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Validation of a population‐based method to assess drug‐induced alterations in the QT interval: a self‐controlled crossover study
Author(s) -
Iribarren Carlos,
Round Alfred D.,
Peng Jonathan A.,
Lu Meng,
Zaroff Jonathan G.,
Holve Taylor J.,
Prasad Amit,
Stang Paul
Publication year - 2013
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3479
Subject(s) - medicine , qt interval , amiodarone , flecainide , long qt syndrome , dronedarone , population , pharmacology , anesthesia , environmental health , atrial fibrillation
Purpose The purpose of this study was to ascertain, in the context of an integrated health care delivery system, the association between a comprehensive list of drugs known to have potential QT liability and QT prolongation or shortening. Methods By using a self‐controlled crossover study with 59 467 subjects, we ascertained intra‐individual change in log‐linear regression‐corrected QT ( QT creg ) during the period between 1995 and mid‐2008 for 90 drugs while adjusting for age, gender, race/ethnicity, comorbid conditions, number of electrocardiograms (ECGs), and time between pre‐ECG and post‐ECG. The proportion of users of each drug‐developing incident long QT was also estimated. Results Two drugs (nicardipine and levalbuterol) had no statistically significant intra‐individual QT creg shortening effects, 10 drugs had no statistically significant prolonging effect, and 78 (87%) of the drugs had statistically significant intra‐individual mean QT creg lengthening effects, ranging from 7.6 ms for aripiprazole to 25.2 ms for amiodarone. Three drugs were associated with mean QT creg prolongation of 20 ms or greater: amiodarone (antiarrhythmic), terfenadine (antihistaminic), and quinidine (antiarrhythmic); whereas 11 drugs were associated with mean QT creg prolongation of 15 ms or greater but less than 20 ms: trimipramine (tricyclic antidepressant), clomipramine (tricyclic antidepressant), disopyramide (antiarrhythmic), chlorpromazine (antipsychotic), sotalol (beta blocker), itraconazole (antifungal), phenylpropanolamine (decongestant/anorectic), fenfluramine (appetite suppressant), midodrine (antihypotensive), digoxin (cardiac glycoside/antiarrhythmic), and procainamide (antiarrhythmic). Conclusions QT prolonging effects were common and varied in strength. Our results lend support to past Food and Drug Administration regulatory actions and support the role for ongoing surveillance of drug‐induced QT prolongation. Copyright © 2013 John Wiley & Sons, Ltd.