An Updated Safety Review of the Relationship Between Atypical Antipsychotic Drugs, the QTc Interval and Torsades de Pointe As: Implications for Clinical Use.
Level 5 - mechanism / opinion, no new human data
Narrative literature review without systematic review or meta-analytic pooling
PubMed 39126643 · doi:10.1080/14740338.2024.2392002
What was done
The authors conducted a literature search using PubMed and Embase with the search terms 'antipsychotics' and 'torsades de pointes'. The review summarizes physiological mechanisms of QTc prolongation, comparative arrhythmogenic risks of specific atypical antipsychotics, risk-prediction models, and recommendations for clinical prescribing.
What was found
The abstract reports qualitative comparative findings without numerical effect sizes or incidence statistics. Ziprasidone and iloperidone were identified as significantly more likely to prolong the QTc interval compared to agents such as brexpiprazole, cariprazine, olanzapine, and clozapine. The authors highlight personalized risk assessment using clinical, demographic, and ECG factors, alongside selecting lower-risk medications at the lowest efficacious dose.
Why it matters
It summarizes differential cardiac safety profiles across atypical antipsychotics to assist clinicians in balancing psychiatric efficacy against ventricular arrhythmia and Torsades de Pointes risks.
Limits
The abstract provides no numerical data, effect sizes, confidence intervals, or sample sizes (number of studies or patients). As a narrative review rather than a systematic review or meta-analysis, the risk of selection bias is high, and protocolized study appraisal methods were not reported.
Cited by
- supports Geodon (ziprasidone) causes a significant degree of QT interval prolongation.