Publications

Published: February 2010

Antipsychotics and cardiac safety

Information on this subject has been updated. Read the most recent information.

Prescriber Update 31(1): 4–5
February 2010

Prescribers are reminded that antipsychotics are associated with QT interval prolongation. The QT interval is the measure of time between the onset of ventricular depolarisation and completion of ventricular repolarisation. A prolonged QT interval is a risk factor for sudden cardiac death. A corrected QT interval (QTc) greater than 450ms in men and greater than 470ms in women is considered to be prolonged.

A European review classified these medicines into three categories according to the level of information on cardiotoxic risk.1

Insufficient information Intermediate information Good information
Pipotiazine
Prochlorperazine
Amisulpride
Chlorpromazine
Clozapine
Fluphenazine
Flupenthixol
Levomepromazine
Olanzapine
Quetiapine
Risperidone
Trifluoperazine
Zuclopenthixol
Haloperidol
Droperidol
Pimozide
Sertindole
Ziprasidone


The data sheets for these medicines are being updated to include more information on the risk of QT interval prolongation.  For medicines with good evidence of QT prolongation, it is recommended that they are not used in patients with:

Caution should also be used in patients with cardiovascular disease or a family history of QT prolongation. The need for ECG monitoring should be assessed on an individual patient basis.

References

  1. Medicines and Healthcare products Regulatory Agency. 2009. Antipsychotic Drugs. www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Antipsychoticdrugs/index.htm