Effects of atypical antipsychotic drugs on QT interval in patients with mental disorders

Aronow, Wilbert S.; Shamliyan, Tatyana

doi:10.21037/atm.2018.03.17

Cited by 48 publications

(29 citation statements)

References 87 publications

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“…Yet, cardiovascular events may occur more frequently when quetiapine is prescribed compared to the majority of other second-generation antipsychotics. [19][20][21] Molecular biological experiences and several case report evaluations strongly indicate a higher risk of QTprolongation when quetiapine is combined with other QT-prolonging drugs, 22,23 for example methadone. 24 Based on the clinical effects of quetiapine mentioned above, we hypothesized that quetiapine can increase the risk of fatal poisonings with opioids, which can be attributed to sedation, respiratory depression, hypotension, and cardiac arrhythmia in case of methadone.…”

Section: Introductionmentioning

confidence: 99%

“…QT prolongation, which may be observed as syncope are primarily seen in overdose. Yet, cardiovascular events may occur more frequently when quetiapine is prescribed compared to the majority of other second‐generation antipsychotics 19‐21 . Molecular biological experiences and several case report evaluations strongly indicate a higher risk of QTprolongation when quetiapine is combined with other QT‐prolonging drugs, 22,23 for example methadone 24 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?

Andersen

Simonsen

Andersen

2020

Basic Clin Pharma Tox

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Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-ago go channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?

Andersen

Simonsen

Andersen

2020

Basic Clin Pharma Tox

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“…L'olanzapine semble un traitement de choix du fait de son moindre risque sur le plan cardiologique [9][10][11], mais expose à une prise de poids importante. L'aripiprazole pourrait aussi être privilégié pour la même raison [11,12], mais nous n'avons pas retrouvé d'étude où il était associé à la lévothyroxine pour le traitement de troubles psychotiques en lien avec une hypothyroïdie. L'arrêt des traitements psychotropes pourra être envisagé une fois le bilan thyroïdien stabilisé et les symptômes psychiatriques contrôlés.…”

Section: Discussionunclassified

Troubles psychiques révélant une hypothyroïdie profonde

Köhl¹,

Lutchmaya²,

Ray

2019

Ann. Fr. Med. Urgence

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“…It is well known that quetiapine prolongs the QT interval in a dose-dependent manner [23]. Because DDIs that increase quetiapine's plasma concentration, such as those occurring with other CYP3A substrates like amlodipine and sertraline [23,24], can mimic higher doses of quetiapine, it is likely that they cause or contribute to the associated risk for QT interval prolongation. Two case reports from the literature of CYP3A4-mediated DDIs involving quetiapine resulted in TdP.…”

Section: Quetiapine: Interactions and Implicationsmentioning

confidence: 99%

Cytochrome P450 (CYP450) Interactions Involving Atypical Antipsychotics Are Common in Community-Dwelling Older Adults Treated for Behavioral and Psychological Symptoms of Dementia

Matos¹,

Bain²,

Bankes³

et al. 2020

Pharmacy

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Treatment of behavioral and psychological symptoms of dementia (BPSD) and comorbidities often necessitates the concomitant use of antipsychotics and non-antipsychotic drugs, thereby potentiating the risk for drug–drug interactions (DDIs). The primary objective of our study was to identify potentially clinically relevant cytochrome P450 (CYP)-mediated DDIs involving antipsychotics among participants enrolled in the Program of All-Inclusive Care for the Elderly (PACE) with BPSD. Additionally, we wanted to determine the prevalence of antipsychotic use in this population. The study included 10,001 PACE participants. The practice setting used a proprietary clinical decision support system (CDSS) to analyze simultaneous multidrug interactions. A retrospective analysis of pharmacy claims data was conducted to identify DDIs involving antipsychotics prescribed for BPSD, using snapshots of medication profiles paired with the CDSS. Of the participants who met inclusion criteria, 1190 (11.9%) were prescribed an antipsychotic; of those, 1071 (90.0%) were prescribed an atypical antipsychotic. Aripiprazole commonly caused (being a perpetrator drug 94.6% of the time) potential DDIs with antidepressants (e.g., duloxetine, venlafaxine, mirtazapine), opioids (e.g., hydrocodone, oxycodone, tramadol) and metoprolol via the CYP2D6 isoform. Risperidone commonly caused (85.7%) potential DDIs with donepezil, lamotrigine and trazodone via the CYP3A4 isoform. Quetiapine exclusively suffered (100%) from potential DDIs with amlodipine, buspirone, omeprazole or topiramate via the CYP3A4 isoform. Antipsychotics are commonly prescribed to PACE participants for BPSD treatment and they may interact with other drugs used to treat comorbidities. A thorough review of concomitant medications will help mitigate the likelihood of potentially dangerous CYP-mediated DDIs involving antipsychotics.

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Effects of atypical antipsychotic drugs on QT interval in patients with mental disorders

Cited by 48 publications

References 87 publications

Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?

Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?

Troubles psychiques révélant une hypothyroïdie profonde

Cytochrome P450 (CYP450) Interactions Involving Atypical Antipsychotics Are Common in Community-Dwelling Older Adults Treated for Behavioral and Psychological Symptoms of Dementia

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