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Cardiovascular Side Effects of Novel Antipsychotics

Published online by Cambridge University Press:  07 November 2014

Sanjay Gupta ,
Prakash S. Masand  and
Ashok J. Kothari
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Abstract

Since the introduction of clozapine, several novel antipsychotic agents have been introduced and more are in Phase II/III studies. Because these agents are used clinically as first-line treatment, we need to be more familiar with their side-effect profiles. This manuscript reviews the cardiovascular side effects of currently available novel antipsychotics. The medications reviewed include clozapine, risperidone, olanzapine, quetiapine, and ziprasidone. Guidelines are suggested for the use of these medications in clinical practice.

Type
Feature Articles
Information
CNS Spectrums , Volume 6 , Issue 11: Investigating and Treating Psychosis , November 2001 , pp. 912 - 918
Copyright
Copyright © Cambridge University Press 2001

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References

REFERENCES

1. Gury, C, Canceil, O, Laria, P. Antipsychotic drugs and cardiovascular safety: current studies of prolonged QT interval and risk of ventricular arrhythmia. Encephale. 2000;26:62–72.Google Scholar
2. Reilly, JG, Ayis, SA, Ferrier, IN. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet. 2000;355:1048–1052.CrossRefGoogle ScholarPubMed
3. Moss, AJ. Measurement of QT ihterval and the risk associated with QTc interval prolongation: a review. Am J Cardiol. 1993;72:238–258.Google Scholar
4. Fayek, M, Kingsbury, SJ, Simpson, GM, Zada, J. Cardiac effects of antipsychotics medications. Psychiatr Serv. 2001;52:607–609.CrossRefGoogle ScholarPubMed
5. American Psychiatric Association. Sudden Death in Psychiatric Patients: The Role of Neuroleptic Drugs. Task Force Report 27. Washington, DC: American Psychiatric Association; 1987.Google Scholar
6. Faber, TS, Zehender, M, Just, H. Drug-induced torsades de pointes: incidence management and prevention. Drug Saf. 1994;11:463–476.CrossRefGoogle ScholarPubMed
7. Welch, R, Chue, P. Antipsychotic agents and QT changes. J Psychiatry Neurosci. 2000;25:154–160.Google Scholar
8. Selzer, A, Wray, HW. Quinidine syncope: paroxysmal ventricular fibrillation occur-ring during treatment of chronic atrial arrhythmias. Circulation. 1964;30:17–26.CrossRefGoogle Scholar
9. Rodem, DM, Woosley, RL, Primm, R.K.Incidence and clinical features of quinidine associated long QT syndrome: implications for patient care. Am Heart J. 1986;111:1088–1093.Google Scholar
10. Kay, GN, Plumb, VJ, Arciniegas, JG, et al. Torsades de pointes: the long-short initiating sequence and other clinical features: observations in 32 patients. J Am Coll Cardiol. 1983;2:806–817.Google Scholar
11. Bauman, JL, Bauernfeind, RA, Hoff, JV, et al. Torsades de pointes due to quinidine: observations in 31 patients. Am Heart J. 1984;107:425–430.Google Scholar
12. Torp-Pederson, C, Moller, M, Bloch-Thomsen, PE, et al. The Danish investigation of arrhythmia and mortality on dofetilide study group: dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med. 1999;341:679–911.Google Scholar
13. Stambler, BS, Wood, MA, Ellen Bogen, KA, et al. Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter to fibrillation. Ibutilide Repeat Dose Study Investigators. Circulation. 1996;94:1613–1621.CrossRefGoogle ScholarPubMed
14. Haverkamp, W, Breithardt, G, Camm, AJ, et al. The potential for QT prolongation and proarrhythmia by non-antiarrhythmie drugs: clinical and regulatory implications. Eur Heart J. 2000;21:1216–1231Google Scholar
15. Thioridazine HC1 [package insert]. East Hanover. INJ: Novartis Pharmaceuticals Corporation; 2000.Google Scholar
16. Serentil [package insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals Inc; 2000.Google Scholar
17. Barnett, AA. Safety concerns over antipsychotic drug sertindole. Lancet. 1996;348:256Google Scholar
