Skip to main content
PMC home page
Journal of Medical Toxicology logoLink to Journal of Medical Toxicology
. 2007 Dec;3(4):178–181. doi: 10.1007/BF03160936

QT prolongation and torsades de pointes following overdose of ziprasidone and amantadine

Alex F Manini 1,✉, Dara Raspberry 2, Robert S Hoffman 1, Lewis S Nelson 1
PMCID: PMC3550025  PMID: 18072173

Full Text

The Full Text of this article is available as a PDF (383.5 KB).

Footnotes

This case report was previously presented in abstract format at the 27th International Congress of the European Association of Poison Centres and Clinical Toxicologists (Athens, Greece) in May 2007. There was no outside funding of any kind used for this study.

References

  • 1.FDA Drug Approvals — G. Available at http://www.fda.gov/ cder/approval/g.htm. Accessed September 27,2006.
  • 2.Nemeroff CB, Lieberman JA, Weiden PJ, et al. From clinical research to clinical practice: a 4-year review of ziprasidone. CNS Spectr. 2005;10(11):S1–20. doi: 10.1017/s1092852900019842. [DOI] [PubMed] [Google Scholar]
  • 3.Perlis RH, Welge JA, Vornik LA, Hirschfeld RMA, Keck PE. Atypical antipsychotics in the treatment of mania: a metaanalysis of randomized, placebo-controlled trials. J Clin Psychiatry. 2006;67:509–516. doi: 10.4088/jcp.v67n0401. [DOI] [PubMed] [Google Scholar]
  • 4.Patel NC, Keck PE. Ziprasidone: efficacy and safety in patients with bipolar disorder. Expert Rev Neurother. 2006;6(8):1129–1138. doi: 10.1586/14737175.6.8.1129. [DOI] [PubMed] [Google Scholar]
  • 5.Stimmel GL, Gutierrez MA, Lee V. Ziprasidone: an atypical antipsychotic drug for the treatment of schizophrenia. Clin Ther. 2002;24:21–37. doi: 10.1016/S0149-2918(02)85003-2. [DOI] [PubMed] [Google Scholar]
  • 6.Barak Y, Mazeh D, Plopski I, Baruch Y. Intramuscular ziprasidone treatment of acute psychotic agitation in elderly patients with schizophrenia. Am J Geriatr Psychiatry. 2006;14(7):629–633. doi: 10.1097/01.JGP.0000216325.42721.99. [DOI] [PubMed] [Google Scholar]
  • 7.Martel M, Sterzinger A, Miner J, Clinton J, Biros M. Management of acute undifferentiated agitation in the emergency department: a randomized double-blind trial of droperidol, ziprasidone, and midazolam. Acad Emerg Med. 2005;12(12):1167–1172. doi: 10.1111/j.1553-2712.2005.tb01492.x. [DOI] [PubMed] [Google Scholar]
  • 8.Ray WA, Meredith S, Thapa PB, Meador KG, Hall K, Murray KT. Antipsychotics and the risk of sudden cardiac death. Arch Gen Psychiatry. 1991;58:1161–1167. doi: 10.1001/archpsyc.58.12.1161. [DOI] [PubMed] [Google Scholar]
  • 9.Hennessy S, Bilker WB, Knauss JS, Margolis DJ, Kimmel SE, Reynolds RF, et al. Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data. BMJ. 2002;325:1070–1074. doi: 10.1136/bmj.325.7372.1070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SHL. Thioridazine and sudden unexplained death in psychiatric in-patients. Br J Psychiatry. 2002;180:515–522. doi: 10.1192/bjp.180.6.515. [DOI] [PubMed] [Google Scholar]
  • 11.Straus SM, Bleumink GS, Dieleman JP, van der Lei J, ’tJong GW, Kingma JH, et al. Antipsychotics and the risk of sudden cardiac death. Arch Intern Med. 2004;164:1293–1297. doi: 10.1001/archinte.164.12.1293. [DOI] [PubMed] [Google Scholar]
  • 12.2002 Safety Alert—Geodon (ziprasidone HCl). Available at: http://www.fda.gov/medwatch/SAFETY/2002/geodon.htm. Accessed October 13, 2006.
  • 13.Alert for healthcare professionals—Ziprasidone (marketed as Geodon). Available at: http://www.fda.gov/cder/drug/ InfoSheets/HCP/ziprasidoneHCP.htm. Accessed September 27,2006.
  • 14.Physicians’ desk reference. 58th. Montvale, NJ: Thomson PDR; 2004. pp. 2597–2603. [Google Scholar]
