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% |
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
