Key result
Thioridazine-induced ventricular arrhythmias cluster with high doses or risk factors, yet pacing remains rarely used.
Why the study?
Arrhythmias associated with thioridazine and the use of transient cardiac pacing to treat them are not well characterized despite known efficacy.
Supports thioridazine dose limits and risk screening in adults; leaves open pacing role in phenothiazine arrhythmias.
All cases of arrhythmias associated with thioridazine were reviewed (177 cases). No case of severe ventricular arrhythmia was reported in children. In adults, at therapeutic doses, ventricular tachycardia or fibrillation (VT/VF) or torsade de pointes was observed mainly in patients with concomitant risk factors. At doses higher than 800 mg, atrioventricular (A-V) and bundle branch blocks were associated with VT/VF. Mortality was higher in patients with A-V blocks. Although transient cardiac pacing is known to be efficacious to control phenothiazine-induced arrhythmias, it was rarely used.
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Donatini et al. (2008) conducted a review in Arrhythmias associated with thioridazine (n=177). Thioridazine was evaluated. Thioridazine-associated ventricular arrhythmias occurred primarily in adults with risk factors or doses >800 mg, and despite its known efficacy, transient cardiac pacing was rarely utilized.
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