Published: February 2010
Publications
Antipsychotics and cardiac safety
Information on this subject has been updated. Read the most recent information.
Prescriber Update 31(1): 4–5
February 2010
Prescribers are reminded that antipsychotics are associated with QT interval prolongation. The QT interval is the measure of time between the onset of ventricular depolarisation and completion of ventricular repolarisation. A prolonged QT interval is a risk factor for sudden cardiac death. A corrected QT interval (QTc) greater than 450ms in men and greater than 470ms in women is considered to be prolonged.
A European review classified these medicines into three categories according to the level of information on cardiotoxic risk.1
Insufficient information | Intermediate information | Good information |
---|---|---|
Pipotiazine Prochlorperazine |
Amisulpride Chlorpromazine Clozapine Fluphenazine Flupenthixol Levomepromazine Olanzapine Quetiapine Risperidone Trifluoperazine Zuclopenthixol |
Haloperidol Droperidol Pimozide Sertindole Ziprasidone |
The data sheets for these medicines are being updated to include more information
on the risk of QT interval prolongation. For medicines with good evidence
of QT prolongation, it is recommended that they are not used in patients
with:
- Clinically significant cardiac disorders.
- QTc interval prolongation.
- A history of ventricular arrhythmia or torsades de pointes.
- Uncorrected hypokalaemia.
- Current treatment that includes other QT prolonging medicines.
Caution should also be used in patients with cardiovascular disease or a family history of QT prolongation. The need for ECG monitoring should be assessed on an individual patient basis.
References
- Medicines and Healthcare products Regulatory Agency. 2009. Antipsychotic Drugs. www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Antipsychoticdrugs/index.htm