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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Article
The Prevalence and Significance of Antipsychotic Dosing on QTc Prolongation
Author(s)
Shannon DeGrote, Michael Shuman, Shaiza Khan
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DOI:10.17265/2159-5542/2017.05.004
Affiliation(s)
Captain James A. Lovell Federal Health Care Center, North Chicago, USA
ABSTRACT
QTc prolongation is a common
black box warning within medication labeling. However, it is unclear if QTc prolonging
drugs carry the same risk for torsade de pointes as primary or congenital prolongation.
The majority of previous studies regarding antipsychotics are limited by a variety
of factors. This was a retrospective, cohort study amongst 114 patients at the FHCC
to examine the risk of developing QTc prolongation and torsade de pointes in relation
to antipsychotic dosing. The primary objective is to determine the incidence rate
and mean of QTc prolongation stratified to dose of five antipsychotics. The secondary
objective is to determine the incidence of QTc of ≥ 500 msecs and torsades de pointes
stratified to dose. The frequency of QTc prolongation was analyzed using chi-square
and Fischer’s exact test as appropriate with a p < 0.05 being labeled as significant. The average length of QTc
prolongation stratified to the dose of antipsychotic was analyzed using linear regression
analysis. Dose dependency of QTc prolongation with the five antipsychotic drugs
of interest (haloperidol, ziprasidone, olanzapine, risperidone, and ziprasidone)
was not supported in this study based on the non-significant linear regression analyses.
However, the frequency of torsade de pointes and changes of > 60 msec in the
QTc were relatively rare. Thus frequent monitoring is likely unnecessary unless
the patient has a prolonged QT at baseline or other risk factors.
KEYWORDS
antipsychotics, QTc prolongation, torsade de pointes, haloperidol, risperidone, olanzapine, quetiapine ziprasidone
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