Psychiatric medications and potential effects on cardiac rhythm

In the last month we have been having discussions at work about the potential for psychiatric medications to adversely effect cardiac rhythms, and in particular QTc prolongation.  The advice on ECG monitoring seems to be developing even though many of these medications have been in routine use for many years.

In Guidance that has since been circulated attention was drawn to the need for a baseline ECG prior to prescription of haloperidol and that “prescription without this would be unlicensed“. It was also correctly stated that “this may have implications for the rapid tranquilisation policy”. I have drawn this to the attention of  Healthcare Improvement Scotland given their involvement in national improvement work and patient safety.

Furthermore, in recent weeks, two more psychiatric drugs have been added to the QT.org drugs list: these being Memantine (which is licensed for use in moderate to severe dementia of an Alzheimer’s type) and Maprotiline (antidepressant). On learning this one psychiatric medical professional said “At the risk of being facetious, I think we all need to get a portable ECG machine to carry around with us.”

 

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