Tachycardia associated with moxifloxacin
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7277.23 (Published 06 January 2001) Cite this as: BMJ 2001;322:23All rapid responses
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I too was taken aback by the skimpy nature of this report and it's
vague clinical context. I would agree with the first respondent that there
are many unclear issues. Surely at least an ECG is required to illustrate
the complex noted with a serious clinical event suggested. Were drugs of
abuse such as cocaine or amphetamines ruled out seems another basic
assessment which is missing. These interactions are always important in
context of the patient, their genetic susceptibility and the drug dose
metabolism.
There is a large world interest in this type of rare adverse drug
reaction and as none of the floruquinolones are listed in that database
then the authors might wish to provide a more detailed report via the
following web site -
http://www.georgetowncert.org/qtdrugs_torsades.asp
I would recommend it to interested readers of this potentially
important observation.
Competing interests: No competing interests
I am curious as to the type of tachycardia induced, i.e. ventricular,
Torsades... The rate, 120, would not suggest a ventricual origin. Also,
has there been any other investigation into the mechanism. It seems that
this patient had this happen only once, was that common among all
patients? You mentioned that he was afrebrile, was he afebrile at the time
of the tachycardia? Also, he was said to have taken 500mg of Aspirin for a
headache. Are you sure it was not Tylenol or another p450 medication? On
that line of thinking, has Torsades ever been recorded on (a) patient(s)
taking these meds? If so, is it associated with any concomitant meds?
This is an interesting topic. Docs have been using Cipro for years
without too many side effects or problems. Are these tachycardias
associated only with the newer meds in this class?
Lastly, it seems that yearly we are exposed to a flouroquinolone that
is supposed to be "the drug for all bugs." Trovan came out, and people
died. Now we are seeing these problems. What is next with this class of
antibiotics? Why do some stand the test of time, i.e. Cipro, and some
don't? Is the American FDA not doing it's job in pre-release testing?
I learned a while back to hold off using any of these new super drugs
for at least a year. I saw too many docs giving out Fen-Phen like candy.
Now these docs are named in lawsuits. So, as a resident, I learned to wait
and watch as the more bold try things. If a patient is adamant about a new
med, I always tell them my thoughts and document their wishes on the chart
in detail.
Thanks for this interesting and thought provoking article.
Competing interests: No competing interests
Torsades R Us
This is an interesting article. It's not clear what kind of
tachycardia this man had, but it's certainly worth considering medication-
induced torsades. An international registry of medication-induced
arrhythmias has now been established, to enable collection of cases of
this rare but serious adverse event. Please contact us if you have
encountered cases of probable or possible medication-related torsades -
see www.qtdrugs.org &/or call 1-888-826-3847. All that is required is
some clinical information, ECG(s) and some DNA (blood or buccal swab).
Whether the patient had a bad outcome or a lucky escape, it is tragic to
lose the opportunity to learn from their experience. If we can figure out
the genetics and other risk factors for vulnerability, we may be able to
prevent future tragedies.
Michael Kilborn
Competing interests: No competing interests