Abstract:

Many antipsychotic drugs cause QT prolongation, although the effect differs based on the particular drug. We sought to determine the potential for antipsychotic drugs to prolong the QTc interval (>470 ms in men and >480 ms in women) using the Bazett formula in a "real-world" setting by analyzing the electrocardiograms of 1017 patients suffering from schizophrenia. Using logistic regression analysis to calculate the adjusted relative risk (RR), we found that chlorpromazine (RR for 100 mg=1.37, 95% confidence interval (CI)=1.14 to 1.64; p<.005), intravenous haloperidol (RR for 2 mg=1.29, 95% CI=1.18 to 1.43; p<.001), and sultopride (RR for 200 mg=1.45, 95% CI=1.28 to 1.63; p<.001) were associated with an increased risk of QTc prolongation. Levomepromazine also significantly lengthened the QTc interval. The second-generation antipsychotic drugs (i.e., olanzapine, quetiapine, risperidone, and zotepine), mood stabilizers, benzodiazepines, and antiparkinsonian drugs did not prolong the QTc interval. Our results suggest that second-generation antipsychotic drugs are generally less likely than first-generation antipsychotic drugs to produce QTc interval prolongation, which may be of use in clinical decision making concerning the choice of antipsychotic medication.

日本語要旨:

抗精神病薬は心電図上のQTｃの延長をきたすことが知られている。本研究では、107人の要約を受けている統合失調症患者におい、QTｃを測定した。クロルプロマジンなどの第一世代薬ではQTｃ延長と相関があったが、オナザピン、抗不安薬、ベンゾジアゼピンなどの第二世代薬ではQTｃ延長を認めなかった。この結果は、薬剤選択に資すると考える。