Differential Changes in QTc Duration during In-Hospital Haloperidol Use

Abstract

AimsTo evaluate changes in QT duration during low-dose haloperidol use, and determine associations between clinical variables and potentially dangerous QT prolongation.MethodsIn a retrospective cohort study in a tertiary university teaching hospital in The Netherlands, all 1788 patients receiving haloperidol between 2005 and 2007 were studied; ninety-seven were suitable for final analysis. Rate-corrected QT duration (QTc) was measured before, during and after haloperidol use. Clinical variables before haloperidol use and at the time of each ECG recording were retrieved from hospital charts. Mixed model analysis was used to estimate changes in QT duration. Risk factors for potentially dangerous QT prolongation were estimated by logistic regression analysis.ResultsPatients with normal before-haloperidol QTc duration (male ≤430 ms, female ≤450 ms) had a significant increase in QTc duration of 23 ms during haloperidol use; twenty-three percent of patients rose to abnormal levels (male ≥450 ms, female ≥470 ms). In contrast, a significant decrease occurred in patients with borderline (male 430–450 ms, female 450–470 ms) or abnormal before-haloperidol QTc duration (15 ms and 46 ms, respectively); twenty-three percent of patients in the borderline group, and only 9% of patients in the abnormal group obtained abnormal levels. Potentially dangerous QTc prolongation was independently associated with surgery before haloperidol use (ORadj 34.9, p = 0.009) and before-haloperidol QTc duration (ORadj 0.94, p = 0.004).ConclusionQTc duration during haloperidol use changes differentially, increasing in patients with normal before-haloperidol QTc duration, but decreasing in patients with prolonged before-haloperidol QTc duration. Shorter before-haloperidol QTc duration and surgery before haloperidol use predict potentially dangerous QTc prolongation.

A study of the use of sedative PRN medication in patients at a secure hospital

“…As in studies conducted in acute settings, we found that benzodiazepines were the PRN drugs most commonly prescribed but that antipsychotic prescriptions were also common, particularly Haloperidol. This is despite Haloperidol's propensity to cause extra-pyramidal side effects and prolongation of QTc interval (Blom et al, 2011). Its popularity may be due to the fact that it can be administered IM as well as orally and can be given at the same time as IM Lorazepam, unlike IM Olanzapine.…”

Antipsychotic Agents

“…Nevertheless, sudden cardiac deaths, though uncommon, have been associated with long-term treatment with older as well as modern antipsychotic drugs, and unanticipated cardiac arrhythmias may contribute to this risk [ 99,140,171,172 ] ; decreased mortality also has been reported in association with long-term antipsychotic treatment [ 206 ] . Prolongation of the QTc interval is especially likely with thioridazine or mesoridazine more than haloperidol among older neuroleptics, somewhat less with ziprasidone, and apparently negligibly with clozapine among second-generation antipsychotics [ 4,26,81 ] . Taken alone, short of severe acute overdoses, such responses to these agents are not likely, but risk increases as additional agents with inhibitory effects on cardiac repolarization are added, including tricyclic antidepressants and class Ia, sodium-channel blocking, antiarrhythmic drugs such as quinidine, procainamide (Pronestyl ® ), and disopyramide (Norpace ® ), or if other risk factors are present.…”

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

“…Evidence from cohorts of palliative care and hospital inpatients treated with haloperidol suggests that severely prolonged QTc intervals (>500 ms) are rare, occurring in less than 1% of patients. 106,112 Future studies of antipsychotic drug treatment and prophylaxis should incorporate ECG monitoring for QTc prolongation. 102 …”