QT prolongation
A change on the heart's electrical trace, caused by some drugs blocking a potassium channel (hERG), that in rare cases sets off a dangerous rhythm. Drugs that do this need ECG checks and care with other medicines and low potassium or magnesium.
Off-target hERG inhibition is common among kinase inhibitors (vandetanib, nilotinib, ribociclib, osimertinib, mobocertinib, selpercatinib, ivosidenib) and other drugs (arsenic trioxide, ondansetron, methadone); labels require baseline and periodic ECGs and electrolyte correction, and combining QT-prolonging drugs is avoided. Clinically important arrhythmia is rare, but QT prolongation has delayed or narrowed approvals and is screened for in early drug development (thorough QT studies). A QTc above 500 ms or an increase over 60 ms usually triggers dose interruption.
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