Sudden cardiac and sudden unexpected death related to antipsychotics: A meta-analysis of observational studies
Open accessAbstract
To estimate the risk of sudden cardiac death (SCD) or sudden unexpected death (SUD) related to individual antipsychotics, a meta-analysis of observational studies was performed. Adjusted odds ratio (OR) of SCD/SUD with 95% confidence intervals (CI) were extracted and pooled; heterogeneity was studied using Q statistic and I(2) index, and its potential causes (e.g., hERG blockade potency) explored using meta-regression. Two cohort (740,306 person-years) and four case-control (2,557 cases; 17,670 controls) studies, investigating nine antipsychotics, were included. Compared with nonusers, the risk was increased for quetiapine (OR = 1.72, 95% CI: 1.33-2.23), olanzapine (OR = 2.04, 1.52-2.74), risperidone (OR = 3.04, 2.39-3.86), haloperidol (OR = 2.97, 1.59-5.54), clozapine (OR = 3.67, 1.94-6.94), and thioridazine (OR = 4.58, 2.09-10.05). Heterogeneity was found (Q = 20.0, P = 0.01; I(2) = 60.0%), and the increasing mean hERG blockade potency (P = 0.01) accounted for 43% of this. The SCD/SUD risk differed between individual antipsychotics, and mean hERG blockade potency could be an explanatory factor. This should be considered when initiating antipsychotic treatment.
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References 45 · Cited by 83
- Authors
- Salvo, F., Pariente, A., Shakir, S., Robinson, P., Arnaud, M., Thomas, S., Raschi, E., Fourrier‐Réglat, A., Moore, N., Sturkenboom, M., Hazell on behalf of Investigators of the ARITMO Consortium, L., & on behalf of Investigators of the ARITMO Consortium
- Affiliations
- Université de Bordeaux (FR)
- Drug Safety Research Unit (GB)
- ADERA (FR)
- Newcastle University (GB)
- University of Bologna (IT)
- Erasmus MC (NL)
- Drug Safety Research Unit Southampton Hampshire UK
- Corresponding author
- Salvo, F
- Venue
- Clinical Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2015-11-20
- Volume
- 99
- Issue
- 3
- Pages
- 306-314
- ISSN
- 0009-9236 (ISSN-L)
- 1532-6535
- OpenAlex
- W1625365640
- Cited by
- 83
- References
- 45
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 10 · 2018: 4 · 2017: 6 · 2016: 12 · 2015: 2
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Clinical Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
- ePrints Soton (University of Southampton) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- European Community's Seventh Framework Program (241679)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- antipsychotic drugs, sudden cardiac death, sudden unexpected death, quetiapine, olanzapine, risperidone, haloperidol, clozapine, thioridazine, drug safety, adverse drug reactions
- MeSH terms
- ERG1 Potassium Channel, Humans, Antipsychotic Agents, Death, Sudden, Cardiac, Inhibitory Concentration 50, Ether-A-Go-Go Potassium Channels, Observational Studies as Topic
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