The relevance of prolonged QTc measurement to pediatric psychopharmacology

Objective: To consider the relevance of prolonged QTc (QT interval corrected for rate) to pediatric psychopharmacology. Method: The authors reviewed publications on QTc prolongation and publications on sudden death in Medline from 1968 to November 2002. Results: The search yielded more than 20,000 publications. Review manuscripts with clinical recommendations outnumber the few pediatric studies of QTc duration during treatment. Most reviews have been published in the past 5 years, during a time when the Food and Drug Administration restricted five psychotropic medications because of QTc prolongation (sertindole: not approved; thioridazine, mesoridazine, and droperidol: black-box warning; and ziprasidone: bolded warning) and nine somatic medications because of QTc prolongation. Conclusion: Pretreatment screening, careful selection of psychotropic and/or somatic medication combinations, and recognition of QTc prolongation in electrocardiographic tracings during treatment with medications that prolong QTc are important components of clinical practice.