QTc Interval Prolongation and Torsade de Pointes Associated with Second-Generation Antipsychotics and Antidepressants: A Comprehensive Review

AbstractThis paper aimed to collect and unite facts known about the effect of methadone treatment on QTc interval prolongation that could determine precipitating factors in the development of heart arrhythmias and their consequences (Torsade de Pointes and sudden cardiac death), and to raise the methadone treatment safety level.Studies conducted up to now clearly demonstrate that methadone therapy evokes changes in the heart’s electrical conduction, but those studies also show that QTc interval prolongation could be precipitated by other factors. The most often present risk factors in our research were dose of methadone, co-medication, and co-morbidity, but other relevant risk factors were gender, age, misuse of illicit drugs, therapy length and tobacco use.Active participation in modern treatment processes and implementation of knowledge acquired recently into daily practice, such as setting up reutilized questionnaires and diagnostic methods to expose higher risk for complications and providing broader therapeutic range for cases of drug replacement necessity, will enhance therapy safety level and bring us to the next step of resocialization of these patients, which needs to remain the final goal of treatment.

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QTc Prolongation in Patients Acutely Admitted to Hospital for Psychosis and Treated with Second Generation Antipsychotics

Schizophrenia Research and Treatment ◽

10.1155/2013/375020 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Erik Johnsen ◽

Kristina Aanesen ◽

Sanjeevan Sriskandarajah ◽

Rune A. Kroken ◽

Else-Marie Løberg ◽

...

Keyword(s):

Antipsychotic Drugs ◽

Statistical Significance ◽

Torsade De Pointes ◽

Positive Association ◽

Qtc Interval ◽

Qtc Prolongation ◽

Chi Square ◽

Exact Test ◽

Second Generation Antipsychotics ◽

Qtc Interval Prolongation

QTc interval prolongation is a side effect of several antipsychotic drugs, with associated risks of torsade de pointes arrhythmias and sudden cardiac death. There is an ongoing debate of whether or not electrocardiogram (ECG) assessments should be mandatory in patients starting antipsychotic drugs. To investigate QTc prolongation in a clinically relevant patient group 171 adult patients acutely admitted to an emergency ward for psychosis were consecutively recruited. ECGs were recorded at baseline and then at discharge or after 6 weeks at the latest (discharge/6 weeks), thus reflecting the acute phase treatment period. The mean QTc interval was 421.1 (30.4) ms at baseline and there was a positive association between the QTc interval and the agitation score whereas the QTc interval was inversely associated with the serum calcium level. A total of 11.6% had abnormally prolonged QTc intervals and another 14.3% had borderline prolongation. At discharge/6 weeks, the corresponding proportions were reduced to 4.2% and 5.3%, respectively. The reduction of the proportion with prolonged QTc intervals reached statistical significance (chi-square exact test:P=0.046). The finding of about one-quarter of the patients with borderline or prolonged QTc intervals could indicate mandatory ECG recordings in this population. This trial is registered with ClinicalTrials.gov ID:NCT00932529.

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Risperidone, QTc interval prolongation, and torsade de pointes: a systematic review of case reports

Psychopharmacology ◽

10.1007/s00213-013-3192-8 ◽

2013 ◽

Vol 228 (4) ◽

pp. 515-524 ◽

Cited By ~ 28

Author(s):

W. Victor R. Vieweg ◽

Mehrul Hasnain ◽

Jules C. Hancox ◽

Adrian Baranchuk ◽

Geneviève C. Digby ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Torsade De Pointes ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Interval Prolongation

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Quetiapine, QTc interval prolongation, and torsade de pointes: a review of case reports

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125313510194 ◽

2013 ◽

Vol 4 (3) ◽

pp. 130-138 ◽

Cited By ~ 31

Author(s):

Mehrul Hasnain ◽

W. Victor R. Vieweg ◽

Robert H. Howland ◽

Christopher Kogut ◽

Ericka L. Breden Crouse ◽

...

Keyword(s):

Case Reports ◽

Torsade De Pointes ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Interval Prolongation

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Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity

Therapeutic Advances in Infectious Disease ◽

10.1177/2049936114527744 ◽

2014 ◽

Vol 2 (2) ◽

pp. 47-59 ◽

Cited By ~ 8

Author(s):

Jules C. Hancox ◽

Mehrul Hasnain ◽

W. Victor R. Vieweg ◽

Michael Gysel ◽

Michelle Methot ◽

...

Keyword(s):

Risk Factors ◽

Case Reports ◽

Torsade De Pointes ◽

Illness Severity ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Interval Prolongation

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Azithromycin, cardiovascular risks, QTc interval prolongation,torsade de pointes, and regulatory issues: A narrative review based on the study of case reports

Therapeutic Advances in Infectious Disease ◽

10.1177/2049936113501816 ◽

2013 ◽

Vol 1 (5) ◽

pp. 155-165 ◽

Cited By ~ 24

Author(s):

Jules C. Hancox ◽

Mehrul Hasnain ◽

W. Victor R. Vieweg ◽

Ericka L. Breden Crouse ◽

Adrian Baranchuk

Keyword(s):

Case Reports ◽

Torsade De Pointes ◽

Narrative Review ◽

Qtc Interval ◽

Cardiovascular Risks ◽

Interval Prolongation ◽

Regulatory Issues ◽

Qtc Interval Prolongation

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Ciprofloxacin does not Prolong the QTc Interval: A Clinical Study in ICU Patients and Review of the Literature

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3zd15 ◽

2017 ◽

Vol 20 (1) ◽

pp. 360 ◽

Cited By ~ 3

Author(s):

Charlotte Heemskerk ◽

Evelien Woldman ◽

Marieke Pereboom ◽

Ruud Van der Hoeven ◽

Aukje Mantel-Teeuwisse ◽

...

Keyword(s):

Qt Interval ◽

Torsade De Pointes ◽

Qtc Interval ◽

Test Results ◽

Interval Prolongation ◽

Icu Patients ◽

Increased Risk ◽

Qtc Interval Prolongation ◽

Student’S T ◽

Student’S T Test

Purpose. Ciprofloxacin may prolong the QT interval and increase the risk of Torsade de Pointes (TdP). Intravenous administration of ciprofloxacin in patients with additional risks may elevate the risk of QTc interval prolongation. We prospectively assessed whether intravenous ciprofloxacin prolongs the QT interval in patients with additional co-morbidities and risk factors. We also reviewed the literature on the QT prolonging effect or TdP inducing effect of ciprofloxacin. Methods. ICU Patients who were treated with intravenous ciprofloxacin as part of their therapy were recruited. ECG was recorded within 60 min before start and in the last 30 min of 1 h infusion, or within 30 min after the end of ciprofloxacin infusion. QT interval was corrected for the heart rate using both Bazett’s and Fridericia’s formula. The changes were analyzed using the paired Student’s t-test. Results. Ten patients were included in the study (average age 74-y, 6 males). The average baseline QTc interval corrected with Bazett’s formula was 448 ms that was shortened during or after ciprofloxacin infusion by 3 ms and 2 ms based on Bazett’s (p=0.67) and Fridericia’s (p=0.68) formula, respectively. No observational study or cohort study thus far has shown that ciprofloxacin has a QT prolonging effect or increases the risk of TdP or (cardiovascular) mortality. Conclusion. Based on our results and the results of previous studies, it is unlikely that ciprofloxacin has a clinically relevant QT prolonging effect or an increased risk of TdP. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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