Thioridazine and sudden unexplained death in psychiatric in-patients

Abstract

Thioridazine alone was associated with sudden unexplained death, the likely mechanism being drug-induced arrhythmia.

Cardiac side effects of psychiatric drugs

“…A study of 495 psychiatric patients, the majority of whom were taking typical agents, reported that droperidol and thioridazine caused QT c prolongation in a dose-related manner (Reilly et al, 2000). A further study identified an excess of sudden deaths in patients taking thioridazine (Reilly et al, 2002). Subsequent to these observations, droperidol was withdrawn from the market and changes were made to the licensed indications for thioridazine.…”

The Impact of Cardiometabolic Risk in Patients with Severe Mental Illness: From Evidence to Clinical Management

“…Most antipsychotics and some antidepressants may be associated with QTc prolongation (Glassman, 2005). Patients using AP have higher rates of cardiac arrest or ventricular arrhythmias than controls, with ratios ranging from 1.7 to 5.3 (Ray et al, 2001;Hennessy et al, 2002;Reilly et al, 2002). Antipsychotics associated with a greater risk of QTc prolongation include pimozide, thioridazine and mesoridazine among the FGAs (Vieweg, 2002;Reilly et al, 2002) and sertindole and ziprasidone among the SGAs (Thomas et al, 2010).…”

“…Patients using AP have higher rates of cardiac arrest or ventricular arrhythmias than controls, with ratios ranging from 1.7 to 5.3 (Ray et al, 2001;Hennessy et al, 2002;Reilly et al, 2002). Antipsychotics associated with a greater risk of QTc prolongation include pimozide, thioridazine and mesoridazine among the FGAs (Vieweg, 2002;Reilly et al, 2002) and sertindole and ziprasidone among the SGAs (Thomas et al, 2010). However, the largest randomized study to date (n=18,154) did not find a statistically significant difference in the risk of sudden cardiac death between ziprasidone and olanzapine treated patients with schizophrenia (Strom et al, 2011).…”

Response of IKrand hERG Currents to the Antipsychotics Tiapride and Sulpiride

“…These drugs share an ability to block the rapid component of the delayed rectifier K ＋ current (IKr), resulting in a delayed repolarization of the cardiac action potential and prolongation of the QT interval, possibly leading to torsades de pointes [1]. Several epidemiological studies and case-control reports have shown that the rate of sudden death is increased in psychiatric patients taking antipsychotic drugs [2][3][4][5]. Tiapride has been classified as a selective dopamine D2-receptor antagonist and is used as an atypical neuroleptic drug for the treatment of agitation, aggressiveness, anxiety, and sleep disorders in elderly patients [6].…”