Typical and atypical antipsychotics increase risk of sudden cardiac death.

ED FROM Ray WA, Chung CP, Murray KT, et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009;360:225–35. Correspondence to: Dr Wayne A Ray, Department of Preventative Medicine, Village at Vanderbilt, Suite 2600, 1501 21st Avenue South, Nashville, TN 37212, USA; [email protected] Source of funding: National Heart, Lung, and Blood Institute and the Agency for Healthcare Quality and Research. C O M M EN TA R Y N umerous psychotropic drugs have been associated with cardiac conduction changes and this is particularly the case with antipsychotics. Most antipsychotics are associated with prolongation of the QT interval and some have been linked to Torsade de Pointes. A handful of studies have previously linked antipsychotic use to sudden cardiac death but these studies mainly involved the use of older typical antipsychotics. Ray and colleagues robustly demonstrate that both typical and atypical antipsychotics are associated with a significantly increased rate of sudden cardiac death and that the risk is dose related. This latter finding substantially strengthens one’s confidence in the robustness of the former. The overall rate of sudden cardiac death was extremely low (17.9 deaths per 10 000 patient years) but the 2–3fold increased risk afforded by the use of antipsychotics is clearly clinically significant. The present study shows that all antipsychotics are likely to increase the risk of sudden cardiac death regardless of their individual propensity to affect the QT interval. It also provides the most robust evidence to date to support the use of lowest possible doses of all antipsychotics in the treatment of psychosis. No longer should clinicians unthinkingly prescribe higher and higher doses of antipsychotics, even within licensed dose ranges, assuming such doses to be safe. The clear dose related risk of sudden cardiac death should provoke a marked change in prescribing practice. David Taylor, PhD Maudsley Hospital, London, UK Competing interests: DT has received research funding and consultancy honoraria from AstraZeneca, BristolMyers Squibb, Janssen-Cilag, Lundbeck, Novartis, Eli Lilly and Sanofi-Aventis. 1. Taylor DM. Antipsychotics and QT prolongation. Acta Psychiatr Scand 2003;107:85–95. Aetiology 92 EBMH August 2009 Vol 12 No 3 group.bmj.com on June 17, 2017 Published by http://ebmh.bmj.com/ Downloaded from