Mirtazapine's effect on the QT interval in medically hospitalized patients.
Mirtazapine's effect on the QT interval in medically hospitalized patients.
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DOI：
10.9740/mhc.2020.01.030
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发表时间：
2020-01-01
期刊：
影响因子：
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通讯作者：
Palmer, Brian A
中科院分区：
文献类型：
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作者：
Allen, Nicholas D;Leung, Jonathan G;Palmer, Brian A
简介：米氮平在伴有或不伴有针对睡眠、食欲、恶心和疼痛的正式精神病合并症的医学疾病患者中通常耐受良好。然而，很少有关于米氮平的潜力，以延长校正的QT间期（QTc）在此population.METHODS：从一个回顾性队列的患者住院的各种医疗单位，精神科咨询建议米氮平，心电图（ECG）数据提取ECG获得了3天前和6天后的初步咨询。使用描述性统计量描述QTc变化和不良心脏结局，包括偶发室性心动过速、尖端扭转型室性心动过速和心源性猝死。多元线性回归模型完成，以评估潜在的混杂变量对QTc changes.Results的效果：完整的premirtazapine和postmirtazapine心电图数据61例，QTc的平均变化为-0.31毫秒（SD=36.62毫秒）。QTc变化不受患者年龄和性别、初始和最大米氮平剂量、ECG间隔天数、伴随QTc延长药物的数量、Charlson合并症评分和电解质异常的显著影响。由于不完整的钾，镁和离子钙的数据，电解质被排除在最终的回归model.DISCUSSION：尽管这种回顾性研究的局限性，这些数据表明，适度剂量的米氮平可能不会显着影响QTc在内科疾病患者。回顾性队列分析更可行，但前瞻性对照试验可以更系统地评估医疗环境中较高剂量米氮平的QTc变化。
INTRODUCTION: Mirtazapine is generally well tolerated in medically ill patients with and without formal psychiatric comorbidity to target sleep, appetite, nausea, and pain. However, there is little data regarding mirtazapine's potential to prolong the corrected QT interval (QTc) in this population.METHODS: From a retrospective cohort of patients hospitalized on a variety of medical units for whom a psychiatric consult recommended mirtazapine, electrocardiogram (ECG) data were extracted for ECGs obtained up to 3 days before and 6 days after the initial consult. Descriptive statistics were used to characterize the QTc changes and adverse cardiac outcomes, including incident ventricular tachycardia, torsades de pointes, and sudden cardiac death. Multiple linear regression models were completed to assess the effect of potential confounding variables on QTc changes.RESULTS: Complete premirtazapine and postmirtazapine ECG data were available for 61 patients, and the average change in QTc was -0.31 ms (SD=36.62 ms). No incidental adverse cardiac outcomes were found. QTc changes were not significantly affected by patient age and sex, initial and maximum mirtazapine dose, days between ECGs, number of concomitant QTc prolonging medications, Charlson comorbidity scores, and electrolyte abnormalities. Due to incomplete potassium, magnesium, and ionized calcium data, electrolytes were excluded from the final regression model.DISCUSSION: Despite the limitations of this retrospective study, these data suggest that modest doses of mirtazapine may not significantly affect the QTc in medically ill patients. Retrospective cohorts are more feasibly analyzed, but prospective controlled trials could more systematically assess QTc changes with higher doses of mirtazapine in medical settings.