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Management of QT Prolongation by Grade of Severity of ADR
Learning ObjectivesManagement of QT Prolongation by Grade of Severity of ADR
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Management of increased QT prolongation (QTcF) entails looking at the grade of severity of the Adverse Drug Reaction (ADR), details of which is provided in the table below.
| NORMAL VALUE | GRADE 1 (MILD) | GRADE 2 (MODERATE) | GRADE 3 (SEVERE) | GRADE 4 (LIFE THREATENING) |
|---|---|---|---|---|
|
QTcF M: < 450 F: < 470 |
M: 450-480 ms F: 470-480 |
481-500 ms | > 500 ms on two separate ECGs | > 500 ms and life threating consequences |
| Condition | Asymptomatic | Asymptomatic, transient rhythm abnormality | Recurrent, persistent, symptomatic arrhythmia | Unstable dysrhythmia |
| Action | Check electrolytes and correct it, as necessary. Monitor Electrocardiogram (ECG) more closely. | Check electrolytes. If abnormal, hold all QTcF prolonging drugs and correct the electrolytes before restarting them. Monitor ECG more closely. | Consider hospitalization, hold QTcF prolonging drugs and correct electrolytes as necessary. Repeat ECG after 24 hours and reintroduce the drugs if QTcF remains below 500 ms. |
Hospitalize and repeat electrolytes as necessary. Stop the offending drug. Repeat ECG after 24 hours. |
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- WHO Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
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