RATIONALE: A recent publication asserted that even low-dose risperidone may induce corrected QT (QTc) interval prolongation up to 500 ms without drug-induced IKr blockade. We seek to better understand the complexity of any link between risperidone-induced/associated QTc interval prolongation and torsade de pointes (TdP). OBJECTIVES: The objective of this study is to systematically analyze all available case reports of risperidone, QTc interval prolongation, and/or TdP. METHOD: We identify case reports using PubMed, Medline, EMBASE, and Cochrane. RESULTS: Of the 15 cases found, nine were adult women (ages 31, 33, 34, 37, 47, "elderly", 77, 84, and 87 years) and one was a teenager. There were four men (ages 28, 29, 29, and 46 years) and one preadolescent boy. Besides risperidone administration or overdose, traditional risk factors for QTc interval prolongation and TdP included female sex (n = 10), older age (n = 4), heart disease (n = 3), hypokalemia (n = 2), bradycardia (n = 1), liver disease (n = 1), QTc interval prolonging drugs other than risperidone (n = 8), and metabolic inhibitors (n = 2). TdP occurred in four cases. Six patients died, and three deaths were probably related to TdP. CONCLUSION: Risperidone (when properly prescribed in patients free of other risk factors for QTc interval prolongation and TdP) is a relatively safe drug. Conventional statistics can neither predict the individual patient who will experience TdP nor determine the relationship of drug dose to QTc interval prolongation and TdP. Narrative medicine using a case report format appears to be an alternative and valuable additional approach to advance our understanding of this relationship and to reduce risks.
RATIONALE: A recent publication asserted that even low-dose risperidone may induce corrected QT (QTc) interval prolongation up to 500 ms without drug-induced IKr blockade. We seek to better understand the complexity of any link between risperidone-induced/associated QTc interval prolongation and torsade de pointes (TdP). OBJECTIVES: The objective of this study is to systematically analyze all available case reports of risperidone, QTc interval prolongation, and/or TdP. METHOD: We identify case reports using PubMed, Medline, EMBASE, and Cochrane. RESULTS: Of the 15 cases found, nine were adult women (ages 31, 33, 34, 37, 47, "elderly", 77, 84, and 87 years) and one was a teenager. There were four men (ages 28, 29, 29, and 46 years) and one preadolescent boy. Besides risperidone administration or overdose, traditional risk factors for QTc interval prolongation and TdP included female sex (n = 10), older age (n = 4), heart disease (n = 3), hypokalemia (n = 2), bradycardia (n = 1), liver disease (n = 1), QTc interval prolonging drugs other than risperidone (n = 8), and metabolic inhibitors (n = 2). TdP occurred in four cases. Six patients died, and three deaths were probably related to TdP. CONCLUSION:Risperidone (when properly prescribed in patients free of other risk factors for QTc interval prolongation and TdP) is a relatively safe drug. Conventional statistics can neither predict the individual patient who will experience TdP nor determine the relationship of drug dose to QTc interval prolongation and TdP. Narrative medicine using a case report format appears to be an alternative and valuable additional approach to advance our understanding of this relationship and to reduce risks.
Authors: Sami Viskin; Uri Rosovski; Andrew J Sands; Edmond Chen; Peter M Kistler; Jonathan M Kalman; Laura Rodriguez Chavez; Pedro Iturralde Torres; Fernando E S Cruz F; Osmar A Centurión; Akira Fujiki; Philippe Maury; Xiaomin Chen; Andrew D Krahn; Franz Roithinger; Li Zhang; G Michael Vincent; David Zeltser Journal: Heart Rhythm Date: 2005-06 Impact factor: 6.343
Authors: L Zhang; K W Timothy; G M Vincent; M H Lehmann; J Fox; L C Giuli; J Shen; I Splawski; S G Priori; S J Compton; F Yanowitz; J Benhorin; A J Moss; P J Schwartz; J L Robinson; Q Wang; W Zareba; M T Keating; J A Towbin; C Napolitano; A Medina Journal: Circulation Date: 2000-12-05 Impact factor: 29.690
Authors: W Victor R Vieweg; Mehrul Hasnain; Robert H Howland; John M Hettema; Christopher Kogut; Mark A Wood; Ananda K Pandurangi Journal: Am J Med Date: 2012-06-27 Impact factor: 4.965
Authors: Gerrit Frommeyer; Henning von der Ahe; Benedict Brücher; Dirk G Dechering; Philipp S Lange; Florian Reinke; Kristina Wasmer; Julia Köbe; Christian Pott; Gerold Mönnig; Lars Eckardt Journal: Naunyn Schmiedebergs Arch Pharmacol Date: 2016-07-12 Impact factor: 3.000
Authors: Lan Chi Vo; Christopher Snyder; Courtney McCracken; Christopher J McDougle; James T McCracken; Michael G Aman; Elaine Tierney; L Eugene Arnold; Daniel Levi; Michael Kelleman; Deirdre Carroll; John Morrissey; Benedetto Vitiello; Lawrence Scahill Journal: J Child Adolesc Psychopharmacol Date: 2016-10-11 Impact factor: 2.576
Authors: P Champeroux; J Y Le Guennec; S Jude; C Laigot; A Maurin; M L Sola; J S L Fowler; S Richard; J Thireau Journal: Br J Pharmacol Date: 2016-01-14 Impact factor: 8.739
Authors: P Champeroux; J Thireau; S Judé; C Laigot-Barbé; A Maurin; M L Sola; J S L Fowler; S Richard; J Y Le Guennec Journal: Br J Pharmacol Date: 2015-03-26 Impact factor: 8.739
Authors: Mirjam Simoons; Adrie Seldenrijk; Hans Mulder; Tom Birkenhäger; Mascha Groothedde-Kuyvenhoven; Rob Kok; Cornelis Kramers; Wim Verbeeck; Mirjam Westra; Eric van Roon; Roberto Bakker; Henricus Ruhé Journal: Drug Saf Date: 2018-07 Impact factor: 5.606