The Experts below are selected from a list of 9396 Experts worldwide ranked by ideXlab platform
Thomas J Bigger - One of the best experts on this subject based on the ideXlab platform.
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antipsychotic drugs prolonged QTc Interval torsade de pointes and sudden death
American Journal of Psychiatry, 2001Co-Authors: Alexander H Glassman, Thomas J BiggerAbstract:OBJECTIVE: The authors review the mechanisms and establish the risk of torsade de pointes and sudden death with antipsychotic drugs. METHOD: They present a review of original concepts, the distinction between familial and drug-induced cases of torsade de pointes, and the recognition of the role of noncardiac drugs in torsade de pointes and sudden death. They review the evidence linking QTc Interval prolongation, potassium channels, and torsade de pointes from both the long QT syndrome and drugs. They examine the risk for torsade de pointes from antipsychotic drugs and estimate the frequency of sudden death on the basis of epidemiological data in normal and schizophrenic populations. RESULTS: All drugs that cause torsade de pointes prolong the QTc Interval and bind to the potassium rectifier channel, but the relationships are not precise. Prediction of torsade de pointes and sudden death can be improved by examining dose dependency, the percent of QTc Intervals higher than 500 msec, and the risk of drug-dr...
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antipsychotic drugs prolonged QTc Interval torsade de pointes and sudden death
American Journal of Psychiatry, 2001Co-Authors: Alexander H Glassman, Thomas J BiggerAbstract:Objective: The authors review the mechanisms and establish the risk of torsade de pointes and sudden death with antipsychotic drugs. Method: They present a review of original concepts, the distinction between familial and drug-induced cases of torsade de pointes, and the recognition of the role of noncardiac drugs in torsade de pointes and sudden death. They review the evidence linking QTc Interval prolongation, potassium channels, and torsade de pointes from both the long QT syndrome and drugs. They examine the risk for torsade de pointes from antipsychotic drugs and estimate the frequency of sudden death on the basis of epidemiological data in normal and schizophrenic populations. Results: All drugs that cause torsade de pointes prolong the QTc Interval and bind to the potassium rectifier channel, but the relationships are not precise. Prediction of torsade de pointes and sudden death can be improved by examining dose dependency, the percent of QTc Intervals higher than 500 msec, and the risk of drug-drug interactions. Although sudden unexpected death occurs almost twice as often in populations treated with antipsychotics as in normal populations, there are still only 10–15 such events in 10,000 person-years of observation. Conclusions: Although pimozide, sertindole, droperidol, and haloperidol have been documented to cause torsade de pointes and sudden death, the most marked risk is with thioridazine. There is no association with olanzapine, quetiapine, or risperidone. Ziprasidone does prolong the QT Interval, but there is no evidence to suggest that this leads to torsade de pointes or sudden death. Only widespread use will prove if ziprasidone is entirely safe. To date, all antipsychotic drugs have the potential for serious adverse events. Balancing these risks with the positive effects of treatment poses a challenge for psychiatry.
Victor W R Vieweg - One of the best experts on this subject based on the ideXlab platform.
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QTc Interval prolongation and torsade de pointes associated with second generation antipsychotics and antidepressants a comprehensive review
CNS Drugs, 2014Co-Authors: Mehrul Hasnain, Victor W R ViewegAbstract:We comprehensively reviewed published literature to determine whether it supported the link between corrected QT (QTc) Interval prolongation and torsade de pointes (TdP) for the 11 second-generation antipsychotics and seven second-generation antidepressants commonly implicated in these complications. Using PubMed and EMBASE, we identified four thorough QT studies (one each for iloperidone, ziprasidone, citalopram, and escitalopram), 40 studies specifically designed to assess QTc Interval prolongation or TdP, 58 publications based on data from efficacy and safety trials, 18 toxicology studies, and 102 case reports. Thorough QT studies, QTc prolongation-specific studies, and studies based on efficacy and safety trials did not link drug-associated QTc Interval prolongation with TdP. They only showed that the drugs reviewed caused varying degrees of QTc Interval prolongation, and even that information was not clear and consistent enough to stratify individual drugs for this risk. The few toxicology studies provided valuable information but their findings are pertinent only to situations of drug overdose. Case reports were most informative about the drug–QTc Interval prolongation–TdP link. At least one additional well established risk factor for QTc prolongation was present in 92.2 % of case reports. Of the 28 cases of TdP, six (21.4 %) experienced it with QTc Interval <500 ms; 75 % of TdP cases occurred at therapeutic doses. There is little evidence that drug-associated QTc Interval prolongation by itself is sufficient to predict TdP. Future research needs to improve its precision and broaden its scope to better understand the factors that facilitate or attenuate progression of drug-associated QTc Interval prolongation to TdP.
