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Related Experiment Videos

Fluconazole-induced torsade de pointes.

V N Tholakanahalli1, A Potti, J F Hanley

  • 1Department of Medicine, School of Medicine,University of North Dakota, Fargo 58102-3677, USA. vtholak@yahoo.com

The Annals of Pharmacotherapy
|April 17, 2001
PubMed
Summary
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Fluconazole use can cause Torsade de Pointes (TDP), a dangerous heart rhythm. This case highlights the probable link between fluconazole and TDP, even at low doses.

Area of Science:

  • Cardiology
  • Pharmacology
  • Infectious Diseases

Background:

  • Fluconazole is a common antifungal medication.
  • Torsade de Pointes (TDP) is a life-threatening ventricular arrhythmia associated with QT interval prolongation.

Observation:

  • A 68-year-old woman developed TDP eight days after starting oral fluconazole for a Candida glabrata presacral abscess.
  • The patient had no other identifiable risk factors for TDP.
  • TDP resolved upon fluconazole discontinuation, with persistent arrhythmias until six days post-cessation.

Findings:

  • The Naranjo probability scale indicated a probable relationship between fluconazole and TDP.
  • The likely mechanism involves fluconazole's depression of potassium currents, leading to QT prolongation.

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  • No other etiology explained the observed QT prolongation or TDP.

    • Implications:

    • Clinicians must be aware of fluconazole's potential to cause QT prolongation and TDP, even at low doses.
    • Serial electrocardiographic monitoring may be prudent for at-risk patients receiving fluconazole.
    • This case underscores the importance of considering drug-induced arrhythmias in patients presenting with TDP.