Ther Adv Drug Saf. 2018 Jun; 9(6): 297–308., PMID: 29854391
Matthew P. Rochester, Allison M. Kane, Sunny Anne Linnebur, and Danielle R. Fixen
Abstract
Antidepressants are widely used medications for a range of medical conditions such as mood disorders and chronic pain in older adults. A vast body of evidence exists concerning the risks of QT interval prolongation associated with these agents and healthcare providers should critically evaluate the potential for QT prolongation when selecting antidepressant agents. Long QT syndrome is a disorder of myocardial repolarization that manifests as a prolonged QT interval on an electrocardiogram (ECG) and has been demonstrated to increase with age. The objective of this review is to present and evaluate existing literature regarding the risk of QT prolongation in older adults, age 60 years and older, and discuss the implications for clinical practice. A PubMed search was conducted to identify studies evaluating the QT prolonging effects of antidepressant medications and publications were chosen based on pertinent criteria. Depending on the antidepressant agent and patient-specific factors, clinicians should assess and monitor electrolytes and EGCs to evaluate the risks and benefits for older adults receiving agents known to prolong the QT interval.
Keywords: antidepressants, antidepressive agents, elderly, long QT syndrome, long QT syndrome/chemically induced, older adults, QT prolongation, QTc interval
Fazit:
- Antidepressiva können eine QTc-Zeit-Verlängerung machen. Mit zunehmendem Alter steigt dieses Risiko weiter an. In den eingeschlossenen Studien war das Risiko für Trizyklische Antidepressiva und Citalopram am größten. Keine Signifikanz konnte für die alleinige Gabe von SSRI und SNRIs festgestellt werden.
- RF: Weiblich, älter wie 65, Elektrolytstörungen (Hypokaliämie, Hypomagnesämie), weitere QT-verlängerte Medikamente, Vorerkrankungen (zb Hypertonus, Diabetes, Schlaganfall)
- Hier: QTc-Zeit definiert als Verlängerung wenn mind. 450ms bei Männern und 460ms bei Frauen.