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quetiapine QTc Interval prolongation and torsade de pointes a review of case reports
Therapeutic Advances in Psychopharmacology, 2014Co-Authors: Mehrul Hasnain, Victor W R Vieweg, Robert H Howland, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Genevieve C Digby, Adrian Baranchuk, Anand DeshmukhAbstract:Recently, both the manufacturer of quetiapine and the US Food and Drug Administration warned healthcare providers and patients about quetiapine-induced QTc Interval prolongation and torsade de pointes (TdP) when using this drug within the approved labeling. We reviewed the case-report literature and found 12 case reports of QTc Interval prolongation in the setting of quetiapine administration. There were no cases of quetiapine-induced TdP or sudden cardiac death (SCD) among patients using quetiapine appropriately and free of additional risk factors for QTc Interval prolongation and TdP. Among the 12 case reports risk factors included female sex (nine cases), coadministration of a drug associated with QTc Interval prolongation (eight cases), hypokalemia or hypomagnesemia (six cases) quetiapine overdose (five cases), cardiac problems (four cases), and coadministration of cytochrome P450 3A4 inhibitors (two cases). There were four cases of TdP. As drug-induced TdP is a rare event, prospective studies to evaluate the risk factors associated with QTc prolongation and TdP are difficult to design, would be very costly, and would require very large samples to capture TdP rather than its surrogate markers. Furthermore, conventional statistical methods may not apply to studies of TdP, which is rare and an 'outlier' manifestation of QTc prolongation. We urge drug manufacturers and regulatory agencies to periodically publish full case reports of psychotropic drug-induced QTc Interval prolongation, TdP, and SCD so that clinicians and investigators may better understand the clinical implications of prescribing such drugs as quetiapine.
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azithromycin cardiovascular risks QTc Interval prolongation torsade de pointes and regulatory issues a narrative review based on the study of case reports
Therapeutic Advances in Infectious Disease, 2013Co-Authors: Jules C Hancox, Victor W R Vieweg, Mehrul Hasnain, Ericka Breden L Crouse, Adrian BaranchukAbstract:Over the past year, three articles have appeared in the New England Journal of Medicine describing conflicting findings about azithromycin and cardiac safety, particular azithromycin-induced QTc Interval prolongation and torsade de pointes. The FDA wants healthcare providers to consider azithromycin-induced fatal cardiac arrhythmias for patients already at risk for cardiac death and other potentially arrhythmogenic cardiovascular conditions. In a systematic review of case reports we sought to determine factors that link to azithromycin-induced/associated QTc Interval prolongation and torsade de pointes. We found 12 cases: seven female and five male. Of the nine adults with reported azithromycin doses, concurrent QTc Interval measurement, and without congenital long QT syndrome, we found no significant relationship between dose and QTc Interval duration. Additional risk factors were female sex, older age, heart disease, QTc Interval prolonging drugs and metabolic inhibitors, hypokalemia, and bradycardia. All 12 subjects had at least two additional risk factors. Elderly women with heart disease appear to be at particularly risk for drug-related QTc Interval prolongation and torsade de pointes.
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risperidone QTc Interval prolongation and torsade de pointes a systematic review of case reports
Psychopharmacology, 2013Co-Authors: Victor W R Vieweg, Anand Deshmukh, Mehrul Hasnain, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Genevieve C Digby, Adrian Baranchuk, Ananda K PandurangiAbstract:A recent publication asserted that even low-dose risperidone may induce corrected QT (QTc) Interval prolongation up to 500 ms without drug-induced IKr blockade. We seek to better understand the complexity of any link between risperidone-induced/associated QTc Interval prolongation and torsade de pointes (TdP). The objective of this study is to systematically analyze all available case reports of risperidone, QTc Interval prolongation, and/or TdP. We identify case reports using PubMed, Medline, EMBASE, and Cochrane. Of the 15 cases found, nine were adult women (ages 31, 33, 34, 37, 47, “elderly”, 77, 84, and 87 years) and one was a teenager. There were four men (ages 28, 29, 29, and 46 years) and one preadolescent boy. Besides risperidone administration or overdose, traditional risk factors for QTc Interval prolongation and TdP included female sex (n = 10), older age (n = 4), heart disease (n = 3), hypokalemia (n = 2), bradycardia (n = 1), liver disease (n = 1), QTc Interval prolonging drugs other than risperidone (n = 8), and metabolic inhibitors (n = 2). TdP occurred in four cases. Six patients died, and three deaths were probably related to TdP. Risperidone (when properly prescribed in patients free of other risk factors for QTc Interval prolongation and TdP) is a relatively safe drug. Conventional statistics can neither predict the individual patient who will experience TdP nor determine the relationship of drug dose to QTc Interval prolongation and TdP. Narrative medicine using a case report format appears to be an alternative and valuable additional approach to advance our understanding of this relationship and to reduce risks.
