QTc Prolongation and Psychotropic Medications

Funk, Margo C.; Beach, Scott R.; Bostwick, Jolene R.; Celano, Christopher M.; Hasnain, Mehrul; Pandurangi, Anand K.; Khandai, Abhisek Chandan; Taylor, Adrienne; Levenson, James L.; Riba, Michelle; Kovacs, Richard J.

doi:10.1176/appi.ajp.2019.1760501

Cited by 35 publications

(34 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…117 Prolongation of QTc (longer than 450 ms in men and longer than 470 ms in women, respectively, when corrected with Bazetts Formula 118 ) can contribute to this. 34 A prolongation of QTc can lead to torsade de pointes and subsequently to sudden death. 119,120 The molecular pathway of this side effect is not completely understood.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Examining side effect variation in antipsychotic treatment and schizophrenia spectrum disorders

Neumeier

Homan

Vetter

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Side effects of antipsychotic drugs play a key role in non-adherence and discontinuation of treatment in schizophrenia spectrum disorders (SSD). Precision medicine aims to minimize such side effects by selecting the right treatment for the right patient. However, to determine the extent of precision medicine that is required, we need to (1) show that there is indeed variation in side effects and (2) estimate the amount of variation in those side effects between patients. While clinical observations suggest that such variation may be considerable, a statistical comparison of side effect variation between active and control treatments is required to confirm this. Here, we hypothesized to find larger side effect variation in treatment compared with control in patients treated with first and second generation antipsychotics. Methods: We included double-blind, placebo-controlled, randomized controlled trials (RCTs) of adults with a diagnosis of SSD and prescription for licensed antipsychotic drugs. Standard deviations of the pre-post treatment differences of weight gain, prolactin levels,and corrected QT (QTc) times were extracted. Data quality and validity were ensured by following the PRISMA guidelines. The outcome measure was the overall variability ratio of treatment to control across RCTs. Individual variability ratios were weighted by the inverse-variance method and entered into a random-effects model. Results: We included N = 16578 patients for weight gain, N = 16633 patients for prolactin levels, and N = 10384 patients for QTc time. Variability ratios (VR) were significantly increased for weight gain (VR = 1.08; 95% CI: 1.02 - 1.14; P = 0.004) and prolactin levels (VR = 1.38; 95% CI: 1.17 - 1.62; P < 0.001) but did not reach significance for QTc time (VR = 1.05; 95% CI: 0.98 - 1.12; P = 0.135). Conclusion: We found increased variability in major side effects in patients with SSD under treatment with second generation antipsychotics, suggesting that subgroups of patients or even individual patients may benefit from improved treatment allocation through stratified or personalized medicine, respectively.

show abstract

Section: Discussionmentioning

confidence: 99%

“…33 Importantly, torsade de pointes tachycardia and sudden cardiac death is a possible severe consequence of QTc prolongation. 34 Such cardiac events are one of the factors that lead to the loss of life expectancy observed in patients with SSD. 35–37…”

Section: Introductionmentioning

confidence: 99%

Examining side effect variation in antipsychotic treatment and schizophrenia spectrum disorders

Neumeier

Homan

Vetter

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…71,72 Nevertheless, polypharmacy should be considered in the decision to perform ECG monitoring, as certain medications may prolong the QTc interval (i.e., citalopram, venlafaxine, bupropion, mirtazapine, and lithium). 73 Fasting insulin assessment was missing for at least 97% of our patients. Such monitoring is not recommended by the CAMESA guidelines for aripiprazole-treated youths.…”

Section: What Is Less Monitored?mentioning

confidence: 96%

Long-Term Metabolic Monitoring of Youths Treated with Second-Generation Antipsychotics 5 Years after Publication of the CAMESA Guidelines Are We Making Progress? Surveillance Métabolique à Long Terme des Jeunes Traités par Antipsychotiques de Deuxième Génération, Cinq ans Après la publication des Lignes Directrices Camesa: Faisons-Nous des Progrès?

