Ziprasidone and iloperidone are significantly more likely to prolong the QTc interval compared to other atypical antipsychotics such as brexpiprazole, cariprazine, olanzapine, and clozapine.
What is the risk of QTc prolongation and Torsades de Pointes associated with atypical antipsychotic drugs, and how can prescribing practices be optimized?
Ziprasidone and iloperidone carry a higher risk of QTc prolongation compared to other atypical antipsychotics, highlighting the need for personalized prescribing and ECG surveillance.
INTRODUCTION: The rising prevalence of psychiatric disorders has resulted in a significant increase in the use of antipsychotic medications. These agents may prolong the corrected QT interval (QTc), running the risk of precipitating ventricular arrhythmias, notably Torsades de Pointes (TdP). Current recommendations vary regarding the optimal approach to safe prescribing practices and QTc surveillance for antipsychotics. This review summarizes the current literature addressing these clinical concerns. AREAS COVERED: The physiologic basis of the QTc interval, mechanisms underlying its susceptibility to pharmacological influence, specific risks associated with atypical antipsychotic agents, and recommendations for safe prescription practices. We performed a literature review using Pubmed and Embase databases, searching for 'antipsychotics' and 'torsades de pointes.' EXPERT OPINION: Finding a safe and universally accepted protocol for prescribing antipsychotics remains a persistent challenge in medicine. Predictive models that integrate clinical history with demographic and ECG characteristics can help estimate an individual's susceptibility to therapy-associated risks, including QTc prolongation. Agents such as ziprasidone and iloperidone are significantly more likely to prolong the QTc interval compared to others such as brexpiprazole, cariprazine, olanzapine, and clozapine. A personalized approach using low-risk medications when clinically feasible, and at the lowest efficacious dose, offers a promising path toward safer antipsychotic prescribing.
Melo et al. (Sat,) conducted a review in Psychiatric disorders. Atypical antipsychotic drugs was evaluated on QTc prolongation and Torsades de Pointes. Ziprasidone and iloperidone are significantly more likely to prolong the QTc interval compared to other atypical antipsychotics such as brexpiprazole, cariprazine, olanzapine, and clozapine.