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methadone QTc Interval prolongation and torsade de pointes case reports offer the best understanding of this problem
Therapeutic Advances in Psychopharmacology, 2013Co-Authors: Victor W R Vieweg, Mehrul Hasnain, Robert H Howland, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Thomas Clausen, Antony Fernandez, Ananda K PandurangiAbstract:We reviewed the literature and found 31 adult cases and 1 newborn case of methadone-associated QTc Interval prolongation and/or torsade de pointes (TdP). Parametric statistics may not be useful in studying this issue because methadone-associated TdP is a very rare event and, hence, “an extreme outlier” consistent with scalable randomness. We may have to rely upon narrative medicine in the form of case reports with all its limitations and hazards to provide our best understanding. We report risk factors for methadone-associated QTc Interval prolongation and TdP based on review of published case reports. We believe both drug manufacturers and the FDA would better serve our patients and inform clinicians if they more readily reported drug-induced outliers such as methadone-associated TdP using a case report format.
Alexander H Glassman - One of the best experts on this subject based on the ideXlab platform.
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antipsychotic drugs prolonged QTc Interval torsade de pointes and sudden death
American Journal of Psychiatry, 2001Co-Authors: Alexander H Glassman, Thomas J BiggerAbstract:OBJECTIVE: The authors review the mechanisms and establish the risk of torsade de pointes and sudden death with antipsychotic drugs. METHOD: They present a review of original concepts, the distinction between familial and drug-induced cases of torsade de pointes, and the recognition of the role of noncardiac drugs in torsade de pointes and sudden death. They review the evidence linking QTc Interval prolongation, potassium channels, and torsade de pointes from both the long QT syndrome and drugs. They examine the risk for torsade de pointes from antipsychotic drugs and estimate the frequency of sudden death on the basis of epidemiological data in normal and schizophrenic populations. RESULTS: All drugs that cause torsade de pointes prolong the QTc Interval and bind to the potassium rectifier channel, but the relationships are not precise. Prediction of torsade de pointes and sudden death can be improved by examining dose dependency, the percent of QTc Intervals higher than 500 msec, and the risk of drug-dr...
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antipsychotic drugs prolonged QTc Interval torsade de pointes and sudden death
American Journal of Psychiatry, 2001Co-Authors: Alexander H Glassman, Thomas J BiggerAbstract:Objective: The authors review the mechanisms and establish the risk of torsade de pointes and sudden death with antipsychotic drugs. Method: They present a review of original concepts, the distinction between familial and drug-induced cases of torsade de pointes, and the recognition of the role of noncardiac drugs in torsade de pointes and sudden death. They review the evidence linking QTc Interval prolongation, potassium channels, and torsade de pointes from both the long QT syndrome and drugs. They examine the risk for torsade de pointes from antipsychotic drugs and estimate the frequency of sudden death on the basis of epidemiological data in normal and schizophrenic populations. Results: All drugs that cause torsade de pointes prolong the QTc Interval and bind to the potassium rectifier channel, but the relationships are not precise. Prediction of torsade de pointes and sudden death can be improved by examining dose dependency, the percent of QTc Intervals higher than 500 msec, and the risk of drug-drug interactions. Although sudden unexpected death occurs almost twice as often in populations treated with antipsychotics as in normal populations, there are still only 10–15 such events in 10,000 person-years of observation. Conclusions: Although pimozide, sertindole, droperidol, and haloperidol have been documented to cause torsade de pointes and sudden death, the most marked risk is with thioridazine. There is no association with olanzapine, quetiapine, or risperidone. Ziprasidone does prolong the QT Interval, but there is no evidence to suggest that this leads to torsade de pointes or sudden death. Only widespread use will prove if ziprasidone is entirely safe. To date, all antipsychotic drugs have the potential for serious adverse events. Balancing these risks with the positive effects of treatment poses a challenge for psychiatry.
