QT interval prolongation.

Zusammenfassung

Ein systematischer Review aller publizierten Fallberichte bezüglich arzneimittelinduzierter Torsade de pointes (TdP) bei älteren (≥80 Jahre) Patienten wurde durchgeführt, um zu untersuchen, wie riskant die Gabe des auslösenden Wirkstoffs war. Insgesamt wurden 61 Berichte über arzneimittelinduzierte TdP bei Patienten im Alter von 80–97 Jahren in die Analyse eingeschlossen. In jedem der Fälle wurde über nichtmodifizierbare Risikofaktoren für arzneimittelinduzierte TdP (z. B. akutes Koronarsyndrom, weibliches Geschlecht und kongestives Herzversagen), modifizierbare Risiken (z. B. Hypokaliämie, schwere Hypomagesiämie und Digitalistoxizität) sowie die riskante Gabe eines QT-Intervall-verlängernden Wirkstoffs (z. B. trotz einer bekannten QT-Intervall-Verlängerung oder eine Vorgeschichte von TdP, gemeinsam mit anderen QT-Intervall-verlängernden Substanzen in einer höheren als der empfohlenen Dosis) berichtet. Insgesamt hatten 54 (88,5%) Patienten nichtmodifizierbare und 21 (34,4%) Patienten modifizierbare Risikofaktoren für arzneimittelinduzierte TdP. Die Gabe des auslösenden Wirkstoffs war bei der Hälfte der Patienten (n = 31; 50,8%) riskant. Das größte Risiko stellte die Anwendung eines QT-Intervall-verlängernden Wirkstoffs in Kombination mit anderen QT-Intervall-verlängernden Substanzen (n = 16; 51,6%) oder die Gabe trotz einer QT-Intervall-Verlängerung (n = 8; 25,8%) dar. Obwohl bei älteren Patienten mit arzneimittelinduzierter TdP häufig Risikofaktoren für eine arzneimittelinduzierte TdP vorliegen, trat diese bei ca. 50% der Patienten nach einer riskanten Gabe eines QT-Intervall-verlängernden Wirkstoffs auf. In dieser Population sollten Ärzte insbesondere die gleichzeitige Gabe von zwei oder mehr QT-Intervall-verlängernden Wirkstoffen oder die Anwendung einer QT-Intervall-verlängernden Substanz trotz bestehender QT-Intervall-Verlängerung vermeiden.

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Authors and Affiliations

  1. Department of Internal Medicine and Geriatrics D, Sheba Medical Center, 5265601, Tel-Hashomer, Israel

    Galia Jackobson, Narin Nard Carmel, Anjelika Kremer & Dan Justo MD

  2. Department of Internal Medicine T, Sheba Medical Center, Tel-Hashomer, Israel

    Dor Lotan

  3. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Dan Justo MD

Authors
  1. Galia Jackobson
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  2. Narin Nard Carmel
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  3. Dor Lotan
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  4. Anjelika Kremer
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  5. Dan Justo MD
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Corresponding author

Correspondence to Dan Justo MD.

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Conflict of interest

G. Jackobson, N.N. Carmel, D. Lotan, A. Kremer and D. Justo declare that they have no competing interests.

This article does not contain any studies on human participants or animals performed by any of the authors.

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Jackobson, G., Carmel, N.N., Lotan, D. et al. Reckless administration of QT interval-prolonging agents in elderly patients with drug-induced torsade de pointes. Z Gerontol Geriat 51, 41–47 (2018). https://doi.org/10.1007/s00391-016-1155-5

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  • DOI: https://doi.org/10.1007/s00391-016-1155-5

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