The Medical Letter on Drugs and Therapeutics
Issue 1509
In Brief: PPIs and Torsades de Pointes; Ciprofloxacin/Fluocinolone (Otovel) for Otitis Media with Tympanostomy Tubes; Ameluz for Actinic Keratoses; Sublingual Nitroglycerin Powder (GoNitro); In Brief: Phentermine (Lomaira) for Weight Loss; Addendum: Statins for Primary Prevention of Cardiovascular Disease
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In Brief: PPIs and Torsades de Pointes
11/29/2016: The first sentence of the second paragraph has been reworded.

The Arizona Center for Education and Research on Therapeutics (AZCERT) has recently added the proton pump inhibitors (PPIs) omeprazole (Prilosec, and others), esomeprazole (Nexium, and others), lansoprazole (Prevacid, and others), and pantoprazole (Protonix, and generics) to its lists of Drugs with Conditional Risk of Torsades de Pointes (TdP) and Drugs to Avoid in Patients with Congenital Long QT Syndrome.1

PPIs do not directly cause prolongation of the QT interval, but they have been associated with hypomagnesemia, which is often accompanied by hypocalcemia and hypokalemia and can result in cardiac repolarization disturbances such as QT interval prolongation.2 Reports have described cases of QT interval prolongation and TdP associated with severe PPI-induced hypomagnesemia.3,4 TdP has also ... more      

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