Abstract
AimsTo evaluate changes in QT duration during low-dose haloperidol use, and determine associations between clinical variables and potentially dangerous QT prolongation.MethodsIn a retrospective cohort study in a tertiary university teaching hospital in The Netherlands, all 1788 patients receiving haloperidol between 2005 and 2007 were studied; ninety-seven were suitable for final analysis. Rate-corrected QT duration (QTc) was measured before, during and after haloperidol use. Clinical variables before haloperidol use and at the time of each ECG recording were retrieved from hospital charts. Mixed model analysis was used to estimate changes in QT duration. Risk factors for potentially dangerous QT prolongation were estimated by logistic regression analysis.ResultsPatients with normal before-haloperidol QTc duration (male ≤430 ms, female ≤450 ms) had a significant increase in QTc duration of 23 ms during haloperidol use; twenty-three percent of patients rose to abnormal levels (male ≥450 ms, female ≥470 ms). In contrast, a significant decrease occurred in patients with borderline (male 430–450 ms, female 450–470 ms) or abnormal before-haloperidol QTc duration (15 ms and 46 ms, respectively); twenty-three percent of patients in the borderline group, and only 9% of patients in the abnormal group obtained abnormal levels. Potentially dangerous QTc prolongation was independently associated with surgery before haloperidol use (ORadj 34.9, p = 0.009) and before-haloperidol QTc duration (ORadj 0.94, p = 0.004).ConclusionQTc duration during haloperidol use changes differentially, increasing in patients with normal before-haloperidol QTc duration, but decreasing in patients with prolonged before-haloperidol QTc duration. Shorter before-haloperidol QTc duration and surgery before haloperidol use predict potentially dangerous QTc prolongation.
Highlights
Haloperidol has for many years been a widely prescribed drug for the treatment of agitation, delirium, acute and chronic psychoses
We examined whether there is an association between haloperidol use and QT duration changes in a common population of elderly hospitalized patients with multiple morbidities and co-medications
By analyzing the ECGs of these patients before, during and after haloperidol use, we studied whether QT duration changed during the in-hospital use of haloperidol, taking other clinical factors into account
Summary
Haloperidol has for many years been a widely prescribed drug for the treatment of agitation, delirium, acute and chronic psychoses. Haloperidol is effective in clinical practice, it has been associated with QTc prolongation on the ECG [1,2,3,4,5,6]. QT prolongation by haloperidol is ascribed to its blocking effects on the cardiac potassium channel hERG and was shown in various clinical studies [12,13,14,15]. Haloperidol is mostly prescribed orally at low doses to elderly patients with multiple co-morbidities. Clinicians are often faced with the need to prescribe haloperidol to patients with other potential causes of QT prolongation, including concomitant medication use and cardiac pathology (e.g., heart failure). Studies on QT prolongation during low-dose haloperidol use in such high-risk patients are lacking
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