QT prolongation is a cardiac rhythm disorder that serves as a surrogate marker for the risk of developing torsades de pointes (TdP). Though TdP is a relatively rare event, it is a serious and life-threatening polymorphic ventricular tachycardia. QT prolongation is a more common occurrence that can be congenital or acquired (medication-induced). Many psychotropic medications are known to prolong the QT interval, so as psychiatric pharmacists, it is imperative that we are familiar with risk reduction, management, and monitoring of QT prolongation.
- Where can I find reliable information regarding drug-specific QT prolongation risk?1
- Many of my patients are on QT prolonging medications and/or have QT prolongation, how do I clinically evaluate their risk for TdP?2-5
- Are there any QT prolongation medication management guidelines available?6-8
- Are there differences between the amounts of QT prolongation among antidepressants and antipsychotics? Can the TdP risk be stratified differently?9-18
References
- CredibleMeds: [Weblink]
- Website sponsored by the Arizona Center for Education and Research on Therapeutics (AZCERT). The site 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.
- LePointe NA. Unraveling torsades de pointes: implications for clinical practice. Presented at the CPNP annual meeting (2015). [Weblink]
- Tisdale J. QTc interval prolongation: Clinical relevance, prevention, and management. Presented at the CPNP annual meeting (2018). [Weblink]
- 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. [Weblink]
- 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]
- Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, 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(8):1047-60. DOI: 10.1161/CIRCULATIONAHA.109.192704. PubMed PMID: 20142454; PubMed Central PMCID: PMC3056123.
- Effects of medications on the QTc interval-charts and general discussions. CPNP Shared Resource. Last Updated: 08/31/2017. [Weblink]
- 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]
- McClelland J, Mathys M. Evaluation of QTc prolongation and dosage effect with citalopram. Ment Health Clin. 2016;6(4):165-70. [Weblink]
- Castro VM, Clements CC, Murphy SN et al. QT interval and antidepressant use: a cross-sectional study of electronic health records. BMJ. 2013;346. [PubMed]
- Girgis SJ, Maroney ME, and 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. [Weblink]
- Beach SR, Celano CM, Noseworthy PA, Januzzi JL, Huffman JC. QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics. 2013;54(1):1-13. DOI: 10.1016/j.psym.2012.11.001. PubMed PMID: 23295003.
- 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.
- Zareba W, Lin DA. Antipsychotic drugs and QT interval prolongation. Psychiatr Q. 2003;74(3):291-306. [Pubmed]
- Haddad PM, Anderson IM. Antipsychotic-related QTc prolongation, torsade de pointes and sudden death. Drugs. 2002;62(11):1649-71. DOI: 10.2165/00003495-200262110-00006. PubMed PMID: 12109926.
- 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.
- 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.
- Kurisu K, Yoshiuchi K. Comparison of Antipsychotics for the Treatment of Patients With Delirium and QTc Interval Prolongation: A Clinical Decision Analysis, Front Psychiatry. 2021;12:609678. [PubMed]