title: Risk of arrhythmia induced by psychotropic medications: a proposal for clinical management.
abstract: Several drugs used in the treatment of mental diseases are associated with an increased risk of sudden cardiac death (SCD). A general cause-relationship between the intake of these drugs and SCD is unattainable, but numerous case reports of drug-induced malignant arrhythmia and epidemiological studies, associating the use of specific drugs with SCD, strongly support the presence of an increased risk. Whereas the absolute risk of drug-induced life-threatening arrhythmia may be relatively low, even small increments in risk of SCD may have a major health impact considering that millions of patients are treated with psychotropics. In subgroups of pre-disposed patients, e.g. patients with cardiac diseases or other co-morbidities, the elderly or patients treated with other negatively interacting drugs, the absolute risk of drug-induced arrhythmia may be considerable. On the other hand, several of the major mental disorders are associated with a large risk of suicide if untreated. The observed risk of malignant arrhythmia associated with treatment with psychotropic drugs calls for clinical guidelines integrating the risk of the individual drug and other potentially interacting risk factors. In this review, data from various authorities on the risk of arrhythmia associated with psychotropic medications were weighted and categorized into three risk categories. Additionally, we suggest a clinically applicable algorithm to reduce the risk of malignant arrhythmia in patients to be treated with psychotropic medications. The algorithm integrates the risk categories of the individual drugs and pre-disposing risk factors and suggests a prudent follow-up for patients with an increased risk. We believe this clinically manageable guideline might improve safety in the many and rapidly increasing number of patients on psychotropic drugs.
authors.affiliation: Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Fanoe
authors.affiliation: Psychiatric Centre Copenhagen and Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark.
authors.forename: Diana
authors.initials: D
authors.lastname: Kristensen
authors.affiliation: Psychiatric Centre Copenhagen and Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Fink-Jensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Henrik Kjærulf
authors.initials: HK
authors.lastname: Jensen
authors.affiliation: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Egon
authors.initials: E
authors.lastname: Toft
authors.affiliation: Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jimmi
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Videbech
authors.affiliation: Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Pehrson
authors.affiliation: Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark henningbundgaard@dadlnet.dk.
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000523:psychology / Q000628:therapy; D004359:Drug Therapy, Combination; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000150:complications; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000150:complications; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs
keywords: Acquired long QT; Drug-induced; Pro-arrhythmia; Psychotropics; Sudden cardiac death; Torsade de Pointes ventricular tachycardia