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Atypical Antipsychotics Linked to Sudden Cardiac Death

Large-scale study shows that users have an almost identical risk as users of typical agents

WEDNESDAY, Jan. 14 (HealthDay News) -- Current users of atypical antipsychotic drugs have a comparable dose-dependent increased risk of sudden cardiac death as users of typical antipsychotic drugs, according to study findings published in the Jan. 15 issue of the New England Journal of Medicine.

Wayne A. Ray, Ph.D., of the Vanderbilt University School of Medicine in Nashville, and colleagues studied 44,218 and 46,089 baseline users of single typical and atypical drugs, respectively, and 186,600 matched non-users of antipsychotic drugs.

During 1,042,159 person-years of follow-up, the researchers found that the rates of sudden cardiac death among current users of typical and of atypical antipsychotic drugs were higher than non-users (adjusted incidence-rate ratios, 1.99 and 2.26, respectively). They also found that the incidence-rate ratios significantly increased with escalating doses of either class of antipsychotic drugs, from 1.31 for those taking low doses of typical antipsychotic drugs to 2.42 for those taking high doses, and from 1.59 for those taking low doses of atypical antipsychotic drugs to 2.86 for those taking high doses.

"A formal model for decision analysis similar to that used for clozapine would bring clarity about the risks and benefits of such a therapeutic risk-management program, and make it possible to use findings such as those reported in the current study as a springboard to detailed data-driven clinical recommendations," state the authors of an accompanying editorial. "Until then, in patient populations for whom the evidence of the efficacy of antipsychotic medications is limited and the risk of a fatal side effect is clear, prudence would suggest that the use of these drugs should be reduced sharply."

Two authors report receiving research grants from Pfizer and one reports consulting fees from plaintiffs' attorneys in antipsychotic drug-related litigation, and another author reports receiving consulting fees from insurance companies regarding antipsychotic drugs.

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