quetiapine-fumarate and Heart-Failure

Atypical antipsychotics are used in cardiac intensive care units (CICU) to treat delirium despite limited data on safety in patients with acute cardiovascular conditions. Patients treated with these agents may be at higher risk for adverse events such as QTc prolongation and arrhythmias. We performed a retrospective cohort study of 144 adult patients who were not receiving antipsychotics before admission and received olanzapine (n = 50) or quetiapine (n = 94) in the Michigan Medicine CICU. Data on baseline characteristics, antipsychotic dose and duration, length of stay, and adverse events were collected. Adverse events included ventricular tachycardia (sustained ventricular tachycardia attributed to the medication), hypotension (systolic blood pressure <90 mm Hg attributed to the medication), and QTc prolongation (QTc increase by ≥60 ms or to an interval ≥500 ms). Twenty-six patients (18%) experienced an adverse event. Of those adverse events, 20 patients (14%) experienced QTc prolongation, 3 patients (2%) had ventricular tachycardia, and 3 patients (2%) had hypotension. Patients who received quetiapine had a higher rate of adverse events (25% vs 6%, p = 0.01) including QTc prolongation (18% vs 6%, p = 0.046). Intensive care unit length of stay was shorter in patients who received olanzapine (6.5 vs 9.5 days, p = 0.047). Eighteen patients (13%) had their antipsychotic continued at discharge from the hospital. In conclusion, QTc prolongation was more common in patients treated with quetiapine versus olanzapine although the number of events was relatively low with both agents in a CICU cohort.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Arrhythmias, Cardiac; Coronary Care Units; Delirium; Endocarditis; Female; Heart Arrest; Heart Failure; Humans; Hypotension; Length of Stay; Long QT Syndrome; Male; Middle Aged; Olanzapine; Quetiapine Fumarate; Respiratory Insufficiency; Retrospective Studies; Shock, Cardiogenic; ST Elevation Myocardial Infarction; Tachycardia, Ventricular

We report the case of an 18-year-old woman with personality disorders who was hospitalized a few hours after suicidal ingestion of acetaminophen, quetiapine, acetylsalicylic acid, and ethanol. Twelve hours after admission, severe liver damage was evident, but the patient was stable and awaiting hepatic transplantation. Electrolytes were successfully controlled. The condition of the liver stabilized. Cardiac biomarkers then deteriorated unexpectedly. Localized ST-segment elevations were noted on electrocardiogram, but angiography ruled out myocardial infarction. A computed tomographic scan ruled out cerebral edema. The patient died of irreversible cardiac arrest 40 hours after admission. Heart failure remained unexplained, and the body underwent forensic autopsy.At autopsy, histologic findings were indicative of acute toxic myocarditis and were concluded to be caused by acetaminophen intoxication. Acetaminophen overdose is common and typically leads to liver failure requiring supportive treatment and emergency liver transplantation. Toxic myocarditis is an extremely rare complication of acetaminophen overdose. It has only been reported 4 times in the literature despite the widespread use and misuse of acetaminophen. Toxic myocarditis remains a possibility in many cases of overdose but can be overlooked in a clinical picture dominated by hepatorenal failure and encephalopathy. Clinicians and forensic pathologists should be aware of this rare potential complication.

Topics: Acetaminophen; Adolescent; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Antipsychotic Agents; Aspirin; Borderline Personality Disorder; Central Nervous System Depressants; Drug Overdose; Ethanol; Female; Gas Chromatography-Mass Spectrometry; Heart Failure; Humans; Myocarditis; Quetiapine Fumarate; Suicide

Topics: Anti-Bacterial Agents; Bipolar Disorder; Diuretics; Female; Heart Failure; Humans; Inappropriate Prescribing; Pneumonia; Quetiapine Fumarate; Torsades de Pointes

Topics: Anti-Bacterial Agents; Bipolar Disorder; Diuretics; Female; Heart Failure; Humans; Inappropriate Prescribing; Pneumonia; Quetiapine Fumarate; Torsades de Pointes

Topics: Anti-Bacterial Agents; Antipsychotic Agents; Bipolar Disorder; Diuretics; Electrocardiography; Female; Heart Failure; Humans; Hypokalemia; Inappropriate Prescribing; Middle Aged; Pneumonia; Quetiapine Fumarate; Torsades de Pointes; Treatment Outcome

The case of a 44-year-old female patient is reported, who ingested trimipramine and quetiapine in a suicide attempt. Initially sinus tachycardia and hypotension were seen, which resulted in a hypotensive cardio-circulatory failure despite fluid therapy and administration of catecholamines. Because of the life-threatening situation and the fact that the ingestion was 2 h prior to admission, a rapid transport to the next hospital was preferred to treatment with active charcoal. Intoxication with tricyclic antidepressants are very common in Europe and have a mortality of up to 15% in severe cases. The specific therapy consists of airway management, hemodynamic stabilization and primary elimination of the poison. Secondary detoxication is less important. The administration of the antidote physostigmine is controversial but carbo medicinalis should be given orally or via a gastric tube.

Topics: Adult; Antidepressive Agents; Antidotes; Antipsychotic Agents; Charcoal; Dibenzothiazepines; Electrocardiography; Female; Heart Failure; Humans; Hypotension; Quetiapine Fumarate; Shock; Suicide, Attempted; Trimipramine