QT prolongation is a cardiac rhythm disorder that serves as a quantifiable marker for the risk of developing torsades de pointes (TdP). Though TdP is a relatively rare event, it is a serious and potentially life-threatening polymorphic ventricular tachycardia. The QT interval is considered prolonged when greater than 450 msec for males or greater than 470 msec for females. QT interval prolongation is a more common occurrence that can be congenital or acquired including medication induced. Many psychotropic medications are known to prolong the QT interval, therefore as psychiatric pharmacists it is imperative that we are familiar with risk reduction, management, and monitoring of QT interval prolongation.

  • Where can I find summarized information regarding drug-specific QT interval prolongation risk?1
  • How do I clinically evaluate the risk of TdP in patients on QT-prolonging medications and/or who have QT prolongation?2-5
  • Are there any QT prolongation medication management guidelines available?6-8
  • What are the differences in QT prolongation among antidepressants and antipsychotics?9-13

Reviewer 1: Austin Smith, PharmD, BCPP
Reviewer 2:  Mackenzie Pierce, PharmD, BCPS, BCPP
2023-2024 AAPP Resident and New Practitioner Committee


  1. CredibleMeds: [Weblink]
    • Website sponsored by the Arizona Center for Education and Research on Therapeutics (AZCERT). The website provides a searchable database of medications that define varying categories of risk of QT prolongation and information for the public and healthcare professionals. Full access requires registration.
  2. Daniel NM, Walsh K, Leach H, et al. Implementation of a QTc-interval monitoring protocol by pharmacists to decrease cardiac risk in at-risk patients in an acute care inpatient psychiatric facility. Ment Health Clin. 2019;9(2):82-87. [PubMed]
  3. Vandael E, Vandenberk B, Vandenberghe J, et al. Development of a risk score for QTc-prolongation: the RISQ-PATH study. Int J Clin Pharm. 2017;39(2):424-432. [PubMed]
  4. Salvati B, Miola A, Toffanin T, et al. Prevalence and risk factors for QTc prolongation in acute psychiatric hospitalization. Prim Care Companion CNS Disord. 2022; 24(1):21. [PubMed]
  5. Girgis SJ, Maroney ME, Liu MT. Evaluation of the use of electrocardiogram monitoring in patients on psychotropic medications that have a risk of QT prolongation. Ment Health Clin. 2016;6(4):171-7. [PubMed]
  6. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010;121:1047-1060. [PubMed]
  7. Funk MC, Beach SR, Bostwick JR et al. APA resource document on QTc prolongation and psychotropic medications. Am J Psychiatry. 2020;177(3):273-274. [PubMed]
  8. Xiong GL, Pinkhasov A, Mangal JP, et al. QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the association for medicine and psychiatry. J Psychosom Res. 2020;135:110138. [PubMed]
  9. McClelland J, Mathys M. Evaluation of QTc prolongation and dosage effect with citalopram. Ment Health Clin. 2016;6(4):165-70. [PubMed]
  10. Beach SR, Celano CM, Sugrue AM, Adams C, Ackerman MJ, Noseworthy PA, et al. QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update. Psychosomatics. 2018;59(2):105-122. DOI: 10.1016/j.psym.2017.10.009. PubMed PMID: 29275963.
  11. Funk KA, Bostwick JR. A comparison of the risk of QT prolongation among SSRIs. Ann Pharmacother. 2013;47(10):1330-41. DOI: 10.1177/1060028013501994. PubMed PMID: 24259697.
  12. Jasiak NM, Bostwick JR. Risk of QT/QTc prolongation among newer non-SSRI antidepressants. Ann Pharmacother. 2014;48(12):1620-8. DOI: 10.1177/1060028014550645. PubMed PMID: 25204465.
  13. Harrigan EP, Miceli JJ, Anziano R, et al. A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition. J Clin Psychopharmacol. 2004;24(1):62-9. [PubMed]