Key result
Antipsychotic polypharmacy shows no clear link to increased sudden cardiac death versus monotherapy.
Why the study?
Antipsychotics are linked to cardiac side effects and sudden cardiac death, and common prescribing patterns involving multiple antipsychotics or additional drugs may influence cardiovascular events.
Does antipsychotic polypharmacy increase sudden cardiac death and QTc prolongation in patients with schizophrenia compared to monotherapy?
Does antipsychotic polypharmacy increase sudden cardiac death and QTc prolongation in patients with schizophrenia compared to monotherapy?
While individual antipsychotics are known to cause QTc prolongation, the synergistic risk of sudden cardiac death with antipsychotic polypharmacy remains unclear and requires further prospective study.
SCD risk with antipsychotic polypharmacy remains unclear despite QTc prolongation; leaves open whether polypharmacy increases mortality beyond monotherapy.
Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association.
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Edinoff et al. (2022) conducted a review in Schizophrenia and psychotic disorders. Antipsychotic polypharmacy vs. Antipsychotic monotherapy was evaluated on Sudden cardiac death and ventricular arrhythmias. It remains unclear whether there is a precise association between antipsychotic polypharmacy and increased sudden cardiac death compared to monotherapy, despite known QTc interval risks.
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