Antipsychotic Polypharmacy and Corrected QT Interval: A Systematic Review
Hiroyoshi Takeuchi1, Takefumi Suzuki2, Gary Remington3
1Post-doctoral Fellow, Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Ontario; Clinical Fellow, Department of Psychiatry, University of Toronto, Toronto, Ontario; Collaborative Researcher, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Summary
Antipsychotic polypharmacy does not definitively worsen corrected QT interval (QTc) prolongation, but caution is advised. Some drug combinations may increase QTc prolongation risk, with limited evidence on clinical benefits.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Antipsychotic polypharmacy is common but its association with QTc prolongation is unclear.
- The corrected QT (QTc) interval is a measure of cardiac repolarization, with prolongation posing risks.
Purpose of the Study:
- To systematically review the literature on the relationship between antipsychotic polypharmacy and QTc interval prolongation.
Main Methods:
- A systematic literature search was performed in October 2014 across MEDLINE, Embase, and PsycINFO.
- Included studies reported QTc intervals or changes in patients on antipsychotic polypharmacy versus monotherapy or baseline.
Main Results:
- 21 articles were reviewed; clinical trials showed mixed results, with some combinations potentially prolonging QTc.
- Observational studies provided inconsistent findings, while case reports suggested an increased risk in some patients.
- Overall, evidence linking antipsychotic polypharmacy to significant QTc prolongation is scarce and inconsistent.
Conclusions:
- Current evidence does not confirm antipsychotic polypharmacy generally worsens QTc prolongation.
- Clinicians should exercise caution due to potential risks with specific antipsychotic combinations.
- The clinical benefits of antipsychotic polypharmacy remain uncertain.
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