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Use of Atypical Antipsychotic Drugs Increases Risk of Sudden Cardiac Death NEW YORK -- January 15, 2009 -- Patients aged 30 to 74 years who took atypical antipsychotics such as risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), and clozapine (Clozaril) had a significantly higher risk of sudden death from cardiac arrhythmias and other cardiac causes than patients who did not take these medications, according to a study published in the January 15 issue of the New England Journal of Medicine. "This study provides critical information about the safety of atypical antipsychotics that can be used to make important treatment decisions for patients," said Carolyn M. Clancy, MD, Agency for Healthcare Research & Quality, Rockville, Maryland. "These findings will help clinicians and patients weigh the risks versus the benefits of these drugs before prescribing them for treatment of depression or other off-label uses for other conditions." Lead researcher Wayne A. Ray, PhD, Department of Preventive Medicine, Vanderbilt University, and Nashville Veterans Affairs Medical Center, Nashville, Tennessee, and colleagues found that current users of atypical antipsychotic drugs had a rate of sudden cardiac death twice that of people who didn't use the drugs and similar to the death rate for patients taking typical antipsychotics, including haloperidol (Haldol) and thioridazine (Mellaril). For the study, researchers reviewed medical records from the Tennessee Medicaid program and identified data on patients prescribed atypical antipsychotics, including the number of prescriptions they received, the dose, and the number of days supplied. They calculated the incidence of sudden cardiac death among 44,218 users of typical antipsychotics, 46,089 users of atypical antipsychotics, and a control group of 186,600 matched nonusers. Results showed that current users of typical and of atypical antipsychotic drugs had higher rates of sudden cardiac death than did nonusers of antipsychotic drugs, with adjusted incidence-rate ratios of 1.99 (95% confidence interval [CI], 1.68-2.34) and 2.26 (95% CI, 1.88-2.72). The incidence-rate ratio for users of atypical antipsychotic drugs as compared with users of typical antipsychotic drugs was 1.14 (95% CI, 0.93-1.39). Former users of antipsychotic drugs had no significantly increased risk (incidence-rate ratio, 1.13; 95% CI, 0.98-1.30). For both classes of drugs, the risk for current users increased significantly with an increasing dose. Among users of typical antipsychotic drugs, the incidence-rate ratios increased from 1.31 (95% CI, 0.97-1.77) for those taking low doses to 2.42 (95% CI, 1.91-3.06) for those taking high doses (P < .001). Among users of atypical agents, the incidence-rate ratios increased from 1.59 (95% CI, 1.03-2.46) for those taking low doses to 2.86 (95% CI, 2.25-3.65) for those taking high doses (P = .01). The findings were similar in the cohort that was matched for propensity score. The researchers concluded that atypical antipsychotics are not a safer alternative to typical antipsychotics in preventing death from sudden cardiac causes. SOURCE: Agency for Healthcare Research & Quality and the New England Journal of Medicine E-mail this page to a friend or colleague! To print, use this version