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Sudden cardiac death risk elevated with atypical, typical antipsychotics

30 January 2009

MedWire News: Both typical and atypical antipsychotic drugs are associated with an increased risk for sudden cardiac death and should not used by children and the elderly, say US researchers.

Atypical antipsychotics are now commonly used to treat patients with schizophrenia and bipolar disorder, since the older, typical antipsychotic drugs are associated with an increased risk of movement disorders.

Typical antipsychotics are also associated with an increased risk of serious heart rhythm disorders and sudden cardiac death, but it is not known whether atypical antipsychotics share this property, explain Wayne Ray, from Vanderbilt University School of Medicine in Nashville, Tennessee, and colleagues.

They add that it is important to find out whether atypical antipsychotics increase the risk of heart problems as they are often also prescribed “off label” for symptoms such as agitation, anxiety and obsessive behaviours.

To investigate, the researchers studied data on 44,218 patients who used typical antipsychotics, 46,089 who used atypical drugs and 186,600 patients who had never used such drugs.

The researchers found that, compared with nonusers, patients who used typical antipsychotics had a 2-fold increased risk of sudden cardiac death and those who used atypical drugs had a 2.2-fold increased risk of the condition.

For both drug classes, the risk of sudden cardiac death was associated with dosage. Among users of typical antipsychotics, low doses were associated with a 1.3-fold increased risk of sudden cardiac death rising to a 2.4-fold increased risk with high doses. Among users of atypical antipsychotics, the risk increased from 1.6-fold for low doses to 2.8-fold with high doses.

However, this increased risk was only significant for current users of antipsychotics, with former users having no significant increased risk of the heart condition.

“Current users of typical and of atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death,” Ray and team conclude. “With regard to this adverse effect, the atypical antipsychotic drugs are no safer than the older drugs.”

In an accompanying article, Sebastian Schneeweiss and Jerry Avorn, from Harvard Medical School in Boston, Massachusetts, USA, suggest that heart tests called electrocardiograms should be performed before and shortly after the start of antipsychotic drug therapy.

They also say that these drugs should be avoided in individuals for whom the benefits have not been clearly established, such as children and the elderly with dementia.

http://www.inpsychiatry.com/news/article.aspx?id=80496

This of course is one of the eternal dilemmas of drug therapy deciding when the therapeutic benefits outweigh the drug induced side effects.