Wednesday, April 12, 2006
So anyway, I've been going overboard in describing my hospital stay; let me digress here to some actual content. I may have mentioned that, since I want to remain ICD-less for a while, my regular cardiologist told me to avoid drugs that are known to cause arrhythmia.
Brief summary: avoid decongestants, non-sedating antihistamines, macrolide antibiotics ("mycins"), anything ending in "zole," and large doses of local anesthetics.
Of course we all know to avoid pseudoephedrine (Sudafed) and ephedrine (OTC asthma inhalers) and other drugs in that class. Were you aware that many herbal teas contain related compounds which can also cause arrhythmia? Avoid teas that contain "ma huang" or "Mormon tea" or "desert tea." Also, watch out for any other drug that is labelled as a decongestant - although pseudoephedrine is the most common, there are others. Several other asthma drugs are also stimulants that should be avoided by people at risk of arrhythmia: theophylline and albuterol, for example.
But then, there are more drugs that are arrhythmogenic, that fewer lay people know about. For example, most of the newer "non-sedating anti-histamines" have some possibility of causing arrhythmia. Terfenadine and astemizole are noted in particular.
But the ones you should be MOST aware of are very common, and at the same time very few family doctors/non-cardiologists realize that they are arrhythmogenic: the "macrolide antibiotics." These are the ones that end in "mycin" - such as erythromycin, clarithromycin (Biaxin), and azithromycin (Zithromax).
One study notes that erythromycin is especially likely to cause arrhythmia in patients who are taking calcium channel blockers. (diltiazem and verapamil are two such antihypertensive calcium antagonists). Diltiazem and verapamil themselves are potential causes of arrhythmia and death.
Several studies I read also mentioned that the "flouroquinolone" antibiotics (a/k/a "quinolones") could have this effect. The best-known quinolone is ciprofloxacin, a/k/a Cipro. Others include levofloxacin and gatifloxacin.
One drug that can have both anti-arrhythmia properties and arrhythmogenic ones is lidocaine. If you have already had sub-cutaneous (injected or IV) lidocaine and not had any negative effects, then you probably can continue to use it. In fact, "Local anesthetics, such as lidocaine and procainamide, are administered in advanced cardiac life support as antiarrhythmics." Local anesthetics are "cardiodepressive." But, there are two things to watch out for: (1) at high doses, these anesthetics can lead to severe vasodilatation and bradycardia leading to ventricular fibrillation and (2) for people who are on certain blockers - beta-blockers, calcium channel blockers, or H1-blockers - the effect of adding one of these anesthetics can overload the metabolism so it can't process the anesthetics properly. Always let your doctor - and your dentist!! - know that you are taking any of these drugs before they give you lidocaine, which is very common for dental work.
Several articles that discussed the macrolide antibiotics also mentioned that the "azole" anti-fungal drugs could cause certain types of arrhythmia.
There have also been a few reports of cisapride (Propulsid) causing arrhythmia.
Examples of macrolides:
Generic name/Trade name
Azithromycin/Zithromax
Clarithromycin/Biaxin, Biaxin XL
Dirithromycin/Dynabac
Erythromycin/Ery-Tab, Eryc, Ilosone, EryPed, various
Troleandomycin/Tao
Some reference articles, if you want lots more technical detail:
http://jpet.aspetjournals.org/cgi/content/full/303/1/218
http://www.ionchannels.org/showabstract.php?pmid=10444234
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10444234&dopt=Abstract
Note: the following site is not a medical site, and it's from a group that often has a political agenda; I don't endorse this site, and I suggest you take it waith a grain of salt and check everything in it with sites sponsored by reputable medical sources. Nonetheless, you may find it interesting:
http://www.worstpills.org/results.cfm?druginduced_id=7
Brief summary: avoid decongestants, non-sedating antihistamines, macrolide antibiotics ("mycins"), anything ending in "zole," and large doses of local anesthetics.
Of course we all know to avoid pseudoephedrine (Sudafed) and ephedrine (OTC asthma inhalers) and other drugs in that class. Were you aware that many herbal teas contain related compounds which can also cause arrhythmia? Avoid teas that contain "ma huang" or "Mormon tea" or "desert tea." Also, watch out for any other drug that is labelled as a decongestant - although pseudoephedrine is the most common, there are others. Several other asthma drugs are also stimulants that should be avoided by people at risk of arrhythmia: theophylline and albuterol, for example.
But then, there are more drugs that are arrhythmogenic, that fewer lay people know about. For example, most of the newer "non-sedating anti-histamines" have some possibility of causing arrhythmia. Terfenadine and astemizole are noted in particular.
But the ones you should be MOST aware of are very common, and at the same time very few family doctors/non-cardiologists realize that they are arrhythmogenic: the "macrolide antibiotics." These are the ones that end in "mycin" - such as erythromycin, clarithromycin (Biaxin), and azithromycin (Zithromax).
One study notes that erythromycin is especially likely to cause arrhythmia in patients who are taking calcium channel blockers. (diltiazem and verapamil are two such antihypertensive calcium antagonists). Diltiazem and verapamil themselves are potential causes of arrhythmia and death.
Several studies I read also mentioned that the "flouroquinolone" antibiotics (a/k/a "quinolones") could have this effect. The best-known quinolone is ciprofloxacin, a/k/a Cipro. Others include levofloxacin and gatifloxacin.
One drug that can have both anti-arrhythmia properties and arrhythmogenic ones is lidocaine. If you have already had sub-cutaneous (injected or IV) lidocaine and not had any negative effects, then you probably can continue to use it. In fact, "Local anesthetics, such as lidocaine and procainamide, are administered in advanced cardiac life support as antiarrhythmics." Local anesthetics are "cardiodepressive." But, there are two things to watch out for: (1) at high doses, these anesthetics can lead to severe vasodilatation and bradycardia leading to ventricular fibrillation and (2) for people who are on certain blockers - beta-blockers, calcium channel blockers, or H1-blockers - the effect of adding one of these anesthetics can overload the metabolism so it can't process the anesthetics properly. Always let your doctor - and your dentist!! - know that you are taking any of these drugs before they give you lidocaine, which is very common for dental work.
Several articles that discussed the macrolide antibiotics also mentioned that the "azole" anti-fungal drugs could cause certain types of arrhythmia.
There have also been a few reports of cisapride (Propulsid) causing arrhythmia.
Examples of macrolides:
Generic name/Trade name
Azithromycin/Zithromax
Clarithromycin/Biaxin, Biaxin XL
Dirithromycin/Dynabac
Erythromycin/Ery-Tab, Eryc, Ilosone, EryPed, various
Troleandomycin/Tao
Some reference articles, if you want lots more technical detail:
http://jpet.aspetjournals.org/cgi/content/full/303/1/218
http://www.ionchannels.org/showabstract.php?pmid=10444234
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10444234&dopt=Abstract
Note: the following site is not a medical site, and it's from a group that often has a political agenda; I don't endorse this site, and I suggest you take it waith a grain of salt and check everything in it with sites sponsored by reputable medical sources. Nonetheless, you may find it interesting:
http://www.worstpills.org/results.cfm?druginduced_id=7
