Copyright Notice This presentation is copyrighted by the Psychopharmacology Institute. Subscribers can download it and use it for professional use. The contents of the presentation may be modified, but the Psychopharmacology Institute logo must remain visible in all slides.

Cardiac Adverse Effects of Mood Stabilizers and Other Medications Scott R. Beach, M.D. Attending Psychiatrist, Massachusetts General Hospital Assistant Professor of Psychiatry, Harvard Medical School

Lithium Sick sinus syndrome AV block Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

Carbamazepine In overdose Slow AV conduction Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

No significant cardiac effects Valproate Lamotrigine No significant cardiac effects Oxcarbazepine Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

Benzodiazepines Catecholamine levels Coronary vascular resistance Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

Clonidine Alpha-2 agonist Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

Trazodone Orthostatic hypotension Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

QT prolongation with medications is the most common cause of postmarketing withdrawal or restriction of drugs.  Some noncardiovascular drugs have been withdrawn for causing only 5 ms to 10 ms increases in the QT interval.   Beach, S. R., Celano, C. M., Noseworthy, P. A., Januzzi, J. L., & Huffman, J. C. (2013). QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics, 54(1), 1-13.

Key Points Among mood stabilizers, lithium is the one that is generally associated with cardiac effects; those include sick sinus syndrome and AV block, which are rare effects. Benzodiazepines generally have minimal cardiovascular effects and may actually be somewhat cardioprotective.

Next Presentation Risk of QT Prolongation with Mood Stabilizers and Other Medications