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Moxifloxacin and Torsade de Pointes

Clinical Pharmacy Fellow, Divisions of Cardiology and Drug Information, School of Pharmacy, University of Connecticut; The Henry Low Heart Center, Hartford Hospital, Hartford, CT

Kirkeith Lertsburapa, MD

Clinical Cardiology Fellow, Division of Cardiology, The Henry Low Heart Center, Hartford Hospital

Jeffrey Kluger, MD

Director, Arrhythmia Center, Division of Cardiology, The Henry Low Heart Center, Hartford Hospital

C Michael White, PharmD

Associate Professor, School of Pharmacy, University of Connecticut; Director, Cardiac Pharmacology Service, Divisions of Cardiology and Drug Information, The Henry Low Heart Center, Hartford Hospital

Reprints: Dr. White, Cardiac Pharmacology Service, Divisions of Cardiology and Drug Information, The Henry Low Heart Center, Hartford Hospital, 80 Seymour St., Hartford, CT 06102, fax 860/545-2277, cmwhite{at}harthosp.org

OBJECTIVE: To report a case of torsade de pointes in a patient receiving moxifloxacin.

CASE SUMMARY: An 87-year-old woman was admitted to the hospital for pneumonia, and antibiotic therapy with intravenous moxifloxacin 400 mg/day was initiated. The patient was noted to have significant QTc interval prolongation 2 hours after administration of moxifloxacin and developed torsade de pointes 8-10 hours after moxifloxacin administration. She was converted back to normal sinus rhythm after a precordial thump. Moxifloxacin was discontinued, and the woman's QTc interval subsequently returned to baseline.

DISCUSSION: Torsade de pointes is a life-threatening arrhythmia that has previously been associated with the use of fluoroquinolones. Minimal information is available regarding the risk of torsade de pointes with moxifloxacin. According to the Naranjo probability scale, the episode in this case was probably related to administration of intravenous moxifloxacin.

CONCLUSIONS: In patients with underlying risk factors for a prolonged QT interval, the use of moxifloxacin can lengthen the interval further and ultimately trigger episodes of torsade de pointes. Moxifloxacin administration in these patients therefore should be administered and monitored judiciously.

Key Words: moxifloxacin, torsade de pointes

Published Online, February 6, 2007. www.theannals.com, DOI 10.1345/aph.1H474