SSRI's and prolonged QT interval

[vz]

Hi.  I have MVP and episodes of SVT.  I am taking Verapamil and Zoloft.  Recently, I read a report in the American Journal of Medicine that listed Zoloft as a drug that may prolong the cardiac QT interval and cause risk for an arrythmia.  My question is:  Do you know if this is true and can possibly happen?  Thanks.

[mrsww]

http://www.arizonacert.org/index.html

[Dr. Erik]

No, you have not proven that a Beta Blocker prolongs the QT interval. Sotalol is not a Beta Blocker. It is a class III Anti-Arrhythmic that has Beta receptor activity. Why don't you look it up in the PDR and compare it to other Class III anti-arrhythmics. Ordinary beta blockers such as Toprol XL, Atenolol and propanolol do not affect the QT interval. If you mixed aspirin with a class III anti-arrhythmic I'm sure one could say that aspirin polongs the QT Interval.

About Beta Blockers shortening the QT interval. Since  beta blockers are used to treat  prolonged QT interval, one would think it is possible that it shortens the QT interval. I'm sure I read somewhere that this is true but cannot back it up as I am unable to find where I read it so I may be wrong on that claim.

[netrox]

You said beta blockers shortens QT. Prove it. I already proved that at least one beta blocker can prolong QT. You claim beta blockers shorten QT. I have never heard of it. Beta blockers merely slow down the heartbeat rate, not shorten QT intervals. They have *insignificant* effect on QT intervals.

Let me repeat your own message: "Also, Beta Blockers shorten the QT interval."

Once again, PROVE THAT BETA BLOCKERS SHORTEN QT INTERVAL! I don't know any drugs that can do that.

-jeff

[Dr. Erik]

If you had read closer you would have seen that the drug that prolongs the QT interval is Sotalol which is an anti-arrhythmic drug with Pro-Arrhythmia properties. They were not talking about ordinary Beta Blockers. Before you cut and paste someone's post and send it back to them to point out they were wrong you should check your facts better. Yes, Sotalol does have some Beta Receptor activity. but the class III anti-arrhythmic properties of the drug is what causes QT prolongation.

[netrox]

"Beta Blockers are not listed as a drug that prolongs the QT interval. I defy you to show written documentation from a legitimate source that says otherwise."

Read what I said. I said it prolongs QT but insignificantly (meaning it's not going to make it a cause for concern). You said it shortens the QT and I have never heard of beta blockers doing that or any drugs that shorten QT.

http://www.emedicine.com/emerg/topic59.htm

-jeff

[Dr. Erik]

Beta Blockers are not listed as a drug that prolongs the QT interval. I defy you to show written documentation from a legitimate source that says otherwise.

[netrox]

"Well, first line treatment of prolong QT interval is a Beta Blocker, with the second being an implanted Defibrillator."

It doesn't mean it'll shorten the QT interval. It merely prevents the heartbeat from going fast even if prolonged QT is present.

-jeff

[michi]

thank you for your support, it helped me. i was a little confused about the doctors thoughts. i think we are all well informed in this forum do to the great answers from the doctors and you guys. I will go back to work today and do my job normal. last year i had from an stress test indused pvcs and my cardio said im fine. thank you, thank you, thank you all so much.

michi

[Dr. Erik]

Well, first line treatment of prolong QT interval is a Beta Blocker, with the second being an implanted Defibrillator.

[netrox]

"Also, Beta Blockers shorten the QT interval."

Are you sure? I believe it's the opposite. Beta blockers prolong the QT intervals albiet insignificantly, not shorten them.

-jeff

[WPWGuy]

Hi, I am no expert, but it sounds like the doc might not know what your arrythmia is and may be taking a cautious approach (about your exercise) until he knows what's up.  On the other hand, PVC's can be fairly common and do not usually indicate a major problem, so I wouldn't get too alarmed...

I assume you would want to have your doc prescribe an event monitor.

[pandora9048]

Hi,
  If your heart is structurally normal and you've had normal tests, why does your doc think the pvc's can be fatal??

