Arrhythmias related to antipsychotics and antidepressants: an analysis of the summaries of product characteristics of original products approved in Germany

Abstract Purpose Most psychiatric drugs, such as antidepressants (AD) and antipsychotics (AP), may cause cardiac adverse events (CAE). We used summaries of product characteristics (SmPC) for assessing the likelihood of AD and AP to cause CAE. Methods We identified all original medicinal products (OMP) of AD and AP approved in Germany. We searched for their SmPCs using the online services of PharmaNet.Bund, Gelbe liste®, Rote Liste®, Fachinfo-Service®, and via manufacturer contact. We extracted frequencies of reported CAE (QT prolongation, Torsade de Pointes tachycardia, and ventricular arrhythmia) and performed a risk assessment. Results We obtained the SmPCs of 24 AD and 26 AP identified as OMP. Comparably high reported frequencies regarding QT prolongation were found for Invega® (paliperidone), Serdolect® (sertindole) (≥ 1/100 and < 1/10), and Zoloft® (sertraline) (≥ 1/10.000 and < 1/1000); regarding Torsade de Pointes tachycardia were found for Serdolect® (≥ 1/1000 to < 1/100), Zoloft®, and Trevilor® (venlafaxine) (≥ 1/10.000 and < 1/1000); regarding ventricular tachycardia for Solian® (amisulpride), Xomolix® (droperidol), Zyprexa® (olanzapine), and Trevilor® (≥ 1/10.000 and < 1/1000). Conclusion The risk and frequency of CAE, as reported in the SmPCs, varied significantly among substances and between groups. There are more reports for AP than AD. The AP with the most frequently reported CAE (QT prolongation and Torsade de Pointes tachycardia) was Serdolect®; for AD, Zoloft® (QT prolongation, Torsade de Pointes tachycardia) and Trevilor® (Torsade de Pointes tachycardia and ventricular tachycardia) carried a higher cardiac risk.

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Cardiac arrhythmias related to psychiatric medication

Nervenheilkunde ◽

10.1055/s-0038-1627522 ◽

2017 ◽

Vol 36 (09) ◽

pp. 747-750

Author(s):

R. W. Freudenmann ◽

C. Schönfeldt-Lecuona ◽

B. J. Connemann ◽

M. Gahr ◽

M. Elsayed

Keyword(s):

Cardiac Arrhythmias ◽

Torsade De Pointes ◽

General Medicine ◽

Fold Increase ◽

Cardiac Risk ◽

Psychiatric Medication ◽

Cardiac Side Effects ◽

Torsade De Pointes Tachycardia ◽

Multiple Drugs ◽

Available Information

SummaryThis narrative review summarizes current available information about cardiac arrhythmias (QT prolongation, Torsade de pointes Tachycardia [TdP], sudden cardiac death) associated with psychiatric medication. Among the most commonly used antipsychotics, amisulpride and ziprasidone are most frequently associated with TdP. Treatment with some antidepressants (SSRIs, tricyclic antidepressants) is associated with a 5- to 6-fold increase in the incidence of out-of-hospital cardiac arrest. Lithium is associated with bradycardia, T-wave changes and AV-block; anxiolytics of the benzodiazepine group do usually not have cardiac side effects. The combination of multiple drugs (including medications from general medicine) that prolong the QT interval has a particularly high cardiac risk.

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Life-Threatening Ventricular Arrhythmia (Torsades de Pointes) after Haloperidol Overdose

Human & Experimental Toxicology ◽

10.1177/096032719101000110 ◽

1991 ◽

Vol 10 (1) ◽

pp. 59-62 ◽

Cited By ~ 42

Author(s):

R.A. Henderson ◽

S. Lane ◽

J.A. Henry

Keyword(s):

Ventricular Tachycardia ◽

Literature Review ◽

Ventricular Arrhythmia ◽

Torsades De Pointes ◽

Qt Prolongation ◽

Life Threatening ◽

Overdrive Pacing

A 48-year-old woman developed QT prolongation and episodes of life-threatening ventricular tachycardia (torsades de pointes) after intentional overdose of haloperidol and orphenadrine. The arrhythmia did not respond to conventional anti-arrhythmic therapy but was suppressed by atrial overdrive pacing. A literature review identified haloperidol as the most likely cause of the torsades de pointes.

