{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:18:21Z","timestamp":1747149501642,"version":"3.40.5"},"reference-count":64,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accp1.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Clinical Pharma"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This is an article in the <jats:italic>Journal of Clinical Pharmacology's<\/jats:italic> Core Entrustable Professional Activities in Clinical Pharmacology series that discusses drug\u2010induced proarrhythmia and is offered as a teaching aid for medical students and residents. Drugs from diverse pharmacological classes can lead to multiple types of arrhythmias including the polymorphic ventricular tachycardia torsades de pointes (TdP). Although typically occurring in self\u2010limiting bursts with or without associated symptoms, which can range from mild lightheadedness and palpitations to syncope and seizures, TdP can also occasionally progress to ventricular fibrillation and sudden cardiac death. To provide patients with the optimal therapeutic benefits of potentially proarrhythmic drugs, prescribers are responsible for obtaining a good understanding of the compound's benefit\u2010risk properties and perform a judicious assessment of the patient's clinical characteristics and individual risk factors. Dose adjustments and\/or additional monitoring of electrocardiograms and electrolyte balances may be appropriate in some cases. This article explains the pharmacological mechanism of action of drug\u2010induced proarrhythmia associated with compounds that prolong the repolarization period, illustrates how this liability is conveyed in a drug's prescribing information (label), details the clinical characteristics of patients most susceptible to this type of proarrhythmia, and describes interventions that can be made if TdP occurs. Three clinical vignettes are provided at the end of the article to highlight the relevance of the preceding discussions.<\/jats:p>","DOI":"10.1002\/jcph.1551","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T18:51:29Z","timestamp":1574189489000},"page":"284-294","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["How to Prescribe Drugs With an Identified Proarrhythmic Liability"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9852-2867","authenticated-orcid":false,"given":"Munveer","family":"Thind","sequence":"first","affiliation":[{"name":"Lankenau Institute for Medical Research  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceutical Corporation  East Hanover New Jersey USA"},{"name":"Cardiac Safety Research Consortium Duke Clinical Research Institute  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Kosari","sequence":"additional","affiliation":[{"name":"Discipline of Pharmacy, Faculty of Health University of Canberra  Bruce Australian Capital Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Rick","family":"Turner","sequence":"additional","affiliation":[{"name":"Cardiac Safety Research Consortium Duke Clinical Research Institute  Durham North Carolina USA"},{"name":"The American College of Clinical Pharmacology  Rockville Maryland USA"},{"name":"Department of Pharmacy Practice Campbell University College of Pharmacy &amp; Health Sciences  Buies Creek North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,19]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000586"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.748"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-019-1600-4"},{"issue":"2","key":"e_1_2_14_5_1","first-page":"Doc18","article-title":"Patient safety during final\u2010year clerkships: a qualitative study of possible error sources and of the potential of Entrustable Professional Activities","volume":"36","author":"Czeskleba A","year":"2019","journal-title":"GMS J Med Educ"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.938"},{"key":"e_1_2_14_7_1","first-page":"263","article-title":"La tachycardie ventriculaire a deux foyers opposes variables","volume":"59","author":"Dessertenne F.","year":"1966","journal-title":"Archives des maladies du couer et des vaissieux"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.1129"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1113\/JP270531"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00008.2016"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12481"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2019.8.3"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.2174\/1389557517666170707110000"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2018.08.035"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000465"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tips.2017.06.004"},{"journal-title":"Journal of the American Association of Nurse Practitioners and Journal of the American Academy of Physician Assistants","article-title":"Drug\u2010induced proarrhythmia: discussion and considerations for clinical practice","author":"Klotzbaugh