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Real-world implications of QT prolongation in patients receiving voriconazole and amiodarone.

Publication ,  Journal Article
Mourad, A; Stiber, JA; Perfect, JR; Johnson, MD
Published in: J Antimicrob Chemother
January 1, 2019

OBJECTIVES: Voriconazole, a triazole antifungal, is frequently prescribed in a complex patient population with comorbidities that require concomitant administration of QT interval-prolonging medications. We sought to evaluate QT interval prolongation in patients receiving concomitant therapy with voriconazole and amiodarone and to assess the development of any potentially fatal cardiac arrhythmias as a result. METHODS: We conducted a retrospective observational study of patients who had received amiodarone and voriconazole concomitantly between 2005 and 2015, with a prior period of monotherapy, who had ECG data during monotherapy (baseline) and concomitant therapy (follow-up). RESULTS: We included 46 patients in our final analysis. Overall, the mean change in QT corrected (QTc) from baseline to follow-up was 49.0 ms (P < 0.001). Eighteen (39.1%) patients had a follow-up QTc interval ≥500 ms, with 17 (37.0%) having a change in QTc interval ≥60 ms from baseline to follow-up. Men were more likely to have a follow-up QTc interval of ≥500 ms. In multivariate analysis, only low serum potassium concentration and concomitant 'possible' QT-prolonging drugs were associated with a follow-up QTc interval ≥500 ms and a lower baseline QTc interval was associated with a change in QTc interval of ≥60 ms. Discharge diagnoses of cardiac arrhythmias and events were assessed and none was found to be related to concomitant therapy. CONCLUSIONS: Concomitant therapy with amiodarone and voriconazole significantly prolonged the QTc interval to a degree greater than that on monotherapy. However, no clinically significant cardiac events were observed.

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Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

January 1, 2019

Volume

74

Issue

1

Start / End Page

228 / 233

Location

England

Related Subject Headings

  • Voriconazole
  • Retrospective Studies
  • Middle Aged
  • Microbiology
  • Male
  • Long QT Syndrome
  • Humans
  • Female
  • Drug Interactions
  • Antifungal Agents
 

Citation

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Mourad, A., Stiber, J. A., Perfect, J. R., & Johnson, M. D. (2019). Real-world implications of QT prolongation in patients receiving voriconazole and amiodarone. J Antimicrob Chemother, 74(1), 228–233. https://doi.org/10.1093/jac/dky392
Mourad, Ahmad, Jonathan A. Stiber, John R. Perfect, and Melissa D. Johnson. “Real-world implications of QT prolongation in patients receiving voriconazole and amiodarone.J Antimicrob Chemother 74, no. 1 (January 1, 2019): 228–33. https://doi.org/10.1093/jac/dky392.
Mourad A, Stiber JA, Perfect JR, Johnson MD. Real-world implications of QT prolongation in patients receiving voriconazole and amiodarone. J Antimicrob Chemother. 2019 Jan 1;74(1):228–33.
Mourad, Ahmad, et al. “Real-world implications of QT prolongation in patients receiving voriconazole and amiodarone.J Antimicrob Chemother, vol. 74, no. 1, Jan. 2019, pp. 228–33. Pubmed, doi:10.1093/jac/dky392.
Mourad A, Stiber JA, Perfect JR, Johnson MD. Real-world implications of QT prolongation in patients receiving voriconazole and amiodarone. J Antimicrob Chemother. 2019 Jan 1;74(1):228–233.
Journal cover image

Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

January 1, 2019

Volume

74

Issue

1

Start / End Page

228 / 233

Location

England

Related Subject Headings

  • Voriconazole
  • Retrospective Studies
  • Middle Aged
  • Microbiology
  • Male
  • Long QT Syndrome
  • Humans
  • Female
  • Drug Interactions
  • Antifungal Agents