PREVENTION OF QTC PROLONGATION WHILE TREATING INFECTION IN PATIENT ON AMIODARONE, AND TRAZODONE
What would you prescribe for someone has a chest infection, allergic to Levaquin, penicillin and taking amiodarone and trazodone? Long QT increased risk of ventricular arrhythmias and sudden cardiac death. QTc prolongation results from dysfunction of cardiac ion channels; predominantly altered function of cardiac potassium (Ikr and Iks) or cardiac sodium channels (Ina) may elicit the phenotype of the long QT syndrome.2 In the congenital form of long QT syndrome (cLQTS), the ion channels are
... on channels are dysfunctional due to inherited mutations. but the same ion channels can also be affected by numerous drugs and hypokalaemia. Polypharmacy leads to a high risk of adverse eوٴects. Accordingly, it is crucial to recognize patients receiving medicines that can induce QT interval prolongation and accomplish serial electrocardiograms, due to the possible risk of ventricular arrhythmias. Especially this patient that was on trazodone and was just diagnosed with atrial fibrillation to be on additional qt prolonging drug-like amiodarone.In addition to everything else, she developed a chest infection and required more antibiotics. What makes it harder is that she is allergic to Levaquin and which stop us from giving the best medications for lung infection even the cephalosporins due to the cross-reactivity with penicillin. The only option was azithromycin but the latter also increase risk of long qt and causing arrhythmia and sudden death if put with the others. After extensive discussion with other health care providers, we started her on Doxycycline under very close observation.