Ananda K Pandurangi - One of the best experts on this subject based on the ideXlab platform.
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risperidone QTc Interval prolongation and torsade de pointes a systematic review of case reports
Psychopharmacology, 2013Co-Authors: Victor W R Vieweg, Anand Deshmukh, Mehrul Hasnain, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Genevieve C Digby, Adrian Baranchuk, Ananda K PandurangiAbstract:A recent publication asserted that even low-dose risperidone may induce corrected QT (QTc) Interval prolongation up to 500 ms without drug-induced IKr blockade. We seek to better understand the complexity of any link between risperidone-induced/associated QTc Interval prolongation and torsade de pointes (TdP). The objective of this study is to systematically analyze all available case reports of risperidone, QTc Interval prolongation, and/or TdP. We identify case reports using PubMed, Medline, EMBASE, and Cochrane. Of the 15 cases found, nine were adult women (ages 31, 33, 34, 37, 47, “elderly”, 77, 84, and 87 years) and one was a teenager. There were four men (ages 28, 29, 29, and 46 years) and one preadolescent boy. Besides risperidone administration or overdose, traditional risk factors for QTc Interval prolongation and TdP included female sex (n = 10), older age (n = 4), heart disease (n = 3), hypokalemia (n = 2), bradycardia (n = 1), liver disease (n = 1), QTc Interval prolonging drugs other than risperidone (n = 8), and metabolic inhibitors (n = 2). TdP occurred in four cases. Six patients died, and three deaths were probably related to TdP. Risperidone (when properly prescribed in patients free of other risk factors for QTc Interval prolongation and TdP) is a relatively safe drug. Conventional statistics can neither predict the individual patient who will experience TdP nor determine the relationship of drug dose to QTc Interval prolongation and TdP. Narrative medicine using a case report format appears to be an alternative and valuable additional approach to advance our understanding of this relationship and to reduce risks.
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methadone QTc Interval prolongation and torsade de pointes case reports offer the best understanding of this problem
Therapeutic Advances in Psychopharmacology, 2013Co-Authors: Victor W R Vieweg, Mehrul Hasnain, Robert H Howland, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Thomas Clausen, Antony Fernandez, Ananda K PandurangiAbstract:We reviewed the literature and found 31 adult cases and 1 newborn case of methadone-associated QTc Interval prolongation and/or torsade de pointes (TdP). Parametric statistics may not be useful in studying this issue because methadone-associated TdP is a very rare event and, hence, “an extreme outlier” consistent with scalable randomness. We may have to rely upon narrative medicine in the form of case reports with all its limitations and hazards to provide our best understanding. We report risk factors for methadone-associated QTc Interval prolongation and TdP based on review of published case reports. We believe both drug manufacturers and the FDA would better serve our patients and inform clinicians if they more readily reported drug-induced outliers such as methadone-associated TdP using a case report format.
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citalopram QTc Interval prolongation and torsade de pointes how should we apply the recent fda ruling
The American Journal of Medicine, 2012Co-Authors: Victor W R Vieweg, Mehrul Hasnain, Robert H Howland, John M Hettema, Christopher Kogut, Mark A Wood, Ananda K PandurangiAbstract:Recently, both the manufacturer of citalopram and the US Food and Drug Administration have warned health care providers and patients about new information implicating drug-induced QTc Interval prolongation and torsade de pointes when using citalopram in doses >40 mg/day. This warning is not placed in the context of either benefits or risks in real-world clinical practice, leaving clinicians with an untenable choice between depriving patients of high-dose citalopram or malpractice litigation. We reviewed the literature and found no cases of citalopram-induced sudden cardiac death among patients taking up to 60 mg/day of citalopram and free of risk factors for QTc Interval prolongation and torsade de pointes. Because psychotropic drug-induced sudden cardiac death is an outlier in the absence of identified risk factors for QTc Interval prolongation and torsade de pointes, we do not believe current Phase 3 and Phase 4 studies provide sufficient information to limit current prescribing practices for citalopram (20 mg to 60 mg/day). We urge drug manufacturers and regulatory agencies to periodically publish full case reports of psychotropic drug-induced QTc Interval prolongation, torsade de pointes, and sudden cardiac death so that clinicians and investigators may better understand the clinical implications of prescribing such drugs as citalopram.
Anand Deshmukh - One of the best experts on this subject based on the ideXlab platform.
