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Drug-specific risk of severe QT prolongation following acute drug overdose.
Clin Toxicol (Phila). 2020 Apr 07 [Online ahead of print]CT

Abstract

Background:

Severe QT prolongation (SQTP) has been identified as a strong predictor of adverse cardiovascular events in acute drug overdose, but drug-specific causes of SQTP in the setting of acute drug overdose remain unclear. We aimed to perform the most definitive study to date describing drug-specific risk of SQTP following acute drug overdose.

Methods:

This was a prospective multicenter cohort study at >50 hospital sites across the US using the ToxIC Registry between 2015 and 2018. Inclusion criteria were adults (≥18 years) receiving medical toxicology consultation for acute drug overdose. The primary outcome was SQTP, which was defined using the computer automated Bazett QT correction (QTc) on the ECG with the previously validated cut point of 500 milliseconds. Mean difference in QTc was also calculated for specific drugs. Drugs associated with SQTP were analyzed using multivariable logistic regression to control for known confounders of QT risk (age, sex, race, cardiac disease).

Results:

From 25,303 patients screened, 6473 met inclusion criteria with SQTP occurring in 825 (13%). Drugs associated with increased adjusted odds of SQTP included Class III antidysrhythmics (sotalol), sodium channel blockers (amitriptyline, diphenhydramine, doxepin, imipramine, nortriptyline), antidepressants (bupropion, citalopram, escitalopram, trazodone), antipsychotics (haloperidol, quetiapine), and the antiemetic serotonin antagonist ondansetron.

Conclusions:

This large US cohort describes drug-specific risk of SQTP following acute drug overdose. Healthcare providers caring for acute drug overdoses from any of these implicated drugs should pay close attention to cardiac monitoring for occurrence of SQTP.

Authors+Show Affiliations

Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA.Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA.Division of Medical Toxicology, Department of Emergency Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32252558

Citation

Campleman, Sharan L., et al. "Drug-specific Risk of Severe QT Prolongation Following Acute Drug Overdose." Clinical Toxicology (Philadelphia, Pa.), 2020, pp. 1-9.
Campleman SL, Brent J, Pizon AF, et al. Drug-specific risk of severe QT prolongation following acute drug overdose. Clin Toxicol (Phila). 2020.
Campleman, S. L., Brent, J., Pizon, A. F., Shulman, J., Wax, P., & Manini, A. F. (2020). Drug-specific risk of severe QT prolongation following acute drug overdose. Clinical Toxicology (Philadelphia, Pa.), 1-9. https://doi.org/10.1080/15563650.2020.1746330
Campleman SL, et al. Drug-specific Risk of Severe QT Prolongation Following Acute Drug Overdose. Clin Toxicol (Phila). 2020 Apr 7;1-9. PubMed PMID: 32252558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drug-specific risk of severe QT prolongation following acute drug overdose. AU - Campleman,Sharan L, AU - Brent,Jeffery, AU - Pizon,Anthony F, AU - Shulman,Joshua, AU - Wax,Paul, AU - Manini,Alex F, AU - ,, Y1 - 2020/04/07/ PY - 2020/4/8/entrez KW - Overdose KW - QT prolongation KW - electrocardiography KW - poisoning KW - toxicology SP - 1 EP - 9 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) N2 - Background: Severe QT prolongation (SQTP) has been identified as a strong predictor of adverse cardiovascular events in acute drug overdose, but drug-specific causes of SQTP in the setting of acute drug overdose remain unclear. We aimed to perform the most definitive study to date describing drug-specific risk of SQTP following acute drug overdose.Methods: This was a prospective multicenter cohort study at >50 hospital sites across the US using the ToxIC Registry between 2015 and 2018. Inclusion criteria were adults (≥18 years) receiving medical toxicology consultation for acute drug overdose. The primary outcome was SQTP, which was defined using the computer automated Bazett QT correction (QTc) on the ECG with the previously validated cut point of 500 milliseconds. Mean difference in QTc was also calculated for specific drugs. Drugs associated with SQTP were analyzed using multivariable logistic regression to control for known confounders of QT risk (age, sex, race, cardiac disease).Results: From 25,303 patients screened, 6473 met inclusion criteria with SQTP occurring in 825 (13%). Drugs associated with increased adjusted odds of SQTP included Class III antidysrhythmics (sotalol), sodium channel blockers (amitriptyline, diphenhydramine, doxepin, imipramine, nortriptyline), antidepressants (bupropion, citalopram, escitalopram, trazodone), antipsychotics (haloperidol, quetiapine), and the antiemetic serotonin antagonist ondansetron.Conclusions: This large US cohort describes drug-specific risk of SQTP following acute drug overdose. Healthcare providers caring for acute drug overdoses from any of these implicated drugs should pay close attention to cardiac monitoring for occurrence of SQTP. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/32252558/Drug-specific_risk_of_severe_QT_prolongation_following_acute_drug_overdose L2 - http://www.tandfonline.com/doi/full/10.1080/15563650.2020.1746330 DB - PRIME DP - Unbound Medicine ER -
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