{"id":598,"date":"2015-02-18T16:23:05","date_gmt":"2015-02-18T16:23:05","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=598"},"modified":"2017-08-21T11:58:52","modified_gmt":"2017-08-21T11:58:52","slug":"primary-care-corner-with-geoffrey-modest-md-hydroxyzine-and-prolonged-qtc","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/02\/18\/primary-care-corner-with-geoffrey-modest-md-hydroxyzine-and-prolonged-qtc\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Hydroxyzine and prolonged QTc"},"content":{"rendered":"<p><strong>By: Dr. Geoffrey Modest<\/strong><\/p>\n<p>The Pharmacovigilence Risk Assessment Committee (PRAC) of the\u00a0\u00a0European Medicines Agency just issues a warning about hydroxyzine being associated with\u00a0increased QTc intervals and torsade de pointes (see\u00a0<a href=\"http:\/\/www.ema.europa.eu\/docs\/en_GB\/document_library\/Press_release\/2015\/02\/WC500182462.pdf\">here<\/a>). Hydroxyzine is a first-generation antihistamine,\u00a0commonly used for pruritus, anxiety disorders, sleep disorders and as a premedication before surgery, as well as off-label as an anti-emetic. \u00a0They felt it was okay to continue using hydoxyzine since the cardiac arrhythmias were most likely to occur in those with risk factors, but\u00a0they do suggest:<\/p>\n<p style=\"padding-left: 30px\">&#8211;maximum dose of 100mg\/d or 2 mg\/kg for kids up to 40\u00a0kg. Use lowest effective dose and for shortest time possible<\/p>\n<p style=\"padding-left: 30px\">&#8211;avoid using in those &#8220;at risk of heart rhythm problems&#8221; or in those taking other medications that prolong the QTc<\/p>\n<p style=\"padding-left: 30px\">&#8211;try to avoid using in those taking medications that lower the potassium or slow the heart rate, since these may predispose to arrhythmias.<\/p>\n<p style=\"padding-left: 30px\">&#8211;try to avoid use in the elderly, but if necessary, only up to 50mg\/d<\/p>\n<p style=\"padding-left: 30px\">&#8211;there was no comment in the warning about the frequency of prolonged QTc, the length of the prolongation, or the frequency of torsades or ventricular tachycardia\/fibrillation<\/p>\n<p>So, quite unfortunate. hydroxyzine has been my go-to med for persistent pruritus.\u200b However, I will now try to avoid it especially in those on other meds which prolong the QTc, especially azithro\/clarithromycin, tricyclics, citalopram, as well as in patients predisposed to arrhythmias. And decreasing the maximum dose in elderly seems appropriate.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hydroxyzine and prolonged QTc [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/02\/18\/primary-care-corner-with-geoffrey-modest-md-hydroxyzine-and-prolonged-qtc\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-598","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=598"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/598\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}