QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update

Beach, Scott R.; Celano, Christopher M.; Sugrue, Alan; Adams, Caitlin; Ackerman, Michael J.; Noseworthy, Peter A.; Huffman, Jeff C.

doi:10.1016/j.psym.2017.10.009

Cited by 144 publications

(93 citation statements)

References 114 publications

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“…Most QT‐prolonging drugs block the rapid component of the cardiac‐delayed rectifier current (IKr, encoded by the KCNH2 gene), although some drugs can also increase the late sodium current . Risk factors for drug‐induced QT prolongation and TdP include characteristics of the drug (propensity for blockade of the delayed potassium rectifier current IKr); transient factors such as bradycardia, frequent ventricular ectopy, and hypokalemia/hypomagnesemia; and patient factors such as age, female gender (especially between puberty and menopause), cardiac comorbidities, impaired repolarization reserve (the redundancy in the repolarizing currents in cardiac cells), or baseline QT prolongation which can be due to genetic or acquired conditions …”

Section: Resultsmentioning

confidence: 99%

“…A particularly challenging group of medications are those used for the management of psychiatric conditions, as many psychotropic medications have been associated with QT prolongation in case reports . Among antidepressant medications, tricyclic antidepressants and citalopram cause more QT prolongation than other selective serotonin reuptake inhibitors (SSRI) and should be avoided as first‐line therapy in patients with cardiac disease or known risk factors for QT prolongation.…”

Section: Resultsmentioning

confidence: 99%

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Update on long QT syndrome

Neira

Enríquez

Simpson

et al. 2019

Cardiovasc electrophysiol

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Long QT syndrome (LQTS) is an inherited disorder characterized by a prolonged QT interval in the 12‐lead electrocardiogram and increased risk of malignant arrhythmias in patients with a structurally normal heart. Since its first description in the 1950s, advances in molecular genetics have greatly improved our understanding of the cause and mechanisms of this disease. Sixteen genes linked to LQTS have been described and genetic testing had become an integral part of the diagnosis and risk stratification. This article provides an updated review of the genetic basis, diagnosis, and clinical management of LQTS.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Update on long QT syndrome

Neira

Enríquez

Simpson

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…QTc prolongation is a potential risk of antipsychotic therapy [ 17 ], and one patient (1%) with premorbid heart disease died from suspected cardiac arrest. No other acute cardiac events were reported.…”

Section: Resultsmentioning

confidence: 99%

Pimavanserin for Psychosis in Parkinson’s Disease-Related Disorders: A Retrospective Chart Review

et al. 2019

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Background Psychosis is common in Parkinson’s disease-related disorders and is associated with significant morbidity. Pimavanserin is a newly approved treatment for Parkinson’s disease psychosis, but real-world experience with pimavanserin has been limited by small sample sizes and limited assessment of longitudinal outcomes. Objective The aim was to summarize the clinical experience with pimavanserin in a large cohort of patients with Parkinson’s disease-related psychosis. Methods We conducted a retrospective chart review of patients who were prescribed pimavanserin at Vanderbilt University Medical Center in the southeast United States between May 2016 and July 2018. We used Chi-squared analyses to compare efficacy and tolerability of pimavanserin, considering patient diagnosis, presence of dementia or delusions, use of deep brain stimulation, and prior antipsychotic failure. Additionally, we compared the clinical characteristics of patients who started treatment and those who did not, to evaluate safety outcomes. Results We identified 107 patients prescribed pimavanserin, and 91 began treatment. Clinical improvement in psychosis was documented in 76% of patients (69/91) and did not differ based on diagnosis, presence of dementia, delusions, use of deep brain stimulation, or prior antipsychotic failure. Adverse effects were reported in 20 patients (22%), the most common of which was worsening gait instability (5/91, 5%). Side effects led to cessation of therapy in 11 of the 91 patients (12%). At current follow-up, 50 (65%) of 77 living patients remain on treatment, with a mean treatment duration of 14.6 months. Although most of these patients are on pimavanserin monotherapy (33/50, 66%), 17 patients (34%) are on a dual-antipsychotic regimen. The living patients no longer on treatment stopped pimavanserin primarily because of a lack of perceived benefit (11/77, 14%), side effects (9/77, 12%), or both (1/77, 1%), though six patients (8%) stopped for reasons unrelated to medication effects, including the desire to reduce overall medication burden and negative media reporting on pimavanserin. Conclusions Study results emphasize long-term efficacy and tolerability of pimavanserin for psychosis in Parkinson’s disease-related disorders, including patients with dementia, delusions, deep brain stimulation use, or prior antipsychotic failure.

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“…Thioridazine had the greatest risk of prolonging QT interval followed in descending order by ziprasidone, quetiapine, chlorpromazine, risperidone, olanzapine, aripiprazole, and haloperidol. Beach et al [60,61] completed a review of QT prolongation and risk of Torsade de Pointes in association with psychotropic medications. They highlighted important risk factors for QT prolongation which are particularly relevant in geriatric populations including history of long QT syndrome, being female, advanced age, electrolyte abnormalities, diuretic use, bradycardia, heart failure, myocardial infarction, renal and/or hepatic dysfunction, hypertension, hypoglycemia/diabetes, hypothyroidism, CNS injury, malnutrition, and polypharmacy.…”

Section: Antipsychotics (Table 1)mentioning

confidence: 99%

Management of Neuropsychiatric Symptoms of Dementia: A Comprehensive Review of the Current Literature

Suarez¹,

Shafi²,

Lapid³

2019

obm geriatr

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Background: Dementia is a progressive and debilitating condition that affects millions of patients in the United States with an enormous impact on healthcare costs, caregivers, and society. Patients with dementia often experience dementia-related neuropsychiatric disturbances, commonly known as Behavioral and Psychological Symptoms of Dementia (BPSD) and more recently Neuropsychiatric symptoms (NPS) in dementia. These symptoms include verbal and physical agitation, aggression, disinhibition, affect lability, apathy, psychosis, depression, and anxiety. Symptom management is important to optimize quality of life, minimize further functional decline, and delay institutionalization. We aim to review the existing published literature on pharmacologic and non-pharmacologic management of NPS. Methods: PubMed, Google Scholar, and Cochrane were searched for available reviews, systematic reviews, meta-analysis, and randomized controlled trials on diagnostic tools and treatment strategies for NPS. Some of the searched terms used included, "neuropsychiatric symptoms of dementia treatment," "NPS treatment," "pharmacologic treatment NPS," "non-pharmacologic treatment NPS," "scales NPS." We also searched for the term "BPSD" instead of "NPS" and "neurocognitive disorder" instead of "dementia." Recent Findings: There are different treatment modalities to address NPS, including pharmacologic and non-pharmacologic approaches, but the evidence throughout the years has been controversial and mostly studied in Alzheimer's disease population making less generalizable to other dementia populations. Summary: NPS continues to be a prevalent and debilitating condition in the elderly population with dementia. Non-pharmacologic strategies continue to be the first-line treatment for NPS despite lack of strong evidence because of their potential benefit and absence of side effects. Conversely, pharmacologic strategies have a potential risk for side effects in addition to the lack of strong evidence about their benefits in NPS; therefore, deprescribing is an important consideration in the management of these patients.

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QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update

Cited by 144 publications

References 114 publications

Update on long QT syndrome

Update on long QT syndrome

Pimavanserin for Psychosis in Parkinson’s Disease-Related Disorders: A Retrospective Chart Review

Management of Neuropsychiatric Symptoms of Dementia: A Comprehensive Review of the Current Literature

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