From the Guidelines
Palonosetron is a preferred anti-nausea medication that does not cause QT prolongation, as evidenced by recent studies 1. When considering anti-nausea medications that do not cause QT prolongation, several options are available.
- Metoclopramide (Reglan) is commonly used at 10mg orally or IV every 6 hours as needed.
- Prochlorperazine (Compazine) can be administered as 5-10mg orally or IV every 6-8 hours.
- Promethazine (Phenergan) is typically given as 12.5-25mg orally, IV, or rectally every 4-6 hours.
- Dexamethasone is often used at 4-8mg IV or orally for chemotherapy-induced nausea. However, palonosetron is a safer alternative due to its lack of QT prolongation risk, as highlighted in a study from 2015 1. Additionally, a more recent study from 2022 1 discusses the use of various anti-nausea medications, including those that do not cause QT prolongation, such as domperidone and phenothiazine antipsychotics. It's essential to note that while these medications don't typically cause QT prolongation, they may have other side effects, such as extrapyramidal symptoms with metoclopramide or sedation with antihistamines like promethazine. For patients with cardiac concerns requiring anti-nausea treatment, palonosetron and other non-QT-prolonging medications are generally safer alternatives to QT-prolonging medications like ondansetron or dolasetron 1.
From the Research
Anti-Nausea Medications without QT Prolongation
- Ondansetron is an option as it is not associated with QT prolongation 2
- Amisulpride, a dopamine D2 and D3 antagonist, does not meaningfully prolong the QTc interval at doses effective for the management of postoperative nausea and vomiting 3
- Some dopamine antagonists, when given at lower doses for non-chemotherapy-induced nausea and vomiting treatment, have a rare risk of QT prolongation 4
Medications to Avoid due to QT Prolongation Risk
- Droperidol, due to the US Food and Drug Administration black box warning regarding the potential for QT prolongation 2
- Serotonin antagonists and some dopamine antagonists, such as metoclopramide, can prolong the QT interval on the ECG 5
- Antidopaminergics and 5-HT3 receptor antagonists may place patients at risk for QTc prolongation 6