Antipsıkotık İlaçların Kardiyovasküler Sistem Üzerine Etkisi
Özet
Psikotik bozukluğu olan bireylerin yaşam süresi, sağlıklı popülasyona kıyasla 10 ila 25 yıl daha kısadır ve bu hastalardaki en yaygın ölüm nedeni kardiyovasküler hastalıklardır. Tedavide ilk tercih olan antipsikotik ilaçlar semptomların şiddetini azaltsa da; hormon dengesizliklerine, metabolik sendroma, obeziteye, diyabete ve ciddi kardiyovasküler sorunlara yol açabilmektedir. Özellikle kalpte iletim anormalliklerine neden olarak QTc intervalini uzatmaları, ani ölüme sebebiyet veren Torsades de Pointes gibi ölümcül ritim bozuklukları ile yakından ilişkilidir. QTc uzaması riski; yüksek doz kullanımı, intramüsküler uygulama, kadın cinsiyeti ve özellikle çoklu antipsikotik kullanımı (polifarmasi) ile belirgin şekilde artmaktadır. Birinci kuşak antipsikotiklerden tioridazin ve ikinci kuşaklardan ziprasidon QTc intervalini en fazla uzatan ilaçlar arasındayken; olanzapin, risperidon ve aripiprazol gibi ilaçlar bu açıdan daha güvenli kabul edilmektedir. Ayrıca antipsikotiklerin beta-blokörlerle eş zamanlı kullanımı da ilaç etkileşimleri nedeniyle aritmi riskini ve toksisiteyi artırır. Bu nedenle mortalite ve morbiditeyi azaltmak adına tedavi öncesinde soygeçmiş sorgulanmalı, bazal EKG çekilmeli, elektrolit, HBA1C, lipid ve kilo takibi yapılmalı, hastalar fiziksel aktiviteye teşvik edilmelidir.
The life expectancy of individuals with psychotic disorders is 10 to 25 years shorter than that of the healthy population, with cardiovascular diseases being the most common cause of death among these patients. Although antipsychotic medications, the primary choice in treatment, reduce the severity of symptoms, they can lead to hormonal imbalances, metabolic syndrome, obesity, diabetes, and serious cardiovascular problems. In particular, their potential to cause conduction abnormalities in the heart and prolong the QTc interval is closely associated with fatal rhythm disorders like Torsades de Pointes, which can cause sudden death. The risk of QTc prolongation significantly increases with high-dose use, intramuscular administration, female gender, and especially the concurrent use of multiple antipsychotics (polypharmacy). While thioridazine among first-generation antipsychotics and ziprasidone among second-generation antipsychotics are among the medications that prolong the QTc interval the most, drugs such as olanzapine, risperidone, and aripiprazole are considered safer in this regard. Additionally, the simultaneous use of antipsychotics with beta-blockers increases the risk of arrhythmia and toxicity due to drug interactions. Therefore, to reduce mortality and morbidity, family history must be questioned before treatment, baseline ECGs must be