Risk of QT prolongation with antipsychotic therapy
https://doi.org/10.33667/2078-5631-2025-21-39-44
Abstract
QT prolongation is one of the most significant adverse reactions associated with the use of antipsychotics due to the high risk of life-threatening ventricular arrhythmias.
The aim of the study was to determine the risk of QT prolongation during antipsychotic therapy.
Materials and methods. An analysis of 1000 cases of hospitalization of patients diagnosed with schizophrenia spectrum disorder (F20-F29) who underwent inpatient treatment in the period from 01/01/2022 to 12/31/2024 was conducted. QTc interval prolongation was defined as a difference of ≥30 ms between the QTc interval values of the baseline and repeat electrocardiograms.
Results. QTc interval prolongation was registered in 17.7% of cases of monotherapy and in 25.3% of cases of polytherapy (OR 1.58; 95% CI 1.063–2.348). The AP dose in monotherapy was lower than the AP dose in polytherapy (p<0.001). Polytherapy was used more often in men (84%) than in women (16%). In monotherapy, no difference was found between QTc groups by gender (p=0.691), age (p=0.960), or AP dose (p=0.369). QTc interval prolongation was most frequently observed during clozapine treatment, both in mono(32.8%, including 6.1% ≥60 ms) and polytherapy (30.5%, including 2.8% ≥60 ms). Lurasidone and trifluoperazine had no effect on the QTc interval in monotherapy.
Discussion. The increased risk of prolongation of the QTc interval during polytherapy may be due to an increase in the total dose of AP, the appointment of AP with a high risk of prolongation of the QTc interval as adjuvant therapy, augmentation of clozapine with other antipsychotics. Our results differ from the information in the international CredibleMeds® database, which may be due to genetic differences in the populations of different regions.
Conclusion. It is recommended to conduct a baseline ECG before prescribing an antipsychotic, regular ECG monitoring during therapy, and adjust treatment in case of prolongation of the QTc interval ≥30 ms. Particular attention is required for patients taking clozapine.
About the Authors
A. V. Kidyaeva
Institute of Personalized Psychiatry and Neurology, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology;
St. Petersburg State Psychiatric Hospital of St. Nicholas
Russian Federation
Russian Federation
Kidyaeva Alla V., junior researcher, head of Psychiatric Dept
St. Petersburg
R. F. Nasyrova
Institute of Personalized Psychiatry and Neurology, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology;
St. Petersburg State Psychiatric Hospital of St. Nicholas;
Department of Psychiatry, Medical Psychology and Narcology with a Course of Postgraduate Professional Education, Altai State Medical University
Russian Federation
Russian Federation
Nasyrova Regina F., DM Sci (habil.), chief researcher, scientific director, cClinical pharmacologist, associate professor at Dept of Psychiatry, Medical Psychology and Narcology and the Course of Advanced Medical Studies
St. Petersburg
Barnaul
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For citations:
Kidyaeva A.V., Nasyrova R.F. Risk of QT prolongation with antipsychotic therapy. Medical alphabet. 2025;(21):39-44. (In Russ.) https://doi.org/10.33667/2078-5631-2025-21-39-44
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