From the Guidelines
Aripiprazole is the antipsychotic medication that does not prolong the QT(c) interval, with a mean QT prolongation of 0 ms, making it a safer option for patients at risk for QT prolongation or those with pre-existing cardiac conditions. According to the study published in Pediatrics 1, the mean QT prolongation for various antipsychotics is as follows:
- Aripiprazole: 0 ms
- Olanzapine: 2 ms
- Risperidone: 0-5 ms
- Quetiapine: 6 ms
- Haloperidol: 7 ms
- Clozapine: 8-10 ms
- Pimozide: 13 ms
- Ziprasidone: 5-22 ms
- Thioridazine: 25-30 ms
Key factors to consider when prescribing antipsychotics include:
- Cardiac safety profile
- Risk of QT prolongation
- Concomitant use of other QT-prolonging medications
- Electrolyte abnormalities (especially hypokalemia and hypomagnesemia)
- Certain medical conditions
It is essential to monitor cardiac function in all patients on antipsychotics, regardless of their QTc profile, as individual responses can vary 1. Aripiprazole's favorable cardiac safety profile makes it a preferred option for patients at risk for QT prolongation or those with pre-existing cardiac conditions.
From the FDA Drug Label
Cardiac Electrophysiology At a dose 3 times the MRHD for the treatment of schizophrenia and 4 times the MRHD for adjunctive therapy to antidepressants for the treatment of MDD, brexpiprazole does not prolong the QTc interval to any clinically relevant extent.
Brexpiprazole is an antipsychotic that does not prolong the QT(c) interval.
- The drug label states that brexpiprazole does not prolong the QTc interval to any clinically relevant extent, even at doses 3-4 times the maximum recommended human dose (MRHD) 2.
From the Research
Antipsychotic Medications that Do Not Prolong QT(c) Interval
- Aripiprazole: Low quality evidence suggests that aripiprazole does not increase QT interval 3, and a meta-analysis revealed that the mean ΔQTc interval was decreased with aripiprazole 4.
- Brexpiprazole: Low quality evidence suggests that brexpiprazole does not increase QT interval 3, and it is associated with a low risk of QT prolongation 5, 6.
- Olanzapine: Low quality evidence suggests that olanzapine does not increase QT interval 3, and it is considered a low-risk medication for QTc prolongation 6.
- Lurasidone: It is associated with the lowest risk of QT prolongation reporting 5, and it is considered a low-risk medication for QTc prolongation 6.
- Cariprazine: It is considered a low-risk medication for QTc prolongation 6.
- Clozapine: It is considered a low-risk medication for QTc prolongation 6.
Antipsychotic Medications that Prolong QT(c) Interval
- Ziprasidone: Low quality evidence suggests that ziprasidone increases QT interval and the rates of QT prolongation 3, and it is significantly more likely to prolong the QTc interval 5, 6.
- Risperidone: Low quality evidence suggests that risperidone is associated with QT prolongation and greater odds of torsades de pointes ventricular tachycardia 3.
- Quetiapine: Low quality evidence suggests that quetiapine is associated with QT prolongation and greater odds of torsades de pointes ventricular tachycardia 3.
- Sertindole: It is associated with the highest risk of QT prolongation reporting 5.
- Amisulpride: It is associated with a high risk of QT prolongation reporting 5.
- Iloperidone: It is significantly more likely to prolong the QTc interval 6.