The safety of atypical antipsychotics: does QTc provide all the answers?

Expert Opinion on Drug Safety
Jimmi Nielsen

Abstract

Drug safety of atypical antipsychotics is important due to the increasing mortality gap between patients with schizophrenia and the general population. This editorial discusses the safety evaluation of ziprasidone with a focus on the risk of the potentially fatal cardiac arrhythmia, torsades de pointes (TdP). The exact incidence of antipsychotic-induced TdP remains unknown because capturing TdP warrants continuous monitoring and tens of thousands of patient-years due to the rarity of TdP. For this reason, surrogate markers such as the QTc interval are used despite their limitations. New surrogate markers Tpeak-Tend and T-wave morphology have seen the light of day but their validity remain unknown. Large pragmatic trials have been conducted, but their contributions to drug safety evaluations are controversial. Finally, psychiatrists should have in mind that safety evaluation should include more than the risk of TdP. Some atypical antipsychotics are associated with life-shortening side effects, such as severe weight gain and type 2 diabetes, which may contribute more to the overall mortality than TdP. In addition to this, suboptimal treatment may result in life-shortening behaviors such as suicide. A shared decision including a t...Continue Reading

References

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Feb 22, 2011·Expert Opinion on Drug Safety·Leslie Citrome

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Citations

Feb 7, 2012·Expert Opinion on Pharmacotherapy·Danielle S Cha, Roger S McIntyre
Mar 5, 2016·Expert Opinion on Drug Safety·Christoffer PolcwiartekJimmi Nielsen
Aug 27, 2014·Schizophrenia Bulletin·Jimmi NielsenTorkel Vang
Feb 6, 2015·Therapeutic Advances in Psychopharmacology·Jimmi NielsenJørgen K Kanters
Jul 31, 2013·Journal of Occupational Rehabilitation·Mary Stergiou-KitaAngela Colantonio

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