From the Guidelines
Antiemetics that do not prolong the QT interval are not explicitly listed in the provided evidence, however, it can be inferred that medications not mentioned as QT-prolonging agents may be considered safe.
- Medications such as metoclopramide 1 are not mentioned in the list of QT-prolonging agents, which includes domperidone, ondansetron, palosetron, granisetron, prochlorperazine, olanzapine, escitalopram, venlafaxine, sertraline, and mirtazapine 1.
- It is essential to note that while metoclopramide is not listed as a QT-prolonging agent in this specific study, other sources may suggest caution with its use, particularly at high doses or in combination with other medications.
- In the absence of explicit evidence, dopamine antagonists like metoclopramide may be considered for patients at risk of QT interval prolongation, although electrocardiogram monitoring is still recommended, particularly with prolonged use or in combination with other QT-prolonging medications.
- The management of QT interval prolongation involves correcting electrolyte abnormalities, discontinuing QT-prolonging medications, and considering treatments like IV magnesium and overdrive pacing in severe cases 1.
- Ultimately, the choice of antiemetic should be guided by the individual patient's risk factors, medical history, and the potential for drug interactions, with careful consideration of the available evidence and consultation with relevant guidelines 1.
From the FDA Drug Label
In this study, the 8 mg dose infused over 15 minutes did not prolong the QT interval to any clinically relevant extent. The antiemetic ondansetron at a dose of 8 mg infused over 15 minutes does not prolong the QT interval to a clinically relevant extent 2.
From the Research
Antiemetics and QT Interval Prolongation
- The relationship between antiemetics and QT interval prolongation has been studied in various research papers 3, 4, 5, 6, 7.
- Some studies have found that ondansetron, a commonly used antiemetic, can cause QT interval prolongation 3, 6, 7.
- However, other studies have found that ondansetron does not significantly prolong the QT interval 4, 5.
- Dolasetron, another antiemetic, has been found not to prolong the QT interval when used in perioperative doses 5.
Specific Antiemetics and QT Interval Prolongation
- Ondansetron:
- A study found that ondansetron caused a mean prolongation of the QTc by 20 ms 3.
- Another study found that ondansetron administration was associated with a mean QTc increase of 16.2 msec 6.
- However, a study found that the mean QT interval before and after injection of 4 mg intravenous ondansetron was not statistically significant 4.
- Dolasetron:
- A study found that perioperative use of dolasetron was not associated with extended QT prolongation 5.
Clinical Significance
- The clinical significance of QT interval prolongation caused by antiemetics is still debated 3, 5.
- Some studies suggest that the risk of torsades de pointes and other cardiac arrhythmias may be increased in patients with underlying cardiovascular disease or other risk factors 7.
- However, other studies have found that the QT interval prolongation caused by antiemetics is not clinically significant 5.