  • 15.Glassman AH, Bigger JT. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry. 2001;158(11):1774–1782. doi: 10.1176/appi.ajp.158.11.1774. [DOI] [PubMed] [Google Scholar]
  • 16.Kelly DL, Love RC. Ziprasidone and the QTc interval: pharmacokinetic and pharmacodynamic considerations. Psychopharmacol Bull. 2001;35(4):66–79. [PubMed] [Google Scholar]
  • 17.Glassman AH. Schizophrenia, antipsychotic drugs, and cardiovascular disease. J Clin Psychiatry. 2005;66(6):5–10. [PubMed] [Google Scholar]
  • 18.Goodnick PJ. Ziprasidone: profile on safety. Expert Opin Pharmacother. 2001;2(10):1655–1662. doi: 10.1517/14656566.2.10.1655. [DOI] [PubMed] [Google Scholar]
  • 19.Citrome L, Volavka J. The promise of atypical antipsychotics: fewer side effects mean enhanced compliance and improved functioning. Postgrad Med. 2004;116(4):49–51. doi: 10.3810/pgm.2004.10.1601. [DOI] [PubMed] [Google Scholar]
  • 20.Heinrich TW, Biblo LA, Schneider A. Torsades de pointes associated with ziprasidone. Psychosomatics. 2006;47(3):264–268. doi: 10.1176/appi.psy.47.3.264. [DOI] [PubMed] [Google Scholar]
  • 21.Scahill L, Blair J, Leckman JF, Martin A. Sudden death in a patient with Tourette syndrome during a clinical trial of ziprasidone. J Psychopharmacol. 2005;19(2):205–206. doi: 10.1177/0269881105049042. [DOI] [PubMed] [Google Scholar]
  • 22.Bazett H. An analysis of the time relationship of electrocardiograms. Heart. 1920;7:353–370. [Google Scholar]
  • 23.Sanguinetti MC, Jiang C, Curran ME, Keating MT. A mechanistic link between an inherited and an acquired cardiac arrhythmia: HERG encodes the Ikr potassium channel. Cell. 1995;81:299–307. doi: 10.1016/0092-8674(95)90340-2. [DOI] [PubMed] [Google Scholar]
  • 24.Juurlink D. Antipsychotics. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS (editors):Goldfrank’s Toxicologic Emergencies. McGraw-Hill: 8th ed., pp. 1040–1043.
  • 25.Harrigan EP, Miceli JJ, Anziano R, Watsky E, Reeves KR, Cutler NR, et al. A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition. J Clin Psychopharmacol. 2004;24:62–69. doi: 10.1097/01.jcp.0000104913.75206.62. [DOI] [PubMed] [Google Scholar]
  • 26.Citrome L, Volavka J, Czobor P, Brooks S, Loebel A, Mandel FS. Efficacy of ziprasidone against hostility in schizophrenia: Post hoc analysis of randomized, open-label study data. J Clin Psychiatry. 2006;67(4):638–642. doi: 10.4088/JCP.v67n0415. [DOI] [PubMed] [Google Scholar]
  • 27.Justo D, Prokhorov V, Heller K, Zeltser D. Torsade de pointes induced by psychotropic drugs and the prevalence of its risk factors. Acta Psychiatr Scand. 2005;111:171–176. doi: 10.1111/j.1600-0447.2004.00469.x. [DOI] [PubMed] [Google Scholar]
  • 28.Roden DM. Drug-induced prolongation of the QT interval. N Eng J Med. 2004;350:1013–1022. doi: 10.1056/NEJMra032426. [DOI] [PubMed] [Google Scholar]
  • 29.Sartori M, Pratt CM, Young JB. Torsade de pointe. Malignant cardiac arrhythmia induced by amantadine poisoning. Am J Med. 1984;77(2):388–391. doi: 10.1016/0002-9343(84)90728-9. [DOI] [PubMed] [Google Scholar]
  • 30.Kay GN, Plumb VJ, Arciniegas JG, Henthorn RW, Waldo AL. Torsades de pointes: the long-short initiating sequence and other clinical features: observations in 32 patients. J Am Coll Cardiol. 1983;2:806–817. doi: 10.1016/S0735-1097(83)80226-5. [DOI] [PubMed] [Google Scholar]
  • 31.Roden DM, Woosley RL, Primm RK. Incidence and clinical features of the quinidine-associated long QT syndrome: implications for patient care. Am Heart J. 1986;111:1088–1093. doi: 10.1016/0002-8703(86)90010-4. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Toxicology are provided here courtesy of Springer

RESOURCES