Since we are on the topic somewhat, any data on which anti-depressants and anti-psychotics shorten/do not prolong QTc?
Of the SSRis, obviously celexa is out, and therefore I presume lexapro as well. I read in a paper that Prozac/Zoloft are moderate risk, and that Paxil is the safest among SSRIs for QTc. True?
And what about Remeron. Some attendings told me its 100% safe, some say it prolongs QTc? My understanding is that Remeron does not prolong QTc, and Wellbutrin shortens QTc.
Finally, with Anti-psychotics, they all prolong it. But which one is the best to shortern/not prolong? My understanding is Zyprexa/Abilify is the best...and Geodan is the worst. True?
abilify has been shown to shorter the QT interval.
most of the neuroleptics that prolong QT interval have been pulled or their use severely limited: pimozide, thioridazine, thiothixene, sertindole, droperidol
out of the SGAs ziprasidone is the worst offender.
personally i am not terribly excited about SRIs and prolongation of the QT interval. the whole citalopram thing is ridiculously overblown. I would have no qualms using it in patients even if they have Long QT syndrome as long as cardiology were happy with it (they usually don't care). I don't tend to use citalopram but I would have no hesitation about prescribing over 40mg of it if indicated.
also remember, we should care less about prolonging the QTc in itself. what we are concerned about is torsades, the risk of which increases with prolonged QTc
I usually consider >500 as of relative concern (but will still use something like olanzapine or abilify) and >550 as a near absolute contraindication. One has to take into consideration other medications (for example methadone, trazodone, a number of antibiotics, antiarrhythmics, TCAs), metabolic derangements, history of heart disease (including IHD, channelopathies, arrhythmias) as well as the severity of the psychiatric disturbance for which the drugs are used. if patient is not psychotic or having agitated delirium, I would drop the drug fairly quickly. The key is considering the risks and benefits, and consulting or collaborating with cardiology where indicated.
The only deaths I've seen are patients on the cardiology service getting too much IV haldol...
