Frequency, characteristics and nature of risk factors associated with use of QT interval prolonging medications and related drug-drug interactions in a cohort of psychiatry patients

Das, Biswadeep; Rawat, Vikram Singh; Ramasubbu, Saravana Kumar; Kumar, Barun

doi:10.1016/j.therap.2019.03.008

Cited by 16 publications

(9 citation statements)

References 64 publications

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“…Study design and methods have been previously described in detail. 19 Briefly, our prospective crosssectional hospital-based study was executed in the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India, from 1 October 2017 to 30 August 2019. In this study, researchers (BD and SK) attended the Psychiatry OPD with the intent of prescription collection of psychiatric patients reporting to the Psychiatry OPD randomly thrice/week.…”

Section: Methodsmentioning

confidence: 99%

Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

Das

Ramasubbu

Agnihotri

et al. 2021

Therapeutic Advances in Cardiovascular Disease

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Background: Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients. Methods: This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions. Results: A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with ‘known’, ‘possible’, and ‘conditional risk of TdP’, respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H2 receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015. Conclusion: Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.

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Section: Methodsmentioning

confidence: 99%

Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

Das

Ramasubbu

Agnihotri

et al. 2021

Therapeutic Advances in Cardiovascular Disease

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“…7 Studies have shown that people diagnosed with a SMI are often on polypharmacy making them more vulnerable to QTc-prolonging drug-drug interactions. [8][9][10] Furthermore, because of an ever-increasing number of medications available, clinicians may face difficulties on how to assess, manage, monitor and refer patients at risk of QTc prolongation. Poor access to health care facilities may also increase the risk of adverse outcomes derived from the use of QT prolonging drug combinations, further contributing to the high premature mortality observed in the SMI population.…”

Section: Video Abstractmentioning

confidence: 99%

Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Zolezzi

Elhakim²,

Elamin

et al. 2021

NDT

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“…Во-первых, 250 исследуемых из 500 были пожилого возраста, что не только добавляет дополнительный балл Во-вторых, особое влияние на довольно высокую частоту наличия риска пируэтной тахикардии оказала специфика оказания медицинской помощи -психиатрический стационар. Большинством исследователей подчеркивается приоритетная роль в развитии лекарственно-индуцированной тахикардии типа пируэт-антипсихотических препаратов и антидепрессантов [23,24]. В то же время включенные в исследование пациенты также принимали антиаритмики и антибактериальные препараты из групп фторхинолонов и макролидов, обладающие электрофизиологическими свойствами, а также диуретические средства, приводящие к гипокалиемии.…”

Section: обсуждение основного результата исследованияunclassified

Safety of pharmacotherapy in a psychiatric inpatient setting and the QT interval

Kirilochev

Олегович²

2021

Annals RAMS

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Background; Events associated with a risk of death are the most serious complications of pharmacotherapy; One of these complications is prolongation of the QT interval leading to Torsades de Pointes, a life-threatening condition that can result in asystole and sudden death. Factors contributing to the development of the long QT syndrome include heredity, structural abnormalities of the heart, electrolyte disorders, female gender, advanced age, use of drugs with certain electrophysiological properties, and drug-drug interactions. Consideration of all these factors can help achieve the most accurate and objective assessment of the risk of these rhythm disturbances. Aims to assess the risk of prolongation of the QT interval and the development of Torsades de Pointes in psychiatric inpatients. Methods. The study enrolled 500 patients who received medical care in a psychiatric inpatient setting. The risk of QT interval prolongation and development of Torsades de Pointes was assessed using the MedSafety Scan medical decision support system. Results. Of the 500 patients treated in the psychiatric inpatient setting, 224 had a risk of QT interval prolongation and developing Torsades de Pointes; the incidence was highest in the group of elderly patients. The mean risk score was 7.59 3.29 in general, 6.02 3.14 in patients aged under 65 years, and 9.16 2.62 in subjects over 65 years of age. An analysis of the frequencies of risk factors for prolongation of the QT interval and Torsades de Pointes revealed that patients aged over 65 years most commonly had atrial fibrillation, chronic heart failure, heart valve disorders, hypertension, and a history of myocardial infarction. Patients under 65 years of age more commonly received medicinal products prolonging the QT interval and drug combinations that can lead to potential drug-drug interactions of relevant clinical significance. Conclusion. The obtained results indicate the importance of assessing the risk of QT interval prolongation and development of Torsades de Pointes in psychiatric inpatients as an affordable preventive tool that can increase the safety of drug therapy.

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Frequency, characteristics and nature of risk factors associated with use of QT interval prolonging medications and related drug-drug interactions in a cohort of psychiatry patients

Cited by 16 publications

References 64 publications

Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Safety of pharmacotherapy in a psychiatric inpatient setting and the QT interval

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