1 Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD, USA.
2 Central Texas Veterans Health Care System, Temple, TX, USA.
Ann Pharmacother. 2018 Sep;52(9):838-848. doi: 10.1177/1060028018769425. Epub 2018 Apr 11.
In 2012, the Food and Drug Administration issued Drug Safety Communications on several drugs associated with QT prolongation and fatal ventricular arrhythmias. Among these was citalopram, a selective serotonin reuptake inhibitor (SSRI) approved for depression and commonly used for posttraumatic stress disorder (PTSD). Evaluation of the risk for QT prolongation among other psychotropic drugs for individuals with PTSD remains limited.
Explore psychotropic drugs associated with QT prolongation among veterans with PTSD.
Patients in the Veterans Health Administration in 2006-2009 with PTSD and QT prolongation (176 cases) were matched 1:4 on age, gender, visit date and setting, and physical comorbidity. Classification trees assessed QT prolongation risk among prescribed medications (n=880).
Receipt of any drug with known risk of QT prolongation varied by group (23% QT cases vs 15% control, p<0.01). Psychotropic medications conferring significant risks included ziprasidone (3% vs 1%, p=0.02) and buspirone (6% vs 2%, p=0.01). Increased risk was not observed for the SSRIs, citalopram and fluoxetine. Classification trees found that sotalol and amitriptyline carried greater risk among cardiac patients and methadone, especially if prescribed with quetiapine, among noncardiac patients. Per adjusted survival model, patients with QT prolongation were at increased risk for death (hazard ratio=1.60; 95% CI=1.04-2.44).
Decision models are particularly advantageous when exploring nonlinear relationships or nonadditive interactions. These findings may potentially affect clinical decision-making concerning treatment for PTSD. For patients at higher risk of QT prolongation, antidepressants other than amitriptyline should be considered. Medications for comorbid conditions should also be closely monitored for heightened QT prolongation risk.
2012 年，美国食品和药物管理局发布了关于几种与 QT 延长和致命性室性心律失常相关药物的药物安全通讯。其中包括西酞普兰，一种用于治疗抑郁症和广泛性焦虑症的选择性 5-羟色胺再摄取抑制剂（SSRIs）。对于 PTSD 患者，评估其他精神类药物 QT 延长风险的研究仍然有限。
探讨 PTSD 患者中与 QT 延长相关的精神类药物。
2006-2009 年在退伍军人健康管理局就诊的 PTSD 合并 QT 延长（176 例）患者，按照年龄、性别、就诊日期和就诊地点、躯体合并症进行 1:4 匹配。分类树评估了处方药物中 QT 延长风险（n=880）。
接受任何一种已知有 QT 延长风险的药物的情况在两组之间存在差异（QT 延长组 23%，对照组 15%，p<0.01）。风险显著增加的精神类药物包括齐拉西酮（3%比 1%，p=0.02）和丁螺环酮（6%比 2%，p=0.01）。SSRIs 西酞普兰和氟西汀并未观察到风险增加。分类树发现，索他洛尔和阿米替林在心脏患者中风险更大，而美沙酮，特别是与喹硫平合用的情况下，在非心脏患者中风险更大。根据调整后的生存模型，QT 延长患者的死亡风险增加（危险比=1.60；95%CI=1.04-2.44）。
决策模型在探索非线性关系或非加性相互作用时特别有利。这些发现可能会对 PTSD 治疗的临床决策产生影响。对于 QT 延长风险较高的患者，应考虑使用除阿米替林以外的抗抑郁药。对于治疗合并症的药物，也应密切监测 QT 延长风险增加的情况。
