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Measuring the Effects of Supratherapeutic Doses of Levofloxacin on Healthy Volunteers Using Four Methods of QT Correction and Periodic and Continuous ECG Recordings

From Johnson & Johnson Pharmaceutical Research and Development, L.L.C., Raritan, New Jersey (Dr. Noel, S. Chien, B. Solanki, Dr. Natarajan); Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr. Noel); Covance Central Diagnostics, Reno, Nevada (Dr. Goodman); and Smith-Hanley Consulting Group, Lake Mary, Florida (M. Padmanabhan).

A clinical trial was conducted in healthy volunteers using both periodic and continuous ECG recordings to assess the effect of increasing doses of levofloxacin on the QT and QTc interval. Periodic and continuous ECGs were recorded before and after subjects were dosed with placebo and increasing doses of levofloxacin (500 mg, 1000 mg, 1500 mg) that included doses twice the maximum recommended dose of 750 mg in a double-blind, randomized, four-period, four-sequence crossover trial. Mean heart rate (HR) and the QT and QTc interval after dosing with levofloxacin and placebo were compared, and HR-QT interval relationships defined by linear regression analysis were calculated. After single doses of 1000 and 1500 mg of levofloxacin, HR increased significantly, as measured by periodic and continuous ECG recordings. This transient increase occurred at times of peak plasma concentration and was without symptoms. Mean QT intervals after placebo and mean intervals after levofloxacin were indistinguishable. Using periodic ECG recordings, single doses of 1500 mg were associated with small increases in QTc that were statistically significant. In contrast, an effect on QTc was shown only using the Bazett formula with data obtained from continuous ECG recordings. Together with the finding that levofloxacin does not influence HR-QT relationships, these findings suggest that levofloxacin has little effect on prolonging ventricular repolarization and that small increases in HR associated with high doses of levofloxacin contribute to the drug's apparent effect on QTc. Single doses of 1000 or 1500 mg of levofloxacin transiently increase HR without affecting the uncorrected QT interval. Differences in mean QTc after levofloxacin compared to placebo vary depending on the correction formula used and whether the data analyzed are from periodic or continuous ECG recordings. This work suggests that using continuous ECG recordings in assessing QT/QTc effects of drugs may be of value, particularly with drugs that might influence HR.

Key Words: Levofloxacin • QT-heart rate relationship • ventricular repolarization • periodic and continuous ECG recordings • QT and QTc intervals

Address for reprints: Gary J. Noel, MD, Clinical Professor of Pediatrics, UMDNJ-Newark, Johnson & Johnson Pharmaceutical Research and Development, L.L.C., 920 Route 202, Box 300, Raritan, NJ 08869.

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