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頁籤選單縮合
題名 | The Torsadogenic Risk of Antipsychotic Drugs=抗精神病藥物產生多型性心室心搏過速之危險性 |
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作者 | 沈武典; 蘇冠賓; | 書刊名 | 臺灣精神醫學 |
卷期 | 14:3 2000.09[民89.09] |
頁次 | 頁6-22 |
分類號 | 418.21 |
關鍵詞 | QTc延長; 抗精神藥物; 多型性心室心搏過速; Antipsychotic drugs; QTc-interval prolongation; Torsade de pointes; |
語文 | 英文(English) |
中文摘要 | 精神病患因心臟血管疾病導致死亡率的偏高和精神科的用藥有關,這個問題常因 藥物的點併及大量使用而顯得更加危險,藥物造成的 QTc-interval 延長及多型性心室心 博過速(如 torsade de pointes)因此受到精神藥理學上極大的重視。本文的目的在喚起 臨床專業者對於上述情形的警覺,故回顧、分析文獻中可能和 QTc-interval 延長及 torsade de pointes 有關之抗精神病藥物及其化學結構,並發現 phenothiazines(如 thioridazine,chlorpromazine)、butyrophenones(如 haloperidol,droperidol)、 substituted benzamides(如 sulpiride,cisapride,metoclopramine,sutopride)、 diphenyl deivatives(如 pimozide,terfenadine)、和 5-HT2/D2 antagonist(如 sertindole,ziprasidone,risperidone)和此類心臟毒性最為相關。因此本文建議,當臨 床上使用上述藥物時,除了安全劑量的考慮之外,更應小心監測心臟功能。本文也提出未來 研究方向,可同時著重 in vivo 的 crossover-design 及 in vitro 的HERG的研究設計。 |
英文摘要 | Objective: This article is written to alert clinicians to the importance of cardiotoxicity associated with antipsychotic drugs. Methods: Cardiac events in the electrocardiogram (ECG) of QTc-interval prolongation and torsade de pointes are described. The literature on antipsychotic drugs with cardiotoxic risk is reviewed and listed according to the chemical categories: phenothiazines (thioridazine, chlorpromazine and trifluoperazine) , butyrophenones, (haloperidol and droperidol), substituted benzamides (cisapride, metoclopramide, sutopride and sulpiride,) dipheny1derivatives ( pimozide and terfenadine), and 5-HT2/D2 antagonist atypical antipsychotic drugs (risperidone, sertindole and ziprasidone}. Results: We have found that cardiotoxicity induced by antipsychotic drugs has been underreported in the psychiatric literature and that some antipsychotic drugs with cardiotoxic risk are not routinely prescribed by psychiatrists. We also suspect that sudden death associated with the clinical use of rapid neuroleptization in previous decades may have been due to the torsadogenicity induced by haloperidol. The whole category of 5-HT2/D2 antagonist atypical antipsychotic drugs has been found to have a high risk for cardiotoxicity. Discussion: The clinicians should be vigilant to this iatrogenic cardiotoxicity and avoid prescribing clinical doses outside the safe ranges of antipsychotic drugs carrying a high cardiotoxic risk. Cardiac safety for any candidate drug shoudld be carefully screened with investigation of in vitro human ether-a-go-go-related gene (HERG) potassium channel blockage and in vivo crossover design studies. |
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