Antipsychotics cardiotoxicity: What's known and what's next

Abstract

Chronic use of antipsychotic medications entails a dilemma between the benefit of alleviating psychotic symptoms and the risk of troubling, sometimes life-shortening adverse effects. Antipsychotic-induced cardiotoxicity is one of the most life-threatening adverse effects that raises widespread concerns. These cardiotoxic effects range from arrhythmia to heart failure in the clinic, with myocarditis/cardiomyopathy, ischemic injuries, and unexplained cardiac lesions as the pathological bases. Multiple mechanisms have been proposed to underlie antipsychotic cardiotoxicity. This review aims to summarize the clinical signs and pathological changes of antipsychotic cardiotoxicity and introduce recent progress in understanding the underlying mechanisms at both the subcellular organelle level and the molecular level. We also provide an up-to-date perspective on future clinical monitoring and therapeutic strategies for antipsychotic cardiotoxicity. We propose that third-generation antipsychotics or drug adjuvant therapy, such as cannabinoid receptor modulators that confer dual benefits — i.e. , alleviating cardiotoxicity and improving metabolic disorders — deserve further clinical evaluation and marketing.

Sudden Cardiac Death in Schizophrenia During Hospitalization: An Autopsy-Based Study

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“…, hypotension or hypertension) to fatal issues such as QT prolongation and congestive heart failure. The three newer antipsychotics mentioned in the article are typical third-generation antipsychotics (TGAs), which display well-documented lower metabolic liability and better performance in targeting negative symptomatology and improving cognitive domains[ 2 ]. In addition, some TGAs such as roliperidone are associated with a lower incidence of cardiovascular side effects in short term.…”

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