Add on lansoprazole to Ceftriaxone Therapy may preciitate Cardiac and mortality Risks: JAMA

A recent retrospective cohort study published in the Journal of American Medical Association found the combined use of lansoprazole and ceftriaxone, a common antibiotic, to decrease the risk of ventricular arrhythmia, cardiac arrest, and cardiac mortality. This combination has been previously linked to a prolonged corrected QT interval on electrocardiograms, however, the study wanted to check whether this translates into clinically significant outcomes for patients.

The primary objective of the study was to compare lansoprazole, a proton pump inhibitor (PPI), with other PPIs during ceftriaxone treatment concerning the risk for ventricular arrhythmia, cardiac arrest, and in-hospital mortality. The study was conducted between January 1, 2015 and December 31, 2021 and included over 31,000 patients hospitalized on internal medicine wards in Ontario, Canada.

The findings indicate a higher risk associated with the lansoprazole and ceftriaxone combination. Within the lansoprazole group, 3.4% of patients experienced ventricular arrhythmia or cardiac arrest, compared to 1.2% in the other PPI group. In terms of in-hospital mortality, the lansoprazole group exhibited a significantly higher rate of 19.9%, compared to 10.1% in the other PPI group.

Propensity-score weighting was employed to adjust for various factors, including hospital site, demographics, comorbidities, and concomitant medications. The adjusted risk difference revealed a notable 1.7% higher risk for ventricular arrhythmia or cardiac arrest and a substantial 7.4% higher risk for in-hospital mortality in the lansoprazole group.

The implications  of the study are significant, suggesting that caution is warranted when considering the combination of lansoprazole and ceftriaxone in patient treatment. The observed elevated risks underscore the importance of further research to validate these findings across different populations and medical settings.

Reference:

IBai, A. D., Wilkinson, A., Almufleh, A., Rai, M., Razak, F., Verma, A. A., & Srivastava, S. (2023). Ceftriaxone and the Risk of Ventricular Arrhythmia, Cardiac Arrest, and Death Among Patients Receiving Lansoprazole. In JAMA Network Open (Vol. 6, Issue 10, p. e2339893). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.39893