Arrhythmias and sudden death in patients taking antipsychotic drugs

High doses and combinations of certain drugs are best avoided

The first report that patients with schizophrenia might be at special risk of arrhythmia and sudden death appeared in the early 1960s, when thioridazine was found to prolong the QT interval, an electrocardiographic abnormality that could lead to torsades de pointes and sudden death.1^–4 This same problem arose with sertindole—lengthening of the QTc interval and an apparent excess of sudden deaths in clinical trials—and led the US Food and Drug Administration to refuse it a licence.5 Nevertheless, whether cardiac deaths are related to the illness itself or to the drugs used to treat it has remained unclear. Data from a very large American cohort of almost 100 000 outpatients with schizophrenia who were treated with antipsychotics were published …