Eline Vandael1, Bert Vandenberk2,3, Joris Vandenberghe4,5, Isabel Spriet6,7, Rik Willems2,3, Veerle Foulon6. 1. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium. Eline.Vandael@pharm.kuleuven.be. 2. Department of Cardiovascular Sciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium. 3. Department of Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium. 4. Department of Neurosciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium. 5. Department of Psychiatry, University Hospitals Leuven, 3000, Leuven, Belgium. 6. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium. 7. Department of Pharmacy, University Hospitals Leuven, 3000, Leuven, Belgium.
Abstract
BACKGROUND: Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death. OBJECTIVE: To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk. SETTING: University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered. MAIN OUTCOME MEASURE: Management of the risk of QTc-prolongation. RESULTS: Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020). CONCLUSIONS: Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.
BACKGROUND: Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death. OBJECTIVE: To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk. SETTING: University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered. MAIN OUTCOME MEASURE: Management of the risk of QTc-prolongation. RESULTS: Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020). CONCLUSIONS: Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.
Authors: David Pickham; Eric Helfenbein; Julie A Shinn; Garrett Chan; Marjorie Funk; Ann Weinacker; Jia-Ni Liu; Barbara J Drew Journal: Crit Care Med Date: 2012-02 Impact factor: 7.598
Authors: Jeffrey J Miceli; Thomas G Tensfeldt; Thomas Shiovitz; Richard J Anziano; Cedric O'Gorman; Rachel H Harrigan Journal: Clin Ther Date: 2010-03 Impact factor: 3.393
Authors: Justin M Fongemie; Nada S Al-Qadheeb; N A Mark Estes; Russel J Roberts; Yutthapong Temtanakitpaisan; Robin Ruthazer; John W Devlin Journal: Pharmacotherapy Date: 2013-03-25 Impact factor: 4.705
Authors: Emma C Davies; Christopher F Green; Stephen Taylor; Paula R Williamson; David R Mottram; Munir Pirmohamed Journal: PLoS One Date: 2009-02-11 Impact factor: 3.240