Shock From Twisting Peaks: A Rare Case of Recurrent Torsades de Pointes Secondary to Leuprolide-Induced Prolonged QT

Abbasi, Danish; Faiek, Saif; Shetty, Sanjay; Khan, Ejaz

doi:10.7759/cureus.9041

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…Leuprolide carries a warning for prolonged QT interval, which is defined as a rate-corrected QT (QTc) interval on electrocardiography above the 99 th percentile, or 480 ms for cisgender women and 470 ms for cisgender men, with QTc interval greater than 440 ms considered borderline 48 . A QT interval greater than 500 ms has been linked with increased risk of torsades de pointes, with at least one documented case associated with leuprolide 48,49 . QT prolongation is also a potential side effect of numerous psychiatric medications, such as stimulants, antidepressants, and antipsychotics (e.g., haloperidol, thioridazine, and ziprasidone).…”

Section: Resultsmentioning

confidence: 99%

“…48 A QT interval greater than 500 ms has been linked with increased risk of torsades de pointes, with at least one documented case associated with leuprolide. 48,49 QT prolongation is also a potential side effect of numerous psychiatric medications, such as stimulants, antidepressants, and antipsychotics (e.g., haloperidol, thioridazine, and ziprasidone). Depending on a patient's risk factors for arrhythmias, routine monitoring may be beneficial if there are unavoidable risk factors and multiple medications.…”

Section: Qt Prolongationmentioning

confidence: 99%

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Psychopharmacological Considerations for Gender-Affirming Hormone Therapy

Kim

Goetz

Grieve

et al. 2023

Harv Rev Psychiatry

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The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians’ lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.

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Section: Resultsmentioning

confidence: 99%