From the Guidelines
Antiemetics that do not prolong the QT interval include ondansetron, palonosetron, dexamethasone, and benzodiazepines like lorazepam, as these are safer options for patients with risk factors for QT prolongation or those taking other QT-prolonging drugs. According to the most recent evidence 1, metoclopramide is not recommended due to its potential to prolong the QT interval. Ondansetron (4-8mg IV/PO every 6-8 hours) and palonosetron (0.25mg IV every 24-48 hours) are 5-HT3 antagonists that are effective for chemotherapy-induced and postoperative nausea. Dexamethasone (4-8mg IV/PO daily) is valuable for chemotherapy-induced and postoperative nausea. Lorazepam (0.5-2mg PO/IV every 6 hours) can help with anticipatory nausea or anxiety-induced symptoms. These medications work through different mechanisms, including serotonin antagonism, anti-inflammatory effects, or GABA enhancement, providing options for treating nausea without the cardiac risks associated with QT prolongation. It's essential to note that the choice of antiemetic should be based on the individual patient's risk factors and medical history, and the most recent guidelines should be consulted for the latest recommendations 1.
From the Research
Antiemetics that do not Prolong QT Interval
- Domperidone is mentioned as a prokinetic that possesses a low risk of extrapyramidal side effects and does not significantly prolong the QT interval 2, 3.
- Metopimazine is another dopamine antagonist that has a low risk of extrapyramidal side effects, but its effect on the QT interval is not explicitly stated as being low risk 2.
- Antihistamines are first-line options for nausea and vomiting in pregnancy and are not typically associated with QT interval prolongation 4.
- Corticosteroids, such as dexamethasone, are used in antiemetic regimens and are not known to prolong the QT interval 2.
- 5-HT3 receptor antagonists, such as ondansetron, are effective in treating chemotherapy-induced nausea and vomiting, but their effect on the QT interval varies, with some agents in this class being associated with QT prolongation 4, 2.
- Neurokinin (NK)1-RAs, such as aprepitant, are used in combination with other antiemetics for chemotherapy-induced nausea and vomiting, and their impact on the QT interval is not typically significant 4, 2.
Considerations for QT Interval Prolongation
- Many dopamine antagonists, including metoclopramide, haloperidol, and prochlorperazine, can increase the risk of prolonged QTc interval 2, 5.
- The risk of QTc prolongation should be considered when choosing an antiemetic, especially in patients with underlying heart conditions or those taking other medications that can prolong the QT interval 6, 5.