Many antipsychotics can prolong the QT interval, posing a significant risk for patients with a history of QT prolongation, potentially leading to life-threatening arrhythmias.
Screen for QT prolongation history and risk factors (e.g., female sex, hypokalemia) before starting.
Use lowest effective dose and monitor ECG at baseline, 1-2 weeks after initiation, and with dose changes.
Contraindicated in patients with congenital long QT syndrome or recent MI.
Emergency treatment for torsades: magnesium sulfate IV and defibrillation if needed.
Certain antipsychotics (e.g., haloperidol, ziprasidone, quetiapine) block the rapid delayed rectifier potassium current (Ikr) via hERG channel inhibition, delaying ventricular repolarization and exacerbating underlying QT prolongation from genetic, electrolyte, or cardiac factors.
Increased risk of torsades de pointes, ventricular tachycardia, sudden cardiac death; symptoms may include palpitations, syncope, or dizziness.
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