QTc Prolongation during Concurrent Treatment with Depot Antipsychotics and High-dose Amisulpride: A Report of 2 Cases

高劑量amisulpride與長效抗精神病針劑所造成之心電圖QTc間隔延長：二例報告及文獻回顧

林穎(Ying Lin) ； 孫藝文(I-Wen Sun) ； 劉珣瑛(Shen-Ing Liu) ； 陳俊延(Chun-Yen Chen) ； 徐堅棋(Chien-Chi Hsu)

《內科學誌》 20卷6期 (2009/12) Pp. 544-549

https://doi.org/10.6314/JIMT.2009.20(6).09

摘要

心電圖QTc間隔的延長，爲抗精神病藥之重要副作用之一。Amisulpride爲一被認爲對心電圖相對安全之抗精神病藥物，造成心臟問題之報告較少。吾人在此報告二例無心臟病史之患者，因注射皮下長效抗精神病藥物與amisulpride高劑量使用而發生QTc的延長。病患一爲37歲女性，之前無心律不整病史。之前使用長效flupenthixol decanoate也未有心臟方面影響。其在同時使用每週長效之flupenthixol 注射及每日口服amisulpride 1400mg後，發生了QTc的延長。此一心電圖之變化在病患將口服藥物更換後恢復正常。病患二是38歲女性，在同時使用haloperidol decanoate 50mg長效針劑注射一次與每日amisulpride 1400mg使用七天之後發生了致命性心律不整。經過急救之後的心電圖發現有QTc的延長，此情形在停用amisulpride三天後得到緩解。兩例都僅在兩藥同時使用時產生此一副作用，可能與對human Ether-a-go-go Related Gene (hERG)鉀離子通道之加成作用有關。

並列摘要

Antipsychotic drugs may cause prolongation of the heart rate-corrected QT interval (QTc). Amisulpride, a relatively new atypical antipsychotic drug, has been considered to have few cardiac adverse effects, except in cases of overdose. We report 2 schizophrenic patients with no history of cardiac disease who developed significant QTc prolongation after concurrent use of intramuscular depot injections of typical antipsychotics and high-dose amisulpride. A 37 year-old woman, had no known history of arrhythmia. Previous exposure to flupenthixol decanoate had not resulted in cardiotoxicity. She was treated with weekly depot injections of flupenthixol and with amisulpride 1400mg/day, after which QTc prolongation was noted. The electrolytes were normal. The ECG normalized when we switched from amisulpride to another antipsychotic medication. Another patient was a 38 year-old woman who had a cardiac arrest after 7 days of concurrent use of haloperidol decanoate 50 mg and amisulpride 1400mg/day. She was resuscitated but was seen to have QTc prolongation on subsequent ECGs. This abnormality resolved within 3 days after amisulpride was discontinued. In both cases, it was only the simultaneous administration of 2 drugs that was associated with the adverse effect. It is possible that the combination had an additive effect on the human Ether-a-go-go Related Gene (hERG) potassium channel.

並列關鍵字

Amisulpride ； Depot antipsychotics ； QTc prolongation ； Cardiotoxicity