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

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.

EKG-gyöngyszem: szerzett hosszú-QT-szindróma

Authors report the case of a patient with drug-induced long QT syndrome. This case highlights the importance of ECG signs of LQTS that may lead to torsade de pointes tachycardia. The patient received the QT prolonging moxifloxacine and the QT remained long even after the offending drug was discontinued. Orv Hetil. 2018; 159(39): 1607–1610.

Cardiac arrhythmias related to psychiatric medication

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.

A presumably benign human ether-a-go-go-related gene mutation (R176W) with a malignant primary manifestation of long QT syndrome

A 12-year-old girl presented with a first prolonged syncope. She was successfully resuscitated by external defibrillation after recording torsade de pointes tachycardia. Repeated electrocardiograms and a 12-channel Holter monitoring showed an intermittent prolongation of the QT interval. Genetic analysis identified a heterozygous point mutation in the KCNH2 gene, which is thought to be associated with a rather mild clinical phenotype of the long QT syndrome.