et al. 2020

View full text Add to dashboard Cite

Objective: The potential metabolic adverse effects of second-generation antipsychotics (SGA) need to be monitored. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics (CAMESA) offers guidelines for this purpose. We aimed to evaluate the long-term rates of youths receiving monitoring in mental health clinics and document the factors that may influence them. Method: The charts of 180 patients (13.3 ± 3.1 years, 54.4% males) receiving SGA treatment for the first time between January 2016 and June 2018 were reviewed. Monitoring was divided into baseline and 1- to 6-month and 9- to 24-month periods. Population under study was stratified into children (4 to 12 years) and adolescents (13 to 18 years). Sociodemographic characteristics, psychiatric diagnosis and comorbidities, prescribed SGAs and comedications, anthropometric measures (AM), blood pressure (BP), blood tests (BT), electrocardiogram, and the psychiatrist’s years of practice were collected. Cross tables were used to present the monitoring rates. Categories were compared by covariate analysis. Rates of patients monitored across categories were compared using Fisher exact test. Results: Monitoring rates for AM, BT, and BP were 55%, 47.8%, and 46.7% at baseline; 50%, 41.7%, and 45.2% at 1 to 6 months; and 47.2%, 41.5%, and 40.6% at 9 to 24 months, respectively. Higher monitoring rates were significantly associated with adolescent status (baseline, 1 to 6 months), a diagnosis of psychotic and/or affective disorder (baseline, 1 to 6 months, 9 to 24 months), having ≤1 psychiatric comorbidities (1 to 6 months), high SGA dose (baseline, 1 to 6 months), and clinician’s experience (baseline, 9 to 24 months). Significantly lower monitoring rates were associated with the psychostimulant/atomoxetine comedication (baseline, 1 to 6 months, 9 to 24 months). Conclusion: Five years after publication of the CAMESA guidelines, metabolic monitoring is conducted for less than half of patients. In our sample, age, diagnostic category, psychiatric comorbidities, SGA dose, clinician’s experience, and comedications influenced the monitoring rates. Major progress still needs to be made before reaching a satisfactory level of monitoring.

show abstract

“…Symptoms of TdP include palpitations, dizziness, and a brief loss of consciousness. Nonspecific symptoms of TdP such as chest pain, dyspnoea, and sweating may also occur (Funk et al, 2020).…”

Section: Assessment Of Other Risk Factors For Qtc Prolongation and Tdp Occurrencementioning

confidence: 99%

“…However, calculation of QTc by Bazett's formula remains the best and most widely used method for TdP risk prediction (Nielsen et al, 2011). Cutoff points for QTc interval prolongation (Goldenberg et al, 2006;Funk et al, 2020) are shown in Table 1. Other authors consider a QTc interval above 450 ms in men and 460 ms in women to be prolonged (Sicouri and Antzelevitch, 2018) or 440 ms for men and 450 for women (Glassman, 2002).…”

mentioning

confidence: 99%

Second generation antidepressants and the risk of arrhythmia

Suwalska

Napierała

Proch

et al. 2021

Pharmacotherapy in Psychiatry and Neurology

View full text Add to dashboard Cite

Objectives. Second generation antidepressants belong to the most commonly prescribed medications; they are used in the treatment of depression, anxiety disorder, and pain. The aim of the study is to evaluate their risk of QT prolongation, which can lead to potentially life-threatening ventricular arrhythmias. Literature review. Based on the Summary of Product Characteristics and CredibleMeds database, we present current knowledge about the risk of QT prolongation caused by second generation antidepressants. Recommendations concerning planning and conducting treatment using second generation antidepressants are discussed. Conclusions. As scientific research shows, newer antidepressants cause fewer side effects than tricyclic antidepressants, but they are not devoid of them. For some of them, there is a proven risk of QT prolongation and torsade de pointes, which can, very rarely, lead to patient’s death. Before prescribing new antidepressants, clinicians should evaluate the patient’s risk of QT prolongation and, in case of high risk, they should apply the lowest effective dose, regularly monitor the patient’s condition, and inform the patient to consult a cardiologist if any alarming symptoms, such as syncope or palpitations, occur.

show abstract

QTc Prolongation and Psychotropic Medications

Cited by 35 publications

References 0 publications

Examining side effect variation in antipsychotic treatment and schizophrenia spectrum disorders

Examining side effect variation in antipsychotic treatment and schizophrenia spectrum disorders

Second generation antidepressants and the risk of arrhythmia

Contact Info

Product

Resources

About