Electrocardiogram (EKG/ECG) changes Side Effect

Drugs that may cause changes of the electrocardiogram (affect components of the ECG curve):

EKG changes

Drug Incidence
Aceon 1.8%
Aciphex
Aloprim < 1%
Amerge Infrequent
Anzemet Rare
Aralen Rare
Atacand > 0.5%
Avelox < 0.1%
Azactam < 1%
Bextra Rare
Busulfex 2%
Cardene 1.4%
Cardizem < 2%
Carnitor 2% to 6%
Catapres < 0.5%
Clorpres Rare
Clozapine 1%
Clozaril 1%
Demadex 2%
Digitek
Diprivan < 1%
Effexor
Eskalith
Evoxac < 1%
FazaClo 1%
Gabitril Infrequent
Haldol Decanoate
Imitrex Infrequent
Kytril Rare
Lamictal Rare
Lanoxicaps
Lanoxin
Lexapro Infrequent
Lofibra
Lotensin
Lupron > 5%
Micardis > 0.3%
Midamor
Naropin < 1%
Nimotop < 1.4%
Novantrone 5% to 11%
Orap 2.7%
Paxil Infrequent
Permax Infrequent
Prandin < 1%
Prograf 3% to 15%
Protonix, < 1%
Retrovir 2.4% to 3%
Salagen < 1%
Seroquel Rare
Suprane < 1%
Taxotere
Teveten < 1%
Thioridazine
Tiazac < 2%
Tricor
Ultram Infrequent
Uniretic > 1%
Verelan 2%
Viagra < 2%
Xopenex
Zemuron < 1%
Zofran Rare
Zomig Rare


PR interval prolongation

PR interval represents the time that it takes an impulse to travel through the atrium and atrioventricular conduction system to the ventricles. Drugs associated with PR interval prolongation:

Drug Incidence
Digoxin (Digitek®, Lanoxin®)1
Donepezil (Aricept®)3
Naratriptan (Amerge®) Infrequent
Propranolol (Atenolol®, Metoprolol®)1
Sumatriptan (Imitrex®) Infrequent
Verapamil (®)2 linearly related to verapamil plasma concentrations


QRS interval prolongation

Medications that block the cardiac Na+ channel are associated with QRS prolongation, including Class I anti-arrhythmics, tricyclic antidepressants, antipsychotics, anticonvulsants, and antimalarials 6.

Drugs with a risk of causing QRS prolongation:

Drug Incidence
Amiodarone
Amitriptyline
Amodiaquine
Amoxapine
Bupivacaine
Bupropion
Carbamazepine
Chloroquine (Aralen®)4 Rare
Citalopram
Desethylamodiaquine
Desipramine
Diltiazem
Diphenhydramine
Dolasetron
Fluoxetine
Imipramine
Lamotrigine
Maprotiline
Mesoridazine
Nortriptyline
Perhexiline
Procaine
Quetiapine (Seroquel®)5 Infrequent
Quinine
Risperidone
Ropivacaine
Thioridazine
Venlafaxine


QT interval prolongation

QT interval is a measure for duration between ventricular depolarization and repolarization. The prolonged QT interval is associated with Torsades de Pointes, a life-threatening ventricular arrhythmia.

Many QT prolonging drugs act by blocking I(Kr), and few drugs are known to prolong the QTc interval by modifying I(Na).

List of QT interval prolonging drugs:

Drug Incidence
Abilify < 1%
Aciphex Rare
Aloxi < 1%
Amerge Infrequent
Apokyn
Celexa
Diflucan
E.E.S.
Effexor Rare
Erythrocin Rare
Erythromycin Rare
Geodon
Haldol Decanoate
Imitrex Infrequent
Levaquin
Lexapro
Noroxin Rare
Orap
PCE Dispertab
Plenaxis > 10%
Prozac
Reminyl Infrequent
Rythmol
Seroquel Infrequent
Symbyax Infrequent
Thioridazine
Trisenox 8%
Uniretic < 1%
VFEND < 1%
Viracept
Zoloft
Zomig Rare


Sinus pause

Drug Incidence
Flecainide (Tambocor®) 1% to 3%


ST section

Drug Incidence
AccuNeb RareAdenoscan
Amerge Infrequent
Anzemet
Cardene Rare
Clozapine
Clozaril
Digitek
Diprivan < 1%
Ellence
Imitrex Infrequent
Lanoxicaps
Lanoxin
Naropin < 1%
OxyContin < 1%
Risperdal Rare
Seroquel Rare
Tarka > 0.3%


T wave

T wave represents repolarization of the ventricles.

Drug Incidence
Adenoscan < 1%Amerge
Anzemet
Aralen Rare
Cardene Rare
Clozapine
Clozaril
Eskalith
Evoxac < 1%
Imitrex Infrequent
Moban Rare
Orap
Pentasa Infrequent
Reminyl Infrequent
Risperdal Rare
Sular < 1%
Symbyax Rare
Tarka > 0.3%
Uniretic < 1%

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References

  • 1. LeWinter MM, Crawford MH, O'Rourke RA, Karliner JS. The effects of oral propranolol, digoxin and combination therapy on the resting and exercise electrocardiogram. Am Heart J. 1977 Feb;93(2):202-9. PubMed
  • 2. Zachariah PK, Shub C, Sheps SG, Schirger A, Wolf MK, Carlson CA. Correlation between verapamil plasma concentration and P-R prolongation in essential hypertension. J Clin Pharmacol. 1988 Sep;28(9):843-7. PubMed
  • 3. Igeta H, Suzuki Y, Tajiri M, Someya T. Cardiovascular pharmacodynamics of donepezil hydrochloride on the PR and QT intervals in patients with dementia. Hum Psychopharmacol. 2014 May;29(3):292-4. PubMed
  • 4. Curry SC, Connor DA, Clark RF, Holland D, Carrol L, Raschke R. The effect of hypertonic sodium bicarbonate on QRS duration in rats poisoned with chloroquine. J Toxicol Clin Toxicol. 1996;34(1):73-6. PubMed
  • 5. Eyer F, Pfab R, Felgenhauer N, Strubel T, Saugel B, Zilker T. Clinical and analytical features of severe suicidal quetiapine overdoses--a retrospective cohort study. Clin Toxicol (Phila). 2011 Nov;49(9):846-53.
  • 6. Harmer AR, Valentin JP, Pollard CE. On the relationship between block of the cardiac Na⁺ channel and drug-induced prolongation of the QRS complex. Br J Pharmacol. 2011 Sep;164(2):260-73. PubMed

Published: August 03, 2016
Last updated: December 12, 2017

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