18. Jann, MW. Clozapine. Pharmacotherapy. 1991;11:179–195.Google Scholar
19. Coward, DM. General pharmacology of clozapine. Br J Psychiatry. 1992;160(suppll7):5–11.CrossRefGoogle Scholar
20. Lieberman, JA, Kane, JM, Johns, CA. Clozapine: guidelines for clinical management. J Clin Psychiatry. 1989;50:329–338.Google ScholarPubMed
21. Lieberman, JA, Safferman, A. Clinical profile of clozapine: adverse reactions and agranulocytosis. Psychiatric Q. 1992;63:3–14.CrossRefGoogle ScholarPubMed
22. Marder, SR. Adverse effects of clozapine [monograph]. J Clin Psychiatry. 1996;14:11–12.Google Scholar
23. Gupta, S, Rajaprabhakaran, R. Clozapine-induced hypertension. Am J Psychiatry. 1994;151;148.Google Scholar
24. Jens, G, Kilian, K, Kerr, C, et al. Myocarditis and cardiomyopathy associated with clozapine. Lancet. 1999;354:1841–1845.Google Scholar
25. Bandelow, B, Degner, D, Kreusch, U, et al. Myocarditis under therapy with clozapine. Schizophr Res. 1995;17:293–294.CrossRefGoogle ScholarPubMed
26. Leo, RJ, Kreeger, JL, Kim, KY. Cardiomyopalhy associated with clozapine. Ann Pharmacother. 1996;30:603–605.CrossRefGoogle ScholarPubMed
27. Kang, UG, Kwoon, JS, Ahn, MA, et al. Electrographic abnormalities in patients treated with clozapine. J Clin Psychiatry. 2000:61:441–446.CrossRefGoogle Scholar
28. Beale, MD, Pritchett, JT, Kellner, CH. Supraventricular tachycardia in a patient receiving ECT, clozapine, and caffeine. Convuls Ther. 1994;10:228–231.Google Scholar
29. Maynes, D. Bilateral pulmonary embolism in a patient on clozapine therapy. Can J Psychiatry. 2000;45:296–297.Google Scholar
30. Hagg, S, Spigset, O, Soderstrom, TG. Association of venous thromboemholism and clozapine. Lancet. 2000;355:1155–1156.CrossRefGoogle Scholar
31. Lacika, S, Cooper, JP. Pulmonary embolus possibly associated with clozapine treatment. Can J Psychiatry. 1999;44:396–397.Google ScholarPubMed
32. Ihde-Scholl, T, Rolli, ML, Jefferson, JW. Clozapine and pulmonary embolus. Am J Psychiatry. 2001;158:499–500.Google Scholar
33. Coodin, S, Ballegeer, T. Clozapine therapy and pulmonary embolism. Can J Psychiatry. 2000;45:395.Google Scholar
34. Walker, AM, Lanza, LL, Arellana, F, Rothman, KJ. Mortality in current and former users of clozapine. Epidemiology. 1997;8:671–677.Google Scholar
35. Clardy, J, Gule, RH. Mortality risk and clozapine. Am J Psychiatry. 1995;152:161.Google Scholar
36. Marder, SR, Meibach, RC. Risperidone in the treatment of schizophrenia. Am J Psychiatry. 1994;151:825–835.Google ScholarPubMed
37. Gupta, S, Black, DW, Smith, D. Risperidone: review of its pharmacology, and therapeutic use in schizophrenia. Ann Clin Psychiatry. 1994;6:173–180.CrossRefGoogle ScholarPubMed
38. Madhusoodanan, S, Brecher, M, Brenner, R, et al. Risperidone in the treatment of elderly patients with psychotic disorders. Amer J Geriatr Psychiatry. 1999;7:132–138.Google Scholar
39. Min, SK, Rhee, CS, Kim, CE, et al. Risperidone versus haloperidol in the treatment of chronic schizophrenic patients: a parallel-group, double-blind comparative trial. Yonsei Med J. 1997;31:967–870.Google Scholar
40. Hatta, K, Takashashi, T, Nakamura, H, et al. The association between intravenous haloperidol and prolonged QT interval. J Clin Psychopharmacol. 2001;21:257–261.Google Scholar
41. Ravin, DS, Levenson, JM. Fatal cardiac event following initiation of risperi-done therapy. Ann Pharmacother. 1997;31:967–870.CrossRefGoogle Scholar
42. Chong, SA, Tan, CH, Lee, HS. Atrial ectopics with clozapine-risperidone combination. J Clin Psychopharmacol. 1997;17:130–131.Google Scholar
43. Pfizer, Inc. Study Report of Ziprasidone Clinical Pharmacology Protocol. 2000. Rockville, MD: Food and Drug Administration Center for Drug Evaluation and Research Division of Cardiorenal Drug Products Consultation; 2000.Google Scholar
44. Lemmens, P, Brecher, M, Baelen, BV. Tolerability and cardiovascular safety of risperidone. Acta Psychiatrica Scand. 1999;99:160–170.Google Scholar
