Buprenorphine, capecitabine and loperamide added to QTdrugs

The safe use of the CredibleMeds^® lists of medications requires that the user have the most up-to-date lists and be aware when changes are made to the lists.  Therefore, we wish to inform you of the following changes.  

Buprenorphine, an opiate (brand names Butrans®, Belbuca®, Bunavail®, Buprenex®, Suboxone®, Zubsolv®): Substantial evidence associates it with QT prolongation but we found no convincing evidence of torsades de pointes arrhythmia (TdP) at this time.  Therefore, it has been added to the list with Possible Risk (PR) of TdP.

Capecitabine, a drug used to treat cancer (brand name Xeloda®):  Substantial evidence of QT prolongation was found but no convincing evidence of TdP. Therefore, it was added to the list with Possible Risk of TdP.

Loperamide (Imodium® and many OTC and Rx brand names), an over-the-counter drug used to treat diarrhea: It is associated with TdP when taken in very high dosages, most often by individuals with opiate use disorder.  Therefore, it was added to the Conditional Risk (CR) of TdP list (Condition = excessive dose).

These drugs are also now included in the list of Drugs to Avoid in patients with Congenital Long QT Syndrome (if at all possible).