Cardiac adverse reactions associated with psychotropic drugs

Rates of cardiovascular morbidity and mortality in psychiatric patients are higher than in the general population: it is estimated that those who suffer from schizophrenia have a life expectancy approximately 20 % shorter than those who do not, and this difference is not fully accounted for by suicide or accidental death.(1) Cardiovascular adverse effects of psychotropic drugs are common, and potentially harmful.(2) The most serious cardiovascular consequences of psychotropic drugs are arrhythmias and sudden death, which principally result from torsades de pointes following progressive QT intervall prolongation. Less severe cardiac adverse drug reactions are extremely common. Orthostatic hypotension, vasodilatation with transient collapse, and reflex sinus tachycardia due to α(1)-adrenoceptor blockade and to anticholinergic effects occur at therapeutic dosages of several psychotropic drugs. Postural hypotension was found in 77 % of patients receiving antipsychotic medication versus 15 % receiving placebo, and a correlation was found with drugs dosage.(3) Furthermore, antipsychotic drug is associated with an increased risk of hip fracture with a relative risk of 2 (confidence interval [CI], 1.6 to 2.6 and accounts for a third of all falls in nursing homes.(4,5)