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Advances in Psychiatric Treatment (2006) 12: 100-109
© 2006 The Royal College of Psychiatrists

Sudden cardiac death and antipsychotics. Part 2: Monitoring and prevention

Nasser Abdelmawla and Alex J. Mitchell

Nasser Abdelmawla is a specialist registrar in psychiatry. He completed his PhD in psychopharmacology and has an interest in drug-induced adverse effects. Alex Mitchell is a consultant in liaison psychiatry at Leicester General Hospital (Department of Liaison Psychiatry, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Tel.: +44 (0)116 2256218; e-mail: alex.mitchell{at}leicspart.nhs.uk) and author of the BMA prize-winning book Neuropsychiatry and Behavioural Neurology Explained. He is interested in the overlap of physical and mental disorders.

Cardiac safety of antipsychotic drugs continues to be a concern for both typical and atypical antipsychotics. Risk appears greatest in those with pre-existing cardiac disease but many patients may have occult cardiovascular disease. In addition, several drugs appear to increase the likelihood of diabetes and weight gain, which may have an additive adverse effect. On the basis of risk of sudden cardiac death and risk of QTc prolongation we suggest considering antipsychotics in two categories – higher and lower risk. Of most concern is the use of large cumulative doses of antipsychotics that are sometimes given inadvertently by different prescribers. Clinicians need to be aware how to read an ECG, and how to monitor physical parameters and interpret the significance of QTc prolongation in relation to antipsychotic prescribing. We suggest provisional guidance on antipsychotic monitoring in relation to cardiac safety but acknowledge that future studies will help clarify which antipsychotic drugs and which concomitant risk factors are most important for those with and without established cardiac disease.




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