Physiological risk factors for QTc prolongation and arrhythmia

Cardiac Long QT syndrome
Bradycardia
Ischemic heart disease
Myocarditis
Myocardial infarction
Left ventricular hypertrophy
Metabolic Hypokalemia
Hypomagnesemia
Hypocalcemia
Others Age > 65
Stress or shock
Anorexia nervosa
Female gender
>1 QT-prolonging agent
Extreme physical exertion

Non-psychotropics associated with QT prolongation

Drug class Drug
Antibiotics erythromycin
clarithromycin
ampicillin
cotrimoxazole
pentamidine
(some quinolones affect QTc — see manufacturers' literature)
Antimalarials chloroquine
mefloquine
quinine
Antiarrhythmics quinidine
disopyramide
procainamide
sotalol
amiodarone
bretylium
Others amantadine
cyclosporin
diphenhydramine
hydroxyzine
methadone
nicardipine
tamoxifen



Risk of QT Prolongation with Various Psychiatric Medications at Therapeutic Doses

Lower Risk Higher Risk Unknown Risk
FGAs loxapine chlorpromazine
haloperidol (7.1 ms)
pimozide
thioridazine (30.1 ms)
fluphenazine
perphenazine
thiothixene
trifluoperazine
SGAs aripiprazole
asenipine
brexpiprazole
clozapine
lurasidone
olanzapine (1.7 ms)
paliperidone
risperidone (3.6 ms)
iloperidone (8.5 - 15.4 ms)
quetiapine (–12 - 2.8 ms)
ziprasidone (3.6 - 15.9 ms)
SSRIs fluoxetine
fluvoxamine
paroxetine
sertraline (3.0 ms)
citalopram (10.58 ms)
escitalopram (7.27 ms)
SNRIs duloxetine
desvenlafaxine
levomilnacipran
venlafaxine
TCAs/TeCAs doxepine (2.38 ms) amitriptyline (5.1 ms)
clomipramine
desipramine
imipramine (12.8 ms)
nortriptyline (23.3 ms)
Other Antidepressants bupropion
trazodone
vilazidone
vortioxetine
mirtazapine



Management of QT prolongation in patients receiving antipsychotic drugs

QTc Action Refer to cardiologist
>440 ms (men) or >470 ms (women) None unless abnormal T-wave morphology Consider if in doubt
>440 ms (men) or >470 ms (women) but <500 ms Consider reducing dose or switching to drug of lower effect; repeat ECG Consider
>500 ms Repeat ECG. Stop suspected causative drug(s) and switch to drug of lower effect Immediately
Abnormal T-wave morphology Review treatment. Consider reducing dose or switching to drug of lower effect Immediately
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Last updated March 09 2019 12:22:13. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.