Iatrogenic QT Allongation After Concomitant Use of Domperidone with Fluconazole and Ciprofloxacin: Case Report and Review of the Literature

Background/Introduction: Domperidone is a peripheral dopamine antagonist, with antiemetic and gastroprokinetic properties, used in pediatrics for the treatment of RGO associated with an acidity reducer, but it is considered an arrhythmogenic drug by his power to allongation the QT space and therefore risk of ventricular arrhythmia and torsade de pointe. Objective/Aim: Identify the different torsadogenic drugs that can cause cardiac rhythm disorders in a neonatal resuscitation unit of the children's hospital of Rabat Morocco. Methods: Description of a clinical case of a patient who presented with iatrogenic cardiac rhythm disturbances that was attributed after thorough analysis of the patient's prescription to the concomitant use of drugs with known QT prolongation effect. Results: We describe a male infant aged 4 months and 5 days, former preterm infant of 36 SA. Hospitalized in the neonatal service for severe transient respiratory distress complicated by several nosocomial infections for whom anti-infective treatment with ciprofloxacin and fluconazole and anti-reflux treatment with domperidone and sodium alginate were prescribed. The patient presented with bradycardia rhythm disturbances, following which an ECG was performed and revealed a lengthening of the QT space whose etiology has been attributed to an iatrogenic cause. Following a thorough analysis of the patient's prescription by the pharmacist, three drugs have been incriminated as they have a known risk of torsade de pointes with QT prolongation: domperidone, ciprofloxacin and fluconazole. Prescribing the three molecules simultaneously increases the torsadogenic risk. In assessing the benefit-risk balance, the pharmacist suggested that domperidone be stopped. The patient's evolution was favourable with disappearance of cardiac rhythm disorders. Conclusion: The value of having a pharmaceutical presence in the neonatology department for a detailed analysis of the prescription and to avoid any iatrogenic drug event.