QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

Elliott, Anja Friis; Mørk, Thibault Johan; Christensen, Thomas; Jeppesen, Rasmus; Madsen, Nikolaj Juul; Viuff, Anne Grethe; Hjorth, Peter; Nielsen, Jens Cosedis; Munk‐Jørgensen, Povl

doi:10.1017/s1092852917000402

Cited by 19 publications

(30 citation statements)

References 24 publications

(44 reference statements)

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“…Advanced age is a recognised risk factor for the development of TdP associated with the use of QTc-prolonging drugs 1 4 11 12. Ageing is also associated with polypharmacy—in Sweden, people aged ≥75 years are prescribed on average five different drugs20—and there is comprehensive evidence that concomitant administration of more than one TdP-classified drug further increases the risk of developing a QTc prolongation and TdP 3 4 21–25. Our results are confirmative in this aspect.…”

Section: Discussionsupporting

confidence: 78%

Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study

et al. 2020

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ObjectiveTo study the occurrence of torsades de pointes (TdP) ventricular tachycardia in relation to use of drugs labelled with TdP risk, using two nationwide Swedish registers.DesignProspective register-based cohort study.SettingEntire Sweden.ParticipantsPersons aged ≥18 years prescribed and dispensed any drug classified with TdP risk during 2006–2017, according to CredibleMeds. Persons with a registered TdP diagnosis during the study period, using drugs labelled with known (TdP 1), possible (TdP 2) or conditional (TdP 3) risk at the incident of TdP were examined.Primary outcome measuresOccurrence of TdP in relation to exposure rates for individual drugs with TdP risk.Secondary outcome measuresConcurrent use of more than one TdP-labelled drug in a person with a TdP diagnosis.ResultsDuring the study period, 410 TdP cases using drugs with TdP risk labels at the incident were registered; 205 women and 205 men, mean age 74.0 and 71.5 years, respectively. Antidepressants dominated (129/410, 30%), followed by antiarrhythmics (17%). Diuretics and gastric acid-secretion inhibitors, with TdP risk related to induction of hypokalaemia or hypomagnesaemia, were used in 56% and 32% of the 410 TdP cases, respectively. Among the most used antidepressants, citalopram with known TdP 1 risk was associated with both a higher absolute number and incidence of TdP per 100 000 users (two to four times), compared with mirtazapine with possible (TdP 2), and sertraline with conditional (TdP 3) risk. Multiple risk factors, including advanced age, cardiovascular disease and treatment with more than one TdP-classified drug, were frequently observed.ConclusionsAntidepressants followed by antiarrhythmics dominated among TdP risk drugs used by adults with TdP diagnosis, the majority being ≥65 years. TdP risk class and concomitant medication should be considered when prescribing antidepressants to older patients.

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Section: Discussionsupporting

confidence: 78%

Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study

et al. 2020

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“…In particular, AP are known to cause QT prolongation and have been shown to increase the risk of SCD [29, 33]. It is disputable whether APP has a cumulative effect on the QT interval prolongation, but clinicians are advised to be cautious [34–37]. However, it should be noted that AP intoxication as a cause of death is low for the present material (1.8%).…”

Section: Discussionmentioning

confidence: 86%

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Mikkelsen

Hasselstrøm

Línnet

et al. 2020

Journal of Forensic Sciences

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Patients suffering from severe psychiatric disorders have a higher all-cause mortality than the general population [1-3], and this excess mortality further leads to a shorter life span expectancy by 10-25 years [1, 2]. The underlying causes of this excess mortality are not clearly established, but cardiovascular diseases and lifestyle factors such as diabetes, obesity, smoking, and alcohol and drug

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“… 25 Moreover, the QTc interval is still mainly used to analyse the risk of arrhythmia associated with specific drugs or procedures. 26 , 27 Second, the small sample size of this study could be a limitation. However, the post-hoc power analysis showed a power of 0.987 when using the mean value of the QTc interval before anaesthetic induction and 90 minutes after pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 96%

Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

et al. 2018

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ObjectivePneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.MethodsThis prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.ResultsCompared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.ConclusionA long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia.Trial Registration: Registered at ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT02604979; Registration number NCT02604979

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QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

Abstract: We recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.

Cited by 19 publications

References 24 publications

Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study

Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

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