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[Long QT syndrome under cisapride in neonates and infants]
J M Lupoglazoff1, A Bedu, C Faure
1Service de cardiologie, hôpital Robert-Debré, Paris, France.
Insights
High-dose cisapride in infants can cause QT prolongation, a reversible heart rhythm issue. Reducing the dosage or stopping the medication normalizes heart function, emphasizing caution with combined drug use.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Context:
- Cisapride is a common treatment for gastroesophageal reflux in neonates and infants.
- QT prolongation and torsades de pointes are known risks in adults, but data in infants is limited.
Purpose:
- To investigate the incidence and characteristics of QT prolongation in infants treated with cisapride.
- To evaluate the reversibility of cisapride-induced QT prolongation upon dose adjustment or discontinuation.
Summary:
- Seven infants (mean age 41.8 days) without prior cardiac abnormalities received cisapride at a mean dose of 1.31 mg/kg/d.
- ECG and Holter monitoring revealed QT prolongation (mean QTc 486 ms) with a notched T-wave pattern.
- Upon reducing cisapride dosage or stopping the drug, QTc normalized within 48 hours, with a mean QTc shortening of 74 ms.
Impact:
- High-dose cisapride in preterm infants, newborns, and infants is associated with reversible QT prolongation.
- Clinical use of cisapride, especially with other QT-prolonging drugs, requires extreme caution in this population.
Background:
Cisapride is frequently used in the newborn and infant for treatment of gastroesophageal reflux. Twisting-spikes have been reported in adults due to overdosage or therapeutic interaction. We report seven cases of QT prolongation in infants treated with cisapride.
Patients And Methods:
Seven children (one full-term, two mature preterms, four preterm babies), aged (mean, range) 41.8 +/- 21 days (14-79) weighing 2.1 +/- 1.1 kg (1.2-4), free from any cardiac abnormality, except one patent ductus arteriosus, have been studied by ECG and Holter monitoring. They received cisapride at a mean dose of 1.31 +/- 0.2 mg/kg/d (between 1 and 1.7 mg/kg/d).
Results:
The corrected QT (QTc: N < 450 ms) was increased to 486 ms (450-540) with a notched T-wave pattern. No arrhythmia was detected. In five cases, cisapride was stopped and changed to metoclopramide. Cisapride dosage was reduced to 0.8 mg/kg/d in the two others. No other therapeutic modification was done. A control ECG performed 48 hours after therapeutic changes showed a QTc shortening of 74 +/- 18 ms (45-90) and the disappearance of the notches independent of any heart rate changes, leading to normal QTc values: 413 +/- 21 ms (390-440).
Conclusion:
High cisapride dosage in preterm, newborns and infants seems to favor QT prolongation which is reversible when dosage is reduced or drug is stopped. The use of cisapride in combination with other drugs known to increase QT should be done with extreme caution.