US doctors report a case of Torsade de Pointes associated with moxifloxacin use

Doctors at The Henry Low Heart Center, Hartford Hospital, CT, USA, have reported a case of torsade de pointes in an 87-year-old women who was admitted to hospital for the treatment of pneumonia. She had a history of heart disease, including atrial fibrillation and angina, and her treatment on admission included digoxin 0.125 mg daily, metformin 500 mg twice daily, glimepiride 4 mg daily, levothyroxine 0.1 mg daily, omeprazole 20 mg daily, warfarin 1 mg daily and atorvastatin 40 mg daily. Following admission, she was given moxifloxacin, 400 mg i.v. daily, as empirical treatment since no culture/sensitivity data were available on admission.

Two hours later, she was found to have significant QTc interval prolongation and developed torsade de pointes 8 -10 hours after the start of moxifloxacin treatment. At that time she was found to be unconscious in her room. However, her symptoms resolved on stopping moxifloxacin and her QTc interval returned to baseline.

To date, there have been 37 published cases of torsade de pointes linked to treatment wityh fluroquinolones. However, because of the limitations of adverse event reporting the actual number may be much higher than this.

This is the first case of torsade de pointes associated with moxifloxacin use reported in the USA although there have been 3 cases reported elsewhere. The authors advise careful monitoring of patients with risk factors for a prolonged QT interval when they are given a fluoroquinolone.

PMID: 17284508

Ann. Pharmacother. 2007 Feb; 41:336-40.

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