The @entity5126 -like effects of some @entity9022 drugs (particularly tricyclic antidepressants) and many antipsychotic drugs (particularly the phenothiazines) confound treatment of @entity716 and @entity308 in @entity1 with major @entity1032 . This is especially true among elderly @entity1 with existing risk factors for @entity1162 . We used PubMed, previously reported review articles and the extensive personal files of the authors to identify cases of subjects aged>or=60 years who developed @entity1162 , polymorphic @entity1165 (PVT)/ @entity1166 ( @entity1166 ) and/or @entity1164 while taking antipsychotic or @entity9022 drugs or a combination of these medications. We identified 37 @entity1 who had taken, in total, 46 antipsychotic or @entity9022 drugs. Our most striking finding was that almost four-fifths of our cases involved @entity1 . When the 14 critically ill subjects receiving @entity1767 intravenously were excluded, 91.3% of our subjects were @entity1 . Almost three-quarters of our study subjects had @entity65 . Intravenous administration of @entity1767 in the critically ill and profoundly agitated elderly warrants particular comment. Of the 14 subjects in this category identified, six were @entity1 and eight were @entity1 . In 13 cases, the drug dose far exceeded the 2 mg necessary to produce an antipsychotic effect. These clinicians were using an agent to achieve sedation that usually requires very high doses in the critically ill and profoundly agitated elderly to achieve this effect. Inclusion criteria for our literature review required antipsychotic and/or @entity9022 drug-induced @entity1162 . Even so, our finding that 31 of our 37 subjects developed PVT is sobering. However, the reader should not conclude that drug-induced @entity1162 is highly predictive of PVT or its @entity1166 subtype. All of our study subjects had at least two risk factors for @entity1166 , with age and sex being the most common. We included the rare case of a @entity1 with @entity1162 who developed further lengthening of the QTc interval and @entity1166 when prescribed an @entity9022 drug well known to produce @entity1162 . We conclude with recommendations for clinicians not expert in the specialty of cardiology to deal with the many questions raised in this review. Specifically, such clinicians treating elderly patients with antipsychotic and @entity9022 drugs that may prolong the QTc interval should aggressively obtain a baseline ECG for elderly female @entity1 with additional risk factors such as personal or family history of pre- @entity1163 or @entity1163 , electrolyte disturbances or @entity65 . Elderly male @entity1 are also subject to @entity1162 when such risk factors are present. It is important that the clinicians themselves inspect ECGs. If the QT interval is more than half the RR interval, @entity1162 is likely to be present. In such cases, a cardiology colleague interested in QTc interval issues and @entity1166 should be asked to review the ECG. Finally, nothing in our recommendations replaces meticulous attention to US FDA guidelines in the package insert of each drug.

Proarrhythmic risk with antipsychotic and XXXX drugs: implications in the elderly.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient', 'men'] @entity1164 :: ('MESH:D016757', 'Disease') :: ['sudden cardiac death'] @entity1032 :: ('MESH:D008607', 'Disease') :: ['mental illness'] @entity308 :: ('MESH:D003866', 'Disease') :: ['depression'] @entity1165 :: ('MESH:D017180', 'Disease') :: ['ventricular tachycardia'] @entity1162 :: ('MESH:D008133', 'Disease') :: ['QTc interval prolongation', 'corrected QT (QTc) interval prolongation', 'congenital long QT syndrome'] @entity1166 :: ('MESH:D016171', 'Disease') :: ['TdP', 'torsade de pointes'] @entity1163 :: ('MESH:D013575', 'Disease') :: ['syncope'] @entity5126 :: ('MESH:D011802', 'Chemical') :: ['quinidine'] @entity716 :: ('MESH:D011605', 'Disease') :: ['psychosis'] @entity1767 :: ('MESH:D006220', 'Chemical') :: ['haloperidol'] @entity9022 :: ('D000928', 'Chemical') :: ['antidepressant'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cardiovascular disease']
@entity9022 :: (D000928,Chemical) :: ['antidepressant']
