title: QTc prolongation by psychotropic drugs and the risk of Torsade de Pointes.
abstract: BACKGROUND
  Many psychotropic drugs can delay cardiac repolarization and thereby prolong the rate-corrected QT interval (QTc). A prolonged QTc often arouses concern in clinical practice, as it can be followed, in rare cases, by the life-threatening polymorphic ventricular tachyarrhythmia called torsade de pointes (TdP).
  
  
  METHODS
  We searched PubMed for pertinent literature on the risk of QTc prolongation and/or TdP associated with commonly used psychotropic drugs.
  
  
  RESULTS
  Thioridazine and ziprasidone confer the highest risk of QTc prolongation and/or TdP. There is also a clinically significant risk associated with haloperidol given intravenously in high doses. TdP has been reported in a few cases in association with the use of newer antipsychotic drugs (mainly quetiapine and amisulpride), most of the tri- and tetracyclic antidepressants, and the selective monoamine reuptake inhibitors citalopram, fluoxetine, paroxetine, and venlafaxine. As a rule, however, QTc prolongation and/or TdP occur only in the presence of multiple additional risk factors, such as age over 65 years, pre-existing cardiovascular disease, bradycardia, female sex, hypokalemia, hypomagnesemia, a supratherapeutic or toxic serum concentration, or the simultaneous administration of other drugs that delay repolarization or interfere with drug metabolism.
  
  
  CONCLUSIONS
  Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The ECG and electrolytes should be regularly monitored in patients taking psychotropic drugs.
authors: Klinische Pharmakologie, Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie der Universität Regensburg, Universitätstr. 84, 93053 Regensburg, Germany. Wenzel-Seifert.Katharina@klinik.uni-regensburg.de
authors: Katharina
authors: K
authors: Wenzel-Seifert
authors: Markus
authors: M
authors: Wittmann
authors: Ekkehard
authors: E
authors: Haen
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D008133:Long QT Syndrome / Q000453:epidemiology*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D016171:Torsades de Pointes / Q000453:epidemiology*
chemical_list: D011619:Psychotropic Drugs