QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update

Scott R. Beach, Christopher M. Celano, Alan M. Sugrue, Caitlin Adams, Michael John Ackerman, Peter Noseworthy, Jeff C. Huffman

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Some psychotropic medications have been associated with prolongation of the QT interval and QT prolongation, especially in those with medical illness, and are linked to lethal ventricular arrhythmias, such as Torsades de Pointes (TdP). In 2013, we published a review of QT prolongation, TdP, and psychotropic medications. Objective: We provide an update over the past 5 years on the specific concerns most relevant to clinicians who see medically ill patients. Methods: In this nonsystematic review, we aimed to carefully and intensively identify new articles by utilizing a structured PubMed search from 2012-present. Results: QT prolongation remains an imperfect, though well-established marker of risk for TdP. Among antidepressant medications, citalopram does appear to prolong the QT interval more than other selective serotonin reuptake inhibitors, though the clinical significance of this prolongation remains unclear. Escitalopram appears to prolong the QT interval to a lesser extent. Haloperidol carries a risk for QT prolongation, but the assertion that intravenous haloperidol is inherently riskier may be confounded by its primary use in medically ill populations. Among atypical antipsychotic agents, ziprasidone-and possibly iloperidone-is associated with the greatest QT prolongation, whereas aripiprazole appears safest from this standpoint. Conclusions: The evidence for clinically meaningful QT prolongation with most classes of psychiatric agents remains minimal. The most important risk-reducing intervention clinicians can make is undertaking a careful analysis of other QT risk factors when prescribing psychiatric medications.

Original languageEnglish (US)
JournalPsychosomatics
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Torsades de Pointes
Citalopram
Haloperidol
Psychiatry
Serotonin Uptake Inhibitors
PubMed
Antidepressive Agents
Antipsychotic Agents
Cardiac Arrhythmias
Population
Medication
Clinicians

Keywords

  • Cardiac psychiatry
  • Consultation-liaison psychiatry
  • QT prolongation
  • Torsades

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Applied Psychology
  • Psychiatry and Mental health

Cite this

QT Prolongation, Torsades de Pointes, and Psychotropic Medications : A 5-Year Update. / Beach, Scott R.; Celano, Christopher M.; Sugrue, Alan M.; Adams, Caitlin; Ackerman, Michael John; Noseworthy, Peter; Huffman, Jeff C.

In: Psychosomatics, 01.01.2017.

Research output: Contribution to journalArticle

Beach, Scott R. ; Celano, Christopher M. ; Sugrue, Alan M. ; Adams, Caitlin ; Ackerman, Michael John ; Noseworthy, Peter ; Huffman, Jeff C. / QT Prolongation, Torsades de Pointes, and Psychotropic Medications : A 5-Year Update. In: Psychosomatics. 2017.
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