Matson P A, Luby S P, Redd S C, Rolka H R, Meriwether R A
Division of Field Epidemology, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Am J Trop Med Hyg. 1996 Mar;54(3):229-31. doi: 10.4269/ajtmh.1996.54.229.
The antimalarial drug halofantrine hydrochloride has been associated with cardiac arrhythmias. This is a report of a study on the cardiac effects of standard-dose halofantrine (24 mg/kg) on a sample of 48 patients selected from a group of 402 Dega (Montagnard) refugees treated for Plasmodium falciparum infection. Prolongation of the rate-corrected QT interval (QTc) on the electrocardiogram (ECG) was used as an indicator of risk for halofantrine-associated cardiac arrhythmias. We found that standard-dose halofantrine was associated with a lengthening of the mean QTc from 0.04 sec(1/2) to 0.44 sec(1/2). Two patients had a QTc increase of greater than 25%, but none had a follow-up QTc of more than 0.55 sec(1/2), an interval length generally considered to be a risk factor for ventricular arrhythmias. Regression analysis indicated that pretreatment ECGs were poorly predictive of QTc lengthening during therapy, although pretreatment ECGs may be useful to evaluate patients with pre-existing cardiac conditions. The manufacturer has recommended that the halofantrine dose not exceed 24 mg/kg and revised the list of medication contraindications to include some cardiac conditions. Clinicians should weigh a patient's risk, including history of cardiac disease and availability of alternative therapy before use of halofantrine.
抗疟药盐酸卤泛群与心律失常有关。本文报告了一项关于标准剂量卤泛群（24毫克/千克）对48例患者心脏影响的研究，这些患者选自402名接受恶性疟原虫感染治疗的德加（山地部落）难民。心电图（ECG）上校正心率后的QT间期（QTc）延长被用作卤泛群相关心律失常风险的指标。我们发现，标准剂量卤泛群与平均QTc从0.40秒（1/2）延长至0.44秒（1/2）有关。两名患者的QTc增加超过25%，但无一例患者随访时QTc超过0.55秒（1/2），该间期长度通常被认为是室性心律失常的危险因素。回归分析表明，治疗前的心电图对治疗期间QTc延长的预测性较差，尽管治疗前的心电图可能有助于评估已有心脏疾病的患者。制造商建议卤泛群剂量不超过24毫克/千克，并修订了药物禁忌清单以纳入一些心脏疾病。临床医生在使用卤泛群之前应权衡患者的风险，包括心脏病史和替代疗法的可用性。
