QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry

Xiong, Glen L.; Pinkhasov, Aaron; Mangal, Jed P.; Huang, Heather; Rado, Jeffrey; Gagliardi, Jane P.; DeMoss, Dustin; Karol, David E.; Suo, Shannon; Lang, Michael; Stern, Marsha; Spearman, E. Vanessa; Onate, John C; Annamalai, Aniyizhai; Saliba, Zeina; Heinrich, Thomas; Fiedorowicz, Jess G.

doi:10.1016/j.jpsychores.2020.110138

Cited by 24 publications

(33 citation statements)

References 57 publications

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“…Several AP drugs cause prolongation of the QT interval (beginning of the Q wave till the end of the T wave on the electrocardiogram); some APs do this more than others (42).…”

Section: Cardiac Arrythmiamentioning

confidence: 99%

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Seeman

2021

Front. Psychiatry

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Background: Animal and human experiments have confirmed sex differences in the expression of hepatic enzymes that metabolize antipsychotic drugs and that may, in this way, be partly responsible for the clinical sex/gender differences observed in the efficacy and tolerability of antipsychotic treatment.Aim: The aim of this mini review is to synthesize the literature on the pharmacodynamics of male/female differential response to antipsychotic drugs.Method: Relevant search terms were used to search for pre-clinical and human trials and analysis of antipsychotic differential drug response and occurrence/severity of adverse effects in women and men.Results: The search found that sex influences drug response via the amount of a given drug that enters the brain and the number of neurotransmitter receptors to which it can bind. Consequently, sex partly determines the efficacy of a specific drug and its liability to induce unwanted effects. There are other factors that can overshadow or enhance the dimorphic effect of sex, for instance, the host's age, hormonal status, diet and life style as well as the molecular structure of the drug and its dose, and the method of its administration. Most of all, the host's individual genetics affects each step of a drug's pharmacodynamics.Conclusion: On average, women's psychotic symptoms respond to antipsychotic drugs at doses lower than men's. This means that many women may be de facto overdosed and, thus, experience unnecessary adverse effects. That being said, factors such as genetics and age probably determine drug response and tolerability to a greater degree than do biological sex or gender social roles.

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“…Several AP drugs cause prolongation of the QT interval (beginning of the Q wave till the end of the T wave on the electrocardiogram); some APs do this more than others (42).…”

Section: Cardiac Arrythmiamentioning

confidence: 99%

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Seeman

2021

Front. Psychiatry

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“…2 Short-term use of haloperidol is generally well tolerated, 5 although side effects can occur, including extrapyramidal symptoms and QT interval prolongation. 6 To our knowledge, no study has examined to date the efficacy of haloperidol for Covid-19 in clinical populations. Observational studies of patients with Covid-19 taking medications for other indications can help determine their efficacy for Covid-19 and decide which should be prioritized for randomized clinical trials, and minimize the risk for patients of being exposed to potentially harmful and ineffective treatments.…”

Section: Introductionmentioning

confidence: 99%

“…2 Short-term use of haloperidol is generally well tolerated, 5 although side effects can occur, including extrapyramidal symptoms and QT interval prolongation. 6…”

Section: Introductionmentioning

confidence: 99%

Observational Study of Haloperidol in Hospitalized Patients with Covid-19

Hoertel

Sánchez‐Rico

Vernet

et al. 2020

Preprint

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Background: Haloperidol, a widely used antipsychotic, has been suggested as potential effective treatment for Covid-19 on the grounds of its in-vitro antiviral effects against SARS-CoV-2. Methods: We examined the association between haloperidol use and respiratory failure at AP-HP Greater Paris University hospitals. Data were obtained regarding all adult patients hospitalized with Covid-19 since the beginning of the epidemic. Study baseline was defined as the date of hospital admission. The primary endpoint was a composite of intubation or death and the secondary endpoint was discharge home among survivors in time-to-event analyses. We compared outcomes between patients who were exposed to haloperidol and those who were not, using a multivariable Cox regression model with inverse probability weighting according to the propensity score. Results: Of the 13,279 hospitalized adult patients with positive Covid-19 RT-PCR test, 667 patients (5.0%) were excluded because of missing data. Of the remaining 12,612 patients, 104 (0.8%) were exposed to haloperidol. Over a mean follow-up of 20.8 days, the primary endpoint of respiratory failure respectively occurred in 27 patients (26.0%) exposed to haloperidol and 1,700 patients (13.6%) who were not. Among survivors, the secondary endpoint of discharge home occurred in 26 patients (32.1%) who received haloperidol and 6,110 patients (55.3%) who did not. In the main analysis, there were no significant associations between haloperidol use and the primary (HR, 1.09; 95% CI, 0.60 to 1.97, p=0.772) and secondary (HR, 0.88; 95% CI, 0.50 to 1.53, p=0.643) endpoints. Results were similar in multiple sensitivity analyses. Conclusion: In this observational study involving patients with Covid-19 who had been admitted to the hospital, haloperidol use was not associated with risk of intubation or death, or with time to hospital discharge home. These results suggest that haloperidol is unlikely to have a clinical efficacy for Covid-19.

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“…TdP and sudden cardiac death are rare adverse events associated with antipsychotic use. 11 The likelihood of TdP appears to increase with the number of the presenting risk factors including advanced age (65 years or older), history of cardiovascular diseases (myocardial infarction, stroke, arrhythmia, or heart failure), dementia, hypokalemia or hypomagnesemia, and concomitant use of QTc prolonging agents. 12 In an analysis of 12 cases of quetiapine induced QTc prolongation or TdP occurred from 1997 to 2011, 4 patients had 6 or more risk factors.…”

Section: Discussionmentioning

confidence: 99%