title: Other drugs acting on nervous system associated with QT-interval prolongation.
abstract: Several drugs acting on the nervous system have been implicated in the prolongation of the QT interval. Leaving aside the antidepressant and antipsychotic drugs, some have shown to prolong the QT interval in vivo. These include opioids, particularly methadone, inhalational anesthetics, and some preparations used for treatment of cough. These drugs have a narrow therapeutic interval or possible drug interactions that lead to clinical toxicity manifested by arrhythmias. They share the ability to block potassium channels (HERG), prolong the action potential and QT interval, and generate arrhythmias and Torsades de Pointes like other typicality recognized like antiarrhythmics, antihistamines, prokinetics, psychotropics and anti-infectives agents. Muscle relaxants like alcuronium, pancuronium and atracurium associated with or without atropine prolong significantly the QT interval. Methadone is the opiod most tightly associated with QTc prolongation; with much lesser potency buprenorphine and oxycodone can block HERG channels and depress the IKr current in vitro.Antineoplastic chemotherapy like anthracyclines, alkylating drugs, alkilants and cisplatin are associated with electrocardiographic alterations including prolongation of QT and emesis of different grades. It's very important take in account the synergic effects over the QT prolongation when effective antiemetics like 5-HT3 receptor antagonist (granisetron, ondansetron, and dolasetron) are administered. The Knowledge of their pharmacological properties is of vital importance to avoid exposing particularly vulnerable individuals as those with congenital long QT syndrome, and even the general public to unnecessary risk of potentially fatal arrhythmias.
authors.affiliation: Pharmacovigilance Unit, Second Chair of Pharmacology, School of Medicine, Universidad de Buenos Aires, Argentina. catedra2@farmaco-vigilancia.com.ar
authors.forename: Guillermo Alberto
authors.initials: GA
authors.lastname: Keller
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Ponte
authors.forename: Guillermo
authors.initials: G
authors.lastname: Di Girolamo
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000494:pharmacology; D000818:Animals; D000996:Antitussive Agents / Q000009:adverse effects / Q000494:pharmacology; D002491:Central Nervous System Agents / Q000009:adverse effects* / Q000494:pharmacology; D004347:Drug Interactions; D000072237:ERG1 Potassium Channel; D051638:Ether-A-Go-Go Potassium Channels / Q000037:antagonists & inhibitors; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000151:congenital; D012307:Risk Factors; D016171:Torsades de Pointes / Q000139:chemically induced*
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D000996:Antitussive Agents; D002491:Central Nervous System Agents; D000072237:ERG1 Potassium Channel; D051638:Ether-A-Go-Go Potassium Channels; C000606913:KCNH2 protein, human