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quetiapine QTc Interval prolongation and torsade de pointes a review of case reports
Therapeutic Advances in Psychopharmacology, 2014Co-Authors: Mehrul Hasnain, Victor W R Vieweg, Robert H Howland, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Genevieve C Digby, Adrian Baranchuk, Anand DeshmukhAbstract:Recently, both the manufacturer of quetiapine and the US Food and Drug Administration warned healthcare providers and patients about quetiapine-induced QTc Interval prolongation and torsade de pointes (TdP) when using this drug within the approved labeling. We reviewed the case-report literature and found 12 case reports of QTc Interval prolongation in the setting of quetiapine administration. There were no cases of quetiapine-induced TdP or sudden cardiac death (SCD) among patients using quetiapine appropriately and free of additional risk factors for QTc Interval prolongation and TdP. Among the 12 case reports risk factors included female sex (nine cases), coadministration of a drug associated with QTc Interval prolongation (eight cases), hypokalemia or hypomagnesemia (six cases) quetiapine overdose (five cases), cardiac problems (four cases), and coadministration of cytochrome P450 3A4 inhibitors (two cases). There were four cases of TdP. As drug-induced TdP is a rare event, prospective studies to evaluate the risk factors associated with QTc prolongation and TdP are difficult to design, would be very costly, and would require very large samples to capture TdP rather than its surrogate markers. Furthermore, conventional statistical methods may not apply to studies of TdP, which is rare and an 'outlier' manifestation of QTc prolongation. We urge drug manufacturers and regulatory agencies to periodically publish full case reports of psychotropic drug-induced QTc Interval prolongation, TdP, and SCD so that clinicians and investigators may better understand the clinical implications of prescribing such drugs as quetiapine.
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risperidone QTc Interval prolongation and torsade de pointes a systematic review of case reports
Psychopharmacology, 2013Co-Authors: Victor W R Vieweg, Anand Deshmukh, Mehrul Hasnain, Christopher Kogut, Ericka Breden L Crouse, Jayanthi N Koneru, Jules C Hancox, Genevieve C Digby, Adrian Baranchuk, Ananda K PandurangiAbstract:A recent publication asserted that even low-dose risperidone may induce corrected QT (QTc) Interval prolongation up to 500 ms without drug-induced IKr blockade. We seek to better understand the complexity of any link between risperidone-induced/associated QTc Interval prolongation and torsade de pointes (TdP). The objective of this study is to systematically analyze all available case reports of risperidone, QTc Interval prolongation, and/or TdP. We identify case reports using PubMed, Medline, EMBASE, and Cochrane. Of the 15 cases found, nine were adult women (ages 31, 33, 34, 37, 47, “elderly”, 77, 84, and 87 years) and one was a teenager. There were four men (ages 28, 29, 29, and 46 years) and one preadolescent boy. Besides risperidone administration or overdose, traditional risk factors for QTc Interval prolongation and TdP included female sex (n = 10), older age (n = 4), heart disease (n = 3), hypokalemia (n = 2), bradycardia (n = 1), liver disease (n = 1), QTc Interval prolonging drugs other than risperidone (n = 8), and metabolic inhibitors (n = 2). TdP occurred in four cases. Six patients died, and three deaths were probably related to TdP. Risperidone (when properly prescribed in patients free of other risk factors for QTc Interval prolongation and TdP) is a relatively safe drug. Conventional statistics can neither predict the individual patient who will experience TdP nor determine the relationship of drug dose to QTc Interval prolongation and TdP. Narrative medicine using a case report format appears to be an alternative and valuable additional approach to advance our understanding of this relationship and to reduce risks.
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Prolonged QTc Interval and torsades de pointes induced by citalopram.
Texas Heart Institute journal, 2012Co-Authors: Anand Deshmukh, Kyle G. Ulveling, Venkata Alla, Hussam Abuissa, Kelly AireyAbstract:Citalopram is a selective serotonin reuptake inhibitor with a favorable cardiac-safety profile. Corrected QT Interval (QTc) prolongation and cardiac arrhythmias have not been previously reported in association with citalopram use except in the presence of overdose, abnormal electrolyte values, or renal or liver failure. Herein, we report the case of a 40-year-old woman with mental depression who presented with a prolonged QTc Interval and torsades de pointes after the initiation of citalopram at therapeutic doses. The QTc Interval improved when citalopram therapy was discontinued. We recommend that clinicians investigate the family history for sudden deaths and perform baseline electrocardiography before prescribing citalopram. We also recommend routine electrocardiographic testing during citalopram therapy, and that patients with long QT syndrome avoid taking citalopram.
