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Aronow WS, Shamliyan TA. Effects of antidepressants on QT interval in people with mental disorders. Arch Med Sci 2020; 16:727-741. [PMID: 32542073 PMCID: PMC7286318 DOI: 10.5114/aoms.2019.86928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Drug-induced QT prolongation is associated with higher cardiovascular mortality. MATERIAL AND METHODS We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders. RESULTS Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60-1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10-4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24-6.24), venlafaxine (OR = 3.73, 95% CI: 1.33-10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20-18.40, number of adults: 5,298). CONCLUSIONS Evidence regarding the risk of QT prolongation in children is sparse.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine and Cardiology Research, Westchester Medical Center and New York Medical College, New York, USA
| | - Tatyana A. Shamliyan
- Elsevier, Clinical Solutions, Philadelphia, USA
- Corresponding author: Tatyana A. Shamliyan MD, MS, Elsevier Clinical Solutions, 1600 Kennedy Blvd, 19103 Philadelphia, USA, Phone: 2675004863, E-mail:
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Orsolini L, Tomasetti C, Valchera A, Vecchiotti R, Matarazzo I, Vellante F, Iasevoli F, Buonaguro EF, Fornaro M, Fiengo ALC, Martinotti G, Mazza M, Perna G, Carano A, De Bartolomeis A, Di Giannantonio M, De Berardis D. An update of safety of clinically used atypical antipsychotics. Expert Opin Drug Saf 2016; 15:1329-47. [PMID: 27347638 DOI: 10.1080/14740338.2016.1201475] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The atypical antipsychotic (APs) drugs have become the most widely used agents to treat a variety of psychoses because of their superiority with regard to safety and tolerability profile compared to conventional/'typical' APs. AREAS COVERED We aimed at providing a synthesis of most current evidence about the safety and tolerability profile of the most clinically used atypical APs so far marketed. Qualitative synthesis followed an electronic search made inquiring of the following databases: MEDLINE, Embase, PsycINFO and the Cochrane Library from inception until January 2016, combining free terms and MESH headings for the topics of psychiatric disorders and all atypical APs as following: ((safety OR adverse events OR side effects) AND (aripiprazole OR asenapine OR quetiapine OR olanzapine OR risperidone OR paliperidone OR ziprasidone OR lurasidone OR clozapine OR amisulpride OR iloperidone)). EXPERT OPINION A critical issue in the treatment with atypical APs is represented by their metabolic side effect profile (e.g. weight gain, lipid and glycaemic imbalance, risk of diabetes mellitus and diabetic ketoacidosis) which may limit their use in particular clinical samples. Electrolyte imbalance, ECG abnormalities and cardiovascular adverse effects may recommend a careful baseline and periodic assessments.
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Affiliation(s)
- L Orsolini
- a School of Life and Medical Sciences , University of Hertfordshire , Hatfield , Herts , United Kingdom.,b Villa San Giuseppe Hospital, Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - C Tomasetti
- c Polyedra Research Group , Teramo , Italy.,e NHS, Department of Mental Health ASL Teramo , Psychiatric Service of Diagnosis and Treatment, Hospital 'Maria SS dello Splendore,' Giulianova , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - A Valchera
- b Villa San Giuseppe Hospital, Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy
| | - R Vecchiotti
- b Villa San Giuseppe Hospital, Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - I Matarazzo
- g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini,' Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
| | - F Vellante
- g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini,' Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
| | - F Iasevoli
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - E F Buonaguro
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - M Fornaro
- c Polyedra Research Group , Teramo , Italy.,i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | | | - G Martinotti
- h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
| | - M Mazza
- c Polyedra Research Group , Teramo , Italy.,j Department of Life, Health and Environmental Sciences , University of L'Aquila , L'Aquila , Italy
| | - G Perna
- k Department of Clinical Neurosciences , Hermanas Hospitalarias, FoRiPsi, Villa San Benedetto Menni, Albese con Cassano , Como , Italy.,l Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine , University of Miami , Miami , FL , USA
| | - A Carano
- m NHS, Department of Mental Health ASL Ascoli Piceno, Psychiatric Service of Diagnosis and Treatment , Hospital 'Maria SS del Soccorso,' San Benedetto del Tronto , Italy
| | - A De Bartolomeis
- f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II,' Napoli , Italy
| | - M Di Giannantonio
- i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | - D De Berardis
- c Polyedra Research Group , Teramo , Italy.,g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini,' Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. D'Annunzio,' Chieti , Italy
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Polcwiartek C, Sneider B, Graff C, Taylor D, Meyer J, Kanters JK, Nielsen J. The cardiac safety of aripiprazole treatment in patients at high risk for torsade: a systematic review with a meta-analytic approach. Psychopharmacology (Berl) 2015; 232:3297-308. [PMID: 26231497 DOI: 10.1007/s00213-015-4024-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/01/2015] [Indexed: 01/08/2023]
Abstract
RATIONALE Certain antipsychotics increase the risk of heart rate-corrected QT (QTc) prolongation and consequently Torsades de Pointes (TdP) and sudden cardiac death (SCD). Drug-induced Brugada syndrome (BrS) is also associated with SCD. Most SCDs occur in patients with additional cardiac risk factors. OBJECTIVES Aripiprazole's cardiac safety has not been assessed in patients at high risk for torsade, where QTc prolongation risk is highly increased. METHODS MEDLINE, Embase, and The Cochrane Library were searched for preclinical, clinical, and epidemiological studies. Eligible studies were reviewed and cardiac safety data were extracted. Continuous and dichotomous QTc data were used in the meta-analysis. RESULTS Preclinical studies suggested that aripiprazole has limited affinity for the delayed rectifier potassium current. TdP was reported in two case reports and SCD was reported in one case report and one case series. No clinical studies assessing aripiprazole's cardiac safety in patients at high risk for torsade were found. No thorough QT (TQT) study with aripiprazole was found. The meta-analysis revealed that the mean ΔQTc interval was decreased with aripiprazole and QTc prolongation risk was lower compared with placebo and active controls. Epidemiological studies linked aripiprazole to weak/moderate torsadogenicity. No studies were found associating aripiprazole with BrS suggesting low affinity for the fast sodium current. CONCLUSIONS Aripiprazole is a low-risk antipsychotic regarding cardiac safety in healthy patients. However, baseline and steady state electrocardiogram is recommended in patients at high risk for torsade due to marked QTc prolongation, absence of a TQT study, and lack of data in this group.
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