Frequency of use of QT-interval prolonging drugs in psychiatry in Belgium
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Introduction Drug-induced QT-prolongation is an established risk factor for Torsade de pointes and sudden cardiac death. The list of QT-prolonging drugs is extensive and includes many drugs commonly used in psychiatry. Aim In this study we performed a cross-sectional analysis of medication profiles to assess the prevalence of drug interactions potentially leading to QT-prolongation. Setting 6 psychiatric hospitals in Flanders, Belgium. Methods For each patient, the full medication list was screened for the presence of interactions, with special attention to those with an increased risk for QT-prolongation. Current practice on QT monitoring and prevention of drug-induced arrhythmia was assessed. Main outcome measure Number of drug interactions with risk of QT-prolongation. Results 592 patients (46 % female; mean age 55.7 ± 17.1 years) were included in the analysis. 113 QT-prolonging interactions were identified in 43 patients (7.3 %). QT-prolonging interactions occurred most frequently with antidepressants (n = 102) and antipsychotics (n = 100). The precautions and follow-up provided by the different institutions when combining QT-prolonging drugs were very diverse. Conclusion Drug combinations that are associated with QT-prolongation are frequently used in the chronic psychiatric setting. Persistent efforts should be undertaken to provide caregivers with clear guidelines on how to use these drugs in a responsible and safe way.
KeywordsAntidepressants Antipsychotics Belgium Drug-induced QT-prolongation Drug interactions Psychiatry Torsade de pointes
We would like to thank Delphine Lesage, Tinne Leyssens, Eline Sol, Nathalie Rahier, Pieter Ramaut, Annelies Van Huynegem and Hakima Abasbassi from the department of Pharmaceutical Sciences for their contribution to the data collection and analysis. We also want to thank the pharmacists of the 6 psychiatric institutions for their participation: Johan Reyntens, Sint-Jan hospital; Marc De Vos, Sint-Jan-Baptist hospital; Daniel Vrijders, Zoete Nood Gods hospital, Maria De Voght, Sint-Alexius hospital; Erik Pauwels, Sint-Lucia hospital, and Willy De Boever, Sint-Hieronymus hospital.
This work was supported by unconditional grants from Boston Scientific and Medtronic Belgium. Dr. Willems is supported as a clinical researcher by the Fund for Scientific Research Flanders. PhD-student Eline Vandael is supported by funding of the Belgian government agency for Innovation by Science and Technology (IWT).
Conflicts of interest
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