45. Gupta, S, Masand, PS. Olanzapine: review of its pharmacology and indications in clinical practice. Primary Psychiatry. 1997;4:73–81.Google Scholar
46. Czekalla, J, Beasley, CM Jr, Dellva, MA, et al. Analysis of the QTc interval during olanzapine treatment of patients with schizophrenia and related psychosis. J Clin Psychiatry. 2001;62:191–198.Google Scholar
47. Masand, PS, Gupta, S. Long term side effects of novel antipsychotics. Journal of Psychiatric Practice. 2000;6:299–309.CrossRefGoogle ScholarPubMed
48. Casey, DE. Seroquel (quetiapine): preelinical and clinical findings of a new atypical antipsychotic. Exp Opin Invest Drugs. 1996;5:939–957.CrossRefGoogle Scholar
49. Weiden, PJ. Quetiapine (Seroquel): a new “atypical” antipsychotic. J Pract Psych Behav Health. 1997:3:368–374.Google Scholar
50. Misra, LK, Erpenbach, JE, Hamlyn, H, et al. Quetiapine: a new atypical antipsychotic. S D J Med. 1998;51:189–193.Google ScholarPubMed
51. Beelan, AP, Yeo, KT, Lewis, LD. Asymptomatic QTc prolongation associated with quetiapine fumarate overdose in a patient being treated with risperi-done. Hum Exp Toxicol. 2001;20:215–219.CrossRefGoogle Scholar
52. Gajwani, P, Pozudo, L, Tesar, GE. QT interval prolongation associated with quetiapine (seroquel) overdose. Psychosomatics. 2000;41:63–65.Google Scholar
53. Seeger, TF, Seymour, PA, Schmidt, AW, et al. Ziprasidone (CP-88,059): a new antipsychotic with combined dopamine and serotonin receptor antagonist activity. J Pharmacol Exp Ther. 1995,275:101–113.Google Scholar
54. Keck, P Jr, Buffenstein, A, Ferguson, J, et al. Ziprasidone 40 and 120 mg/day in the acute exacerbation of schizophrenia and schizoaffective disorder: a 4 week placebo-controlled trial. Psychopharmacology (Bed). 1998;140:173–184.Google Scholar
55. Daniel, DG, Zimbroff, DL, Potkin, SG, et al. Ziprasidone 80 and 160 mg/day in the acute exacerbation of schizophrenia and sehizoaffective disorder: a 6 week placebo-controlled trial. Neuropsychopharmacology. 1999;x20:491–505.Google Scholar
56. Geodon [package insert]. New York, NY: Pfizer Inc; 2001.Google Scholar
57. Goldman, LS. Medical illness in patients with schizophrenia. J Clin Psychiatry. 1999;60(suppl 21):10–15.Google ScholarPubMed
58. Gupta, S, Masand, PS, Kaplan, D, Bhandary, A. The relationship between schizophrenia and IBS. Schizophr Res 1997;23:265–268.Google Scholar
59. Brown, S, Birtwistle, J, Roe, L, et al. The unhealthy lifestyle of people with schizophrenia. Psychol Med. 1999;29:697–701.Google Scholar
60. Dixon, L, Postrado, L, Delahanty, J, et al. The association of medical comorbidity in schizophrenia with poor physical and mental health. J New Ment Dis. 1999;187:496–502.Google Scholar
61. Pary, RJ, Barton, SN. Communication difficulty of patients with schizophrenia and physical illness. South Med J. 1988;81:489–490.Google Scholar
62. Tsuang, MT, Perkins, K, Simpson, JC. Physical diseases in schizophrenia and affective disorder. J Clin Psychiatry. 1983;44:42–46.Google Scholar
63. Brown, S. Excess mortality of schizophrenia: a meta-analysis. Br J Psychiatry. 1997;171:502–508.Google Scholar
64. Viewig, V, Levenson, J, Pandurangi, A, et al. Medical disorders in schizophrenic patients. Int J Psychiatry Med. 1995;25:137–142.Google Scholar
65. Suellen, M, Cutkendall, SM, Mo, J, Jones, JK, et al. Increased cardiovascular dis-ease in schizophrenia. Poster P-001-04 presented at: 7th World Congress of Biological Psychiatry; July 2001; Berlin, Germany.Google Scholar
66. Hennessy, S, Bilker, WB, Santanna, JC, et al. Cardiac arrest risk appears to vary little by choice of antipsychotic drug. Poster NR 507 presented at: Annual Meeting of the American Psychiatric Association; May 2001; New Orleans, LA.Google Scholar
67. Miceli, JJ, Smith, M, Robarge, L, et al. The effects of ketoconazole on ziprasidone pharmacokinetics-a placebo-controlled crossover study in healthy volunteers. Br J Clin Pharmacol. 2000;49(suppl 1):71S–76S.Google Scholar
68. Ziprasidone. Bioltigical Therapies in Psychiatry. 2001;24:22. Study 128-054.Google Scholar