Psychiatric Pharmacy Essentials: QTc Prolonging Medications

The QT interval is defined as the amount of time it takes the ventricles of the heart to repolarize after activation. This number can vary based on an individual’s heart rate and is often corrected to the QTc interval. A prolonged QTc interval is a risk factor for developing torsades de pointes (TdP), a relatively rare and potentially life-threatening polymorphic ventricular tachycardia. The QTc interval is generally considered prolonged when greater than 450 msec for males or greater than 470 msec for females. QTc interval prolongation can be congenital or acquired, with medication-induced QTc prolongation being a concern. Many psychotropic medications are known to prolong the QTc interval. As psychiatric pharmacists, it is imperative that we are familiar with identifying medications that have been associated with QTc prolongation (particularly psychotropic medications), reducing risk, monitoring, and managing QTc interval prolongation.1-3

  • Where can I find summarized information regarding drug-specific QTc interval prolongation risk?4
  • How do I clinically evaluate the risk of TdP in patients on QTc-prolonging medications and/or who have QTc prolongation?5-9
  • Are there any QTc prolongation medication management guidelines available?10-12
  • What are the differences in QTc prolongation among antidepressants and antipsychotics?13-17
  • How should I evaluate the QT interval in patients with bundle branch block or a pacemaker?18

Reviewer 1: Brooke Bernu, PharmD, BCPS, BCPP
Reviewer 2: Abby Stocks, PharmD, BCPP
2026-2027 AAPP Resident and New Practitioner Committee

  1. Tisdale JE, Chung MK, Campbell KB, Hammadah M, Joglar JA, Leclerc J, et al. Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association. Circulation. 2020 Oct 13;142(15). Ovid Technologies (Wolters Kluwer Health). DOI: 10.1161/cir.0000000000000905.
  2. Indraratna P, Tardo D, Delves M, Szirt R, Ng B. Measurement and Management of QT Interval Prolongation for General Physicians. J Gen Intern Med. 2020 Mar;35(3):865-873. Springer Science and Business Media LLC. DOI: 10.1007/s11606-019-05477-7.
  3. Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Circulation. 2009 Mar 17;119(10). Ovid Technologies (Wolters Kluwer Health). DOI: 10.1161/circulationaha.108.191096.
  4. 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.. CredibleMeds. Arizona Center for Education and Research on Therapeutics (AZCERT). Available from: http://crediblemeds.org/
  5. Daniel NM, Walsh K, Leach H, Stummer L. Implementation of a QTc-interval monitoring protocol by pharmacists to decrease cardiac risk in at-risk patients in an acute care inpatient psychiatric facility. Mental Health Clinician. 2019 Mar 1;9(2):82-87. American Association of Psychiatric Pharmacists (AAPP). DOI: 10.9740/mhc.2019.03.082.
  6. Vandael E, Vandenberk B, Vandenberghe J, Spriet I, Willems R, Foulon V. Development of a risk score for QTc-prolongation: the RISQ-PATH study. Int J Clin Pharm. 2017 Apr;39(2):424-432. Springer Science and Business Media LLC. DOI: 10.1007/s11096-017-0446-2.
  7. Salvati B, Miola A, Toffanin T, Pigato G, Pavan C, Favaro A, et al. Prevalence and Risk Factors for QTc Prolongation in Acute Psychiatric Hospitalization. Prim Care Companion CNS Disord. 2022 Feb 17;24(1). Physicians Postgraduate Press, Inc. DOI: 10.4088/pcc.21m02915.
  8. 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. Mental Health Clinician. 2016 Jul;6(4):171-177. American Association of Psychiatric Pharmacists (AAPP). DOI: 10.9740/mhc.2016.07.171.
  9. Chien HT, Lin SW, Kung TJ, Wang CC, Dong YH, Hwang TJ, et al. Ventricular Arrhythmia and Sudden Death Risk With Concomitant Antipsychotic and SSRI Use. JAMA Netw Open. 2026 Apr 9;9(4):e266028. American Medical Association (AMA). DOI: 10.1001/jamanetworkopen.2026.6028.
  10. Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, et al. Prevention of Torsade de Pointes in Hospital Settings. J Am Coll Cardiol. 2010 Mar;55(9):934-947. Elsevier BV. DOI: 10.1016/j.jacc.2010.01.001.
  11. Funk MC, Beach SR, Bostwick JR, Celano C, Hasnain M, Pandurangi A, et al. QTc Prolongation and Psychotropic Medications. AJP. 2020 Mar 1;177(3):273-274. American Psychiatric Association Publishing. DOI: 10.1176/appi.ajp.2019.1760501.
  12. Xiong GL, Pinkhasov A, Mangal JP, Huang H, Rado J, Gagliardi J, et al. QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry. J Psychosomatic Res. 2020 Aug;135:110138. Elsevier BV. DOI: 10.1016/j.jpsychores.2020.110138.
  13. Cao S, Huang Z, Yang W, Yang S, Chen X, Xie X. Arrhythmic events pertinent with antidepressants: a Bayesian disproportional analysis mining the FDA Adverse Event Reporting System database. Front Psychiatry. 2025 Sep 29;16. Frontiers Media SA. DOI: 10.3389/fpsyt.2025.1637471.
  14. 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 Mar;59(2):105-122. Elsevier BV. DOI: 10.1016/j.psym.2017.10.009.
  15. Funk KA, Bostwick JR. A Comparison of the Risk of QT Prolongation Among SSRIs. Ann Pharmacother. 2013 Oct;47(10):1330-1341. SAGE Publications. DOI: 10.1177/1060028013501994.
  16. Jasiak NM, Bostwick JR. Risk of QT/QTc Prolongation Among Newer Non-SSRI Antidepressants. Ann Pharmacother. 2014 Dec;48(12):1620-1628. SAGE Publications. DOI: 10.1177/1060028014550645.
  17. Bordet C, Garcia P, Salvo F, Touafchia A, Galinier M, Sommet A, et al. Antipsychotics and risk of QT prolongation: a pharmacovigilance study. Psychopharmacology. 2023 Jan;240(1):199-202. Springer Science and Business Media LLC. DOI: 10.1007/s00213-022-06293-4.
  18. Bogossian H, Linz D, Heijman J, Bimpong-Buta NY, Bandorski D, Frommeyer G, et al. QTc evaluation in patients with bundle branch block. IJC Hear & Vasc. 2020 Oct;30:100636. Elsevier BV. DOI: 10.1016/j.ijcha.2020.100636.