title: Aging effects on QT interval: Implications for cardiac safety of antipsychotic drugs.
abstract: OBJECTIVE
  To explore the effect of aging on cardiac toxicity specifically the interaction of age and antipsychotic drugs to alter the QT interval.
  
  
  METHODS
  THE MEDLINE DATABASES WERE SEARCHED USING THE OVIDSP PLATFORMS WITH THE SEARCH STRATEGY: "QT interval" or "QT" and "age" or "aging". The entry criteria were: over 10,000 apparently healthy individuals with data on both sexes; QT interval corrected for heart rate (QTc) and an expression of its variance for multiple age decades extending into the older ages.
  
  
  RESULTS
  QTc increased in duration with increasing age. Considering a modest one SD increment in QTc in the normal population, the addition of Chlorpromazine produced a QTc on average greater than 450 ms for ages 70 years and older. Risperidone, that did not on average alter QTc, would be expected to produce a QTc of 450 ms in persons in their mid 70 years under some circumstances. QTc prolongation > 500 ms with antipsychotic drugs is more likely for persons with QTc initially at the 99(th) percentile. It may occur with Haloperidol which does not on average alter QTc.
  
  
  CONCLUSIONS
  The range of values for the QT interval in apparently normal older men or women, when combined with the range of expected QT interval changes induced by antipsychotic drugs, can readily be associated with prolonged QTc. Individuals with QTc at the 99(th) percentile may have serious QTc prolongation with antipsychotic drugs even those that are not usually associated with QTc prolongation.
authors.affiliation: Department of Medicine (Cardiology), University of British Columbia, 9th Floor 2775 Laurel St., Vancouver, B.C., V5Z 1M9, Canada.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Rabkin
keywords: Aging; Antipsychotic drugs; Cardiac safety; Psychotropic drugs; QT interval
references.citation: J Electrocardiol. 2004;37 Suppl:81-90
references.pmid: 15534815
references.citation: Am J Cardiol. 1993 Aug 26;72(6):23B-25B
references.pmid: 8256751
references.citation: Biopharm Drug Dispos. 2014 Jan;35(1):1-14
references.pmid: 24136298
references.citation: Clin Res Cardiol. 2009 Apr;98(4):208-12
references.pmid: 19031039
references.citation: J Electrocardiol. 2007 Jul;40(3):228-34
references.pmid: 17276451
references.citation: Heart Vessels. 2010 Nov;25(6):500-8
references.pmid: 20936293
references.citation: Ann Noninvasive Electrocardiol. 2010 Apr;15(2):165-74
references.pmid: 20522058
references.citation: Circulation. 2009 Mar 17;119(10):e241-50
references.pmid: 19228821
references.citation: J Electrocardiol. 1994;27 Suppl:14-9
references.pmid: 7884351
references.citation: Ann Noninvasive Electrocardiol. 2012 Oct;17(4):340-8
references.pmid: 23094880
references.citation: J Electrocardiol. 1988 Aug;21(3):219-29
references.pmid: 3171455
references.citation: Eur Heart J. 1998 Sep;19(9):1391-400
references.pmid: 9792266
references.citation: J Clin Psychopharmacol. 2004 Feb;24(1):62-9
references.pmid: 14709949
references.citation: Circulation. 2000 Jan 4-11;101(1):61-6
references.pmid: 10618305
references.citation: Am J Psychiatry. 2001 Nov;158(11):1774-82
references.pmid: 11691681
references.citation: Clin Cardiol. 1996 Dec;19(12):949-52
references.pmid: 8957599
references.citation: Heart Rhythm. 2006 Sep;3(9):1003-7
references.pmid: 16945790
references.citation: Drugs. 1984 Oct;28 Suppl 1:28-45
references.pmid: 6209083
references.citation: Heart Rhythm. 2008 Aug;5(8):1213-5
references.pmid: 18675237
references.citation: Int J Geriatr Psychiatry. 2001 Sep;16(9):900-6
references.pmid: 11571771
references.citation: Br J Clin Pharmacol. 2004 Jan;57(1):6-14
references.pmid: 14678335
references.citation: Can J Cardiol. 1992 Sep;8(7):690-5
references.pmid: 1422988
references.citation: CNS Drugs. 2012 Apr 1;26(4):351-65
references.pmid: 22452529
references.citation: Am J Cardiol. 1981 Sep;48(3):513-6
references.pmid: 7270459
references.citation: Geriatrics. 1988 Dec;43(12):23-9
references.pmid: 3056779
references.citation: N Engl J Med. 2009 Jan 15;360(3):225-35
references.pmid: 19144938
references.citation: Clin Pharmacol Ther. 2011 Aug;90(2):243-5
references.pmid: 21716272
references.citation: Eur J Cardiovasc Prev Rehabil. 2005 Aug;12(4):363-8
references.pmid: 16079644
references.citation: Pacing Clin Electrophysiol. 2001 Jan;24(1):16-21
references.pmid: 11227963
references.citation: J Physiol. 2010 Aug 15;588(Pt 16):2999-3009
references.pmid: 20547678
references.citation: Am Heart J. 1962 Jun;63:747-53
references.pmid: 13913188