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January 16, 2024 — A recent study published in the journal Heart Rhythm has raised alarm bells about the use of antipsychotic drugs, specifically quetiapine and haloperidol, linking them to an elevated risk of ventricular arrhythmias and sudden cardiac death (SCD) caused by drug-induced heart rhythm disorders.
Researchers, including Jamie Vandenberg from the Victor Chang Cardiac Research Institute in New South Wales, Australia, conducted a retrospective analysis of electronic medical records from a large cohort of patients in Taiwan who were prescribed quetiapine or haloperidol. The study found that over 10 percent of patients developed severe QT prolongation, a condition associated with ventricular arrhythmias and sudden cardiac death.
The significance of these findings is underscored by the fact that, of the 41 drugs in the United States market with a known risk of heart rhythm disorders, five are antipsychotic drugs—crucial for treating conditions such as schizophrenia and psychosis. Vandenberg emphasized, “The use of antipsychotic drugs is associated with a nearly two-fold increased risk of sudden cardiac death. If we cannot eliminate this risk, then at the least, we need to minimize the risk by identifying patients at highest risk and managing them more closely.”
Concerns about cardiac conditions linked to antipsychotic drug use have persisted for the last 30 years, leading to the removal or restriction of certain drugs from the market. However, the challenge remains as some of these drugs, despite the associated risks, continue to be essential for clinical needs without safer alternatives.
Co-author Chun-Li Wang from Chang Gung Memorial Hospital in Taiwan emphasized the importance of closely monitoring patients prescribed these medications and implementing risk mitigation strategies. “Clinicians should be aware of the potential risks associated with quetiapine use, particularly the risk of severe QT prolongation and its associated outcomes, including ventricular arrhythmias and sudden cardiac death.”
The study suggests that clinicians should consider conducting an electrocardiogram (ECG) before and after the commencement of antipsychotic drug therapy. If possible, alternative drugs with a lower risk of QT prolongation should be explored. However, if changing medications is not practical, close attention should be paid to reducing other risk factors, such as avoiding prescription of additional drugs that may exacerbate QT prolongation and monitoring for conditions like hypokalemia.
The findings underscore the importance of balancing the therapeutic benefits of antipsychotic drugs with the potential risks, emphasizing the need for vigilant monitoring and personalized patient care to ensure safety.
