QTc prolongation is a cardiac rhythm disorder that serves as a surrogate marker for the risk of developing Torsades de Pointes (TdP). Though TdP is a relatively rare event, it is a serious and life-threatening polymorphic ventricular tachycardia. QTc prolongation is a more common occurrence that can be congenital or acquired (medication-induced). Many psychotropic medications are known to prolong the QT, so as psychiatric pharmacists, it is imperative that we are familiar with risk reduction, management and monitoring of QTc prolongation.
- Where can I find reliable information regarding drug-specific QT prolongation risk?1
- Many of my patients are on QT prolonging medications and/or have QTc prolongation, how do I clinically evaluate their risk for TdP?2-5
- Are there any QTc prolongation medication management guidelines available?6
- Are there differences between the amounts of QTc prolongation among antidepressants and antipsychotics? Can the TdP risk be stratified differently? 7-14
- CredibleMeds: [Weblink]. Website sponsored by the Arizona Center for Education and Research on Therapeutics (AzCERT). The site 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.
- LePointe NA. Unraveling torsades de pointes: implications for clinical practice. Presented at the CPNP annual meeting (2015). [Weblink]
- Tisdale J. QTc interval prolongation: Clinical relevance, prevention, and management. Presented at the CPNP annual meeting (2018). [Weblink]
- Implementation of a QTc-interval monitoring protocol by pharmacists to decrease cardiac risk in at-risk patients in an acute care inpatient psychiatric facility. Ment Health Clin. 2019;9(2):82-87. DOI: 10.9740/mhc.2019.03.082. PubMed PMID: 30842915; PubMed Central PMCID: PMC6398356..
- Donepezil-induced QTc prolongation: A case report. Ment Health Clin. 2019;9(3):128-132. DOI: 10.9740/mhc.2019.05.128. PubMed PMID: 31123660; PubMed Central PMCID: PMC6513057..
- Effects of medications on the QTc interval-charts and general discussions. CPNP Shared Resource. Last Updated: 08/31/2017. [Weblink]
- McClelland J and Mathys M (2016) Evaluation of QTc prolongation and dosage effect with citalopram. Mental Health Clinician. 2016; 6(4): 165-70. [Weblink]
- QT interval and antidepressant use: a cross sectional study of electronic health records. BMJ. 2013;346:f288. DOI: 10.1136/bmj.f288. PubMed PMID: 23360890; PubMed Central PMCID: PMC3558546..
- Girgis SJ, Maroney ME, and Liu MT (2016) Evaluation of the use of electrocardiogram monitoring in patients on psychotropic medications that have a risk of QT prolongation. Mental Health Clinician: 2016; 6(4): 171-7. [Weblink]
- QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics. 2013;54(1):1-13. DOI: 10.1016/j.psym.2012.11.001. PubMed PMID: 23295003..
- QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update. Psychosomatics. 2018;59(2):105- 122. DOI: 10.1016/j.psym.2017.10.009. PubMed PMID: 29275963..
- Wenzel-Seifert K, Wittmann M, Haen E. QTc prolongation by psychotropic drugs and the risk of Torsade de Pointes. Dtsch Arztebl Int. 2011;108(41):687-93. [Pubmed]
- Zareba W, Lin DA. Antipsychotic drugs and QT interval prolongation. Psychiatr Q. 2003;74(3):291-306. [Pubmed]
- Antipsychotic-related QTc prolongation, torsade de pointes and sudden death. Drugs. 2002;62(11):1649-71. DOI: 10.2165/00003495-200262110-00006. PubMed PMID: 12109926..