Key result
Systemic antifungal agents alone rarely triggered Torsade de pointes, as all 28 reported cases had prior risk factors like concomitant QT-prolonging agents (89.2%) or female gender (71.4%).
Why the study?
What are the risk factors associated with Torsade de pointes induced by systemic antifungal agents?
What are the risk factors associated with Torsade de pointes induced by systemic antifungal agents?
Systemic antifungal agents rarely trigger Torsade de pointes alone, but typically do so in the presence of other risk factors such as concomitant QT-prolonging medications or female gender.
QT monitoring for systemic antifungals should focus on patients with additional risk factors; case reports leave open independent proarrhythmic effects.
Torsade de pointes (TdP) is a potentially fatal arrhythmia that might be associated with systemic antifungal agent (SAFAs) administration. The objective of this study was to investigate all published reports on TdP induced by SAFAs in order to characterise this association. Each original report was analysed for the presence of risk factors for TdP: female gender, structural heart disease, electrolyte imbalance, concomitant use of a QT interval prolonging agent which SAFA inhibits its liver metabolism, liver cirrhosis, renal failure and more. Naranjo probability scale for adverse drug reactions was applied for every full report. Twenty-one reports on 28 patients were analysed. All patients survived. Most patients (25/28; 89.2%) used one or more agents that might have prolonged the QT interval and their liver metabolism might have been inhibited by SAFA. Female gender was the second most common risk factor for TdP (20/28; 71.4%). All patients, including female patients, had one or more risk factors for TdP prior to SAFA administration. According to Narajno probability scale, there was no definite association between TdP and SAFA in any report. SAFA alone might seldom trigger TdP. We wish to raise the level of awareness of risk factors for TdP prior to SAFA administration and for concomitant use of other dysrhythmogenic agents in particular.
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Justo et al. (2006) conducted a review in Torsade de pointes (n=28). Systemic antifungal agents was evaluated on Presence of risk factors for TdP and Naranjo probability scale. Systemic antifungal agents alone rarely triggered Torsade de pointes, as all 28 reported cases had prior risk factors like concomitant QT-prolonging agents (89.2%) or female gender (71.4%).
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