QT Interval Prolongation Risk with Abilify and Adderall
Abilify (aripiprazole) does not prolong the QT interval, while Adderall (amphetamine and dextroamphetamine) has no significant documented QT prolongation risk.
Aripiprazole (Abilify) and QT Interval
Aripiprazole is one of the safest antipsychotics regarding QT interval prolongation:
- According to the American Heart Association and American College of Cardiology Foundation guidelines, aripiprazole shows 0 ms mean QT prolongation 1
- The FDA label for aripiprazole mentions that QT prolongation can occur in overdose situations, but not at therapeutic doses 2
- Recent research from 2023 confirms that aripiprazole appears to have minimal risk for QT prolongation compared to other antipsychotics 3
This makes aripiprazole a preferred option among antipsychotics for patients with risk factors for QT prolongation or those taking other medications that may affect cardiac repolarization.
Adderall (Amphetamine/Dextroamphetamine) and QT Interval
Adderall is not listed among medications with QT prolongation risk in any of the major guidelines:
- The comprehensive list of QT-prolonging medications maintained by the Arizona Center for Education & Research on Therapeutics (www.qtdrugs.org, now crediblemeds.org) does not include Adderall or amphetamine/dextroamphetamine combinations 1
- None of the guidelines classify stimulants like Adderall as medications with QT prolongation risk 1, 4
Comparative QT Risk Among Antipsychotics
For context, here's how aripiprazole compares to other antipsychotics regarding QT prolongation:
| Antipsychotic | Mean QT Prolongation (ms) |
|---|---|
| Thioridazine | 25-30 |
| Ziprasidone | 5-22 |
| Pimozide | 13 |
| Clozapine | 8-10 |
| Haloperidol | 7 |
| Quetiapine | 6 |
| Risperidone | 0-5 |
| Olanzapine | 2 |
| Aripiprazole | 0 |
This table clearly shows aripiprazole's favorable cardiac safety profile 1.
Risk Factors for QT Prolongation
When considering medication choices for patients with pre-existing risk factors, it's important to note that QT prolongation risk increases with:
- Female sex
- Age >65 years
- Electrolyte abnormalities (especially hypokalemia, hypomagnesemia)
- Concurrent use of other QT-prolonging medications
- Bradycardia
- Heart failure
- Recent conversion from atrial fibrillation
- Hepatic dysfunction 4
Clinical Implications
- For patients requiring antipsychotic treatment: Aripiprazole is one of the safest options regarding QT prolongation risk
- For patients requiring stimulant treatment: Adderall does not carry significant QT prolongation concerns
- For patients requiring both treatments: The combination does not present additive QT prolongation risk based on available evidence
Monitoring Recommendations
Despite the low risk, for patients with multiple risk factors for QT prolongation:
- Consider baseline ECG before starting any psychotropic medication
- Monitor electrolytes (especially potassium and magnesium)
- Be particularly cautious when adding other medications known to prolong QT interval
- Consider follow-up ECG if symptoms such as syncope, palpitations, or dizziness develop
Conclusion
When choosing between these medications or considering their combination, QT prolongation risk should not be a major concern with either aripiprazole or Adderall at therapeutic doses, making them relatively safe options from a cardiac perspective.