Cardiac effects of standard-dose halofantrine therapy

• Published in: The American journal of tropical medicine and hygiene Vol. 54; no. 3; p. 229
• Main Authors: Matson, P A, Luby, S P, Redd, S C, Rolka, H R, Meriwether, R A
• Format: Journal Article
• Language: English
• Published: United States 01.03.1996
• Subjects: Adolescent; Adult; Aged; Antimalarials - adverse effects; Antimalarials - therapeutic use; Arrhythmias, Cardiac - chemically induced; Arrhythmias, Cardiac - ethnology; Electrocardiography; Female; Heart - drug effects; Heart Rate - drug effects; Humans; Least-Squares Analysis; Malaria, Falciparum - drug therapy; Malaria, Falciparum - ethnology; Male; Middle Aged; Phenanthrenes - adverse effects; Phenanthrenes - therapeutic use; Refugees; Vietnam - ethnology; Vietnam
• ISSN: 0002-9637
• 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.