Published: 4 June 2020

Publications

Antipsychotic medicines: monitor cardiovascular risk

Prescriber Update 41(2): 31
June 2020

Background

The Centre for Adverse Reactions Monitoring was recently alerted to a case where a patient suffered a non-fatal cardiac arrest shortly after administration of an antipsychotic. Whilst the contribution of the medicine to the event was unclear, the patient had multiple risk factors for adverse cardiovascular outcomes. Medsafe would like to remind prescribers of the risks of antipsychotic medicines and the need for cardiovascular risk factor monitoring in patients taking them.

Cardiovascular adverse effects and risk factors

Antipsychotic medicines are associated with significant cardiovascular adverse effects. To varying extents, antipsychotic medicines may cause QT-interval prolongation, tachycardia, arrhythmias and changes in blood pressure^1,2. Clozapine is also associated with myocarditis and cardiomyopathy^3,4.

In addition to direct effects on the cardiovascular system, antipsychotic medicines are associated with metabolic changes including dyslipidaemia, hyperglycaemia and central obesity that further increase the risk of adverse cardiovascular outcomes. Compared to the general population, patients with psychotic disorders have higher rates of smoking and alcohol misuse, poorer nutrition and more sedentary lifestyles, which further increases their cardiovascular risk^5–7.

Monitoring cardiovascular risk factors in patients prescribed antipsychotic medicines is necessary to minimise the risk of serious outcomes². Consult local guidelines and data sheets to find recommended cardiovascular monitoring for individual medicines. (Search for medicine data sheets.)

Communication between psychiatric and primary care providers about who will take responsibility for the patient’s routine cardiovascular monitoring and risk factor management may help to ensure timely intervention of modifiable risk factors¹.

References

1. Galletly C, Castle D, Dark F, et al. 2016. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry 50(5): 410-472. URL: journals.sagepub.com/doi/pdf/10.1177/0004867416641195 (accessed 16 April 2020).
2. New Zealand Formulary. 2020. New Zealand Formulary v94 :Antipsychotic drugs 1 April 2020. URL: nzf.org.nz/nzf_2098 (accessed 16 April 2020).
3. Douglas Pharmaceuticals Ltd N. 2019. Clopine New Zealand Data Sheet 31 October 2019. URL: medsafe.govt.nz/profs/Datasheet/c/Clopinetaboralsuspen.pdf (accessed 17 April 2020).
4. Mylan New Zealand Ltd. 2018. Clozaril New Zealand Data Sheet 14 November 2018. URL: medsafe.govt.nz/profs/Datasheet/c/Clozariltab.pdf (accessed 17 April 2020).
5. Baller JB, McGinty EE, Azrin ST, et al. 2015. Screening for cardiovascular risk factors in adults with serious mental illness: a review of the evidence. BMC Psychiatry 15(1): 55. DOI: 10.1186/s12888-015-0416-y (accessed 16 April 2020).
6. Staveley A, Soosay I and O'Brien AJ. 2017. Metabolic monitoring in New Zealand district health board mental health services. New Zealand Medical Journal 130(1465): 44–52. URL: nzma.org.nz/journal-articles/metabolic-monitoring-in-new-zealand-district-health-board-mental-health-services (accessed 16 April 2020).
7. Vancampfort D, Stubbs B, Mitchell AJ, et al. 2015. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry 14(3): 339–47. DOI: 10.1002/wps.20252 (accessed 16 April 2020).