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QT Prolongation, Torsade de Pointes, Myocardial Ischemia From Coronary Vasospasm, and Headache Medications. Part 1: Review of Serotonergic Cardiac Adverse Events With a Triptan Case

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2012.02300.x ◽

2012 ◽

Vol 53 (1) ◽

pp. 208-216 ◽

Cited By ~ 7

Author(s):

Mark J. Stillman ◽

Stewart Tepper ◽

Deborah E. Tepper ◽

Leslie Cho

Keyword(s):

Myocardial Ischemia ◽

Adverse Events ◽

Torsade De Pointes ◽

Qt Prolongation ◽

Coronary Vasospasm ◽

Cardiac Adverse Events

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QT Prolongation and Torsade de Pointes Ventricular Tachycardia Produced by Ketanserin

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.1986.tb06633.x ◽

1986 ◽

Vol 9 (6) ◽

pp. 836-841 ◽

Cited By ~ 22

Author(s):

ANTONIO E. ALDARIZ ◽

HORACIO ROMERO ◽

MARTA BARONI ◽

HUGO BAGLIVO ◽

RICARDO J. ESPER

Keyword(s):

Ventricular Tachycardia ◽

Torsade De Pointes ◽

Qt Prolongation

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Combination therapy with anti-tachycardia pacing and low-energy shock in patients with ventricular tachycardia

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-4-33-36 ◽

2015 ◽

Vol 17 (2) ◽

pp. 33

Author(s):

A. G. Strelnikov ◽

A. B. Romanov ◽

S. N. Artemenko ◽

I. G. Stenin ◽

V. V. Shabanov ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Combination Therapy ◽

Adverse Events ◽

Ventricular Arrhythmia ◽

Combined Therapy ◽

High Energy ◽

Low Energy ◽

Antitachycardia Pacing ◽

Arrhythmia Therapy

Ventricular arrhythmia therapy by using high-energy shock is associated with adverse events. In this study we estimated combined therapy of antitachycardia pacing and low-energy shock in patients with various types of ventricular tachycardia.

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Cardiac Risk Assessment

Internal Medicine News ◽

10.1016/s1097-8690(11)70034-8 ◽

2011 ◽

Vol 44 (1) ◽

pp. 46-47

Author(s):

HOWARD P. LEVY

Keyword(s):

Risk Assessment ◽

Cardiac Risk ◽

Cardiac Risk Assessment

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Algorithm Refines Cardiac Risk Assessment in Women

Family Practice News ◽

10.1016/s0300-7073(07)70353-5 ◽

2007 ◽

Vol 37 (6) ◽

pp. 12

Author(s):

MARY ANN MOON

Keyword(s):

Risk Assessment ◽

Cardiac Risk ◽

Cardiac Risk Assessment

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Effect on Costs of ACC/AHA Guidelines for Preoperative Cardiac Risk Assessment Before Aortic Surgery

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)88110-7 ◽

1998 ◽

Vol 31 (2) ◽

pp. 485A

Author(s):

J Froehlich

Keyword(s):

Risk Assessment ◽

Aortic Surgery ◽

Cardiac Risk ◽

Cardiac Risk Assessment

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Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Cancers ◽

10.3390/cancers13071631 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1631

Author(s):

Anna Astarita ◽

Giulia Mingrone ◽

Lorenzo Airale ◽

Fabrizio Vallelonga ◽

Michele Covella ◽

...

Keyword(s):

Blood Pressure ◽

Risk Assessment ◽

Multiple Myeloma ◽

Cardiovascular Risk ◽

High Risk ◽

Adverse Events ◽

Risk Score ◽

Risk Group ◽

High Risk Group ◽

Cardiovascular Risk Assessment

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

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