Psychiatric Medications and QTc Prolongation in the Pediatric Population

Various medications used to treat psychiatric conditions are associated with prolongation of the QTc interval, which can lead to Torsades de Pointes, a deadly arrhythmia. Despite evidence of QTc prolongation, clinicians increasingly use psychiatric drugs in the pediatric population. Guidelines for prescribing many of these medications in children do not currently exist. To safely prescribe QTc prolonging drugs, especially in children with preexisting cardiovascular conditions, psychiatric providers, primary care physicians and/or pediatricians should conduct a detailed personal and family medical history, medication record, physical examination, and lab work, if clinically indicated, to rule out potential risk factors. Pharmacist input should be sought, if available. If risk factors are present and pre-treatment assessments identify cardiac risk factors, an assessment by a cardiologist may be necessary. To enhance treatment safety and mitigate QTc prolongation risks associated with psychiatric drug use in children, a standardized approach for drug prescribing that takes patient risk factors into account is proposed.