[Dr. Erik]

I have been where you are.People get thousands of PVC's a day and have no adverse outcome. PVC's can change in intensity at any time. I have gotten them one right after another for a whole day before. As scary and as bad as they make you feel they are still benign. How does one cope with this? Hang in there. It took me years to learn to cope with it. I ignore them and they go away a lot sooner now. Good luck!


Erik

[Momto3]

I don't think the number of pvcs in a 24 hour period alone substantiate a problem.  As you know, there are a number of people on this board who experience thousands of pvcs per day and still they are considered benign.  At one point I was having over 20,000 pvcs in 24 hour recordings, and they were still benign.  So, the main thing is to have the tests done and to trust your doctor.  Once you know you have a structurally normal heart and your doctor has given you an optimistic outlook, try to ignore those pesky pvcs.  Perhaps you could ask your doctor about giving you something for symptomatic relief -- maybe a beta blocker.

Good luck!

[michi]

hi,
i had a bad day today. can someone please tell me how many pvs are too many in an hour timeframe? i have a structure normal heart and all the works done. i never expierenced so many pvcs like today and i was lightheaded. doctor told me no exercise for a while, even with a normal ecg with one pvc. he is scared that i will have exercise indused pvcs which could be fatal. i am open for any advice, thank you

michi

[michi]

I had a very bad day today, i woke up and started to have pvcs and pac. i never had such an extreme set, 2 pvcs in a row, pvc 3-4 normal beats and a pvc, lightheaded and now still tired. i had almost no break. it lastet for about 5.5 hours. I took some potassium, since i changed my diet i think i dont get the right amount of potassium. i did not go to the er but went to the doctor. he says more than 30 pvcs in 24 hours are too many. i am not sure about that, an he does not want me to do my job as an gymnastics coach right now, do to eventually exercise indused pvcs and death change. i have a structually normal heard and all the works done, can you please give some advice, support? thank you
michi

[Dr. Erik]

yes. I have been on this combo of medications for 12 years now without much of a problem. I think the Toprol XL would prevent the Prolonged QT. I also take the Paxil and I take Xanax for anxiety. I take the Toprol for PVC's and Atrial Fibrillation.

[jerry1978]

Hi Erik:
Seems like you and I are on basically the same meds.  I'm o Zoloft 25 mg and Klonopin for Anxiety and Panic, along with Toprol XL 25 mg and Hydrochlorot 25 mg for anxiety-produced hypertension. Jerry

[jerry1978]

Hi Erik:
Seems like you and I are on basically the same meds.  I'm o Zoloft 25 mg and Klonopin for Anxiety and Panic, along with Toprol XL 25 mg and Hydrochlorot 25 mg for anxiety-produced hypertension. Jerry

[Dr. Erik]

I did find where it lists SSRI's as a level four(lowest risk level) risk for Torsades de Pointes. It states: Drugs that, in some reports, were weakly associated with Torsades de Pointes but that, when used in usual dosages, are unlikely to be a risk for Torsades de Pointes.


This just means that people taking the drugs have had reports of long QT interval. But these people most likely had a pre-existing prolongation of the QT interval. Don't worry yourselves too much over it. I too have arrhythmias and I take Paxil. I have had no problems in over a decade. Also, Beta Blockers shorten the QT interval. So if you happen to take one then it would probably cancel out any effect the Zoloft has. I take Toprol XL. Good Luck!


Erik

[Dr. Erik]

There is no connection between SSRI's and prolongation of the QT interval. There  are many combinations of drugs that can cause this phenomenon. SSRI's alone do not cause this prolongation.

[jerry1978]

Great question.  I also await the Doctors answer.  I, too am on Zoloft, along with Klonopin and Toprol XL, and Hydrochlorot.
From what I just read, the QT problem with Zoloft seems to occur when it is used along with Pimozide, and at high doses of 200 mgs.  Jerry

[CCF-M.D.-MJM]

Hi VZ,

Zoloft can prolong QT interval, more often however if you are on other medications that can prolong QT or if you have a congenital syndrome of prolonged QT interval.  It is important to recognize this can happen, but it is very very.  In fact I have never witnessed a case of QT prolongation with a patient on Zoloft--but we know it can happen.

If you are concerned, ask your physician to check an EKG.  It is simple, fast, and will help put your mind at ease.

Hope this helps.