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 donepezil hydroxyzine methadone nicardipine ondansetron 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 (20.5 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 June 21 2023 05:14:41. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.