RJ","key":"e_1_2_14_17_1"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijpp.12303"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm7120533"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1715163516641136"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000492616"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/1574806"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.25008"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1078155217720006"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-23.2.119"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2018.1520837"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.18.0423"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001183"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909118811904"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.19-2-189"},{"issue":"1","key":"e_1_2_14_31_1","first-page":"228","article-title":"Real\u2010world implications of QT prolongation in patients receiving voriconazole and amiodarone","volume":"74","author":"Mourad A","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.01.028"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-019-0196-3"},{"issue":"3","key":"e_1_2_14_34_1","first-page":"239","article-title":"Q\u2010T interval prolongation in cirrhosis: relationship and severity","volume":"9","author":"Hajiaghamohammadi AA","year":"2018","journal-title":"Caspian J Intern Med"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1159\/000485690"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S157630"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2017.10.009"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028018769425"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.917781"},{"volume-title":"Stephens\u2019 Detection of New Adverse Drug Reactions","year":"2004","author":"Talbot J","key":"e_1_2_14_40_1"},{"key":"e_1_2_14_41_1","unstructured":"International Council for Harmonisation of Technical Requirements of Pharmaceuticals for Human Use.www.ich.org. Accessed July 7 2019."},{"key":"e_1_2_14_42_1","unstructured":"ICH S7B.The non\u2010clinical evaluation of the potential for delayed ventricular repolarization (QT interval prolongation) by human pharmaceuticals.https:\/\/database.ich.org\/sites\/default\/files\/S7B_Guideline.pdf. Accessed July 7 2019."},{"key":"e_1_2_14_43_1","unstructured":"ICH E14.The clinical evaluation of QT\/QTc interval prolongation and proarrhythmic potential for non\u2010antiarrhythmic drugs.https:\/\/database.ich.org\/sites\/default\/files\/E14_Guideline.pdf. Accessed July 7 2019."},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-018-0442-0"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpdd.442"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40347-2"},{"key":"e_1_2_14_47_1","unstructured":"Vandetanib Prescribing Information.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2014\/022405s007lbl.pdf. Accessed July 17 2019."},{"key":"e_1_2_14_48_1","unstructured":"Nilotinib Prescribing Information.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2007\/022068lbl.pdf. Accessed July 17 2019."},{"key":"e_1_2_14_49_1","unstructured":"Ivosidenib Prescribing Information.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2018\/211192s000lbl.pdf. Accessed July 17 2019."},{"key":"e_1_2_14_50_1","doi-asserted-by":"publisher","DOI":"10.1586\/17512433.2016.1100073"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-016-0414-2"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-017-2381-5"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-017-0446-2"},{"key":"e_1_2_14_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.13740"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AACN.0000284429.45534.4a"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1177\/009286151104500315"},{"key":"e_1_2_14_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2017.05.001"},{"key":"e_1_2_14_58_1","unstructured":"CredibleMeds\u00ae.https:\/\/www.crediblemeds.org. Accessed July 17 2019."},{"key":"e_1_2_14_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2017.07.010"},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2146"},{"key":"e_1_2_14_61_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2013.840568"},{"issue":"5","key":"e_1_2_14_62_1","first-page":"299","article-title":"Magnesium therapy of cardiac arrhythmias in critical\u2010care medicine","volume":"8","author":"Iseri LT","year":"1989","journal-title":"Magnesium"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1993.tb01224.x"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12726"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.01.001"}],"container-title":["The Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcph.1551","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jcph.1551","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accp1.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcph.1551","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T23:27:18Z","timestamp":1693956438000},"score":1,"resource":{"primary":{"URL":"https:\/\/accp1.onlinelibrary.wiley.com\/doi\/10.1002\/jcph.1551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,19]]},"references-count":64,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1002\/jcph.1551"],"URL":"https:\/\/doi.org\/10.1002\/jcph.1551","archive":["Portico"],"relation":{},"ISSN":["0091-2700","1552-4604"],"issn-type":[{"type":"print","value":"0091-2700"},{"type":"electronic","value":"1552-4604"}],"subject":[],"published":{"date-parts":[[2019,11,19]]},"assertion":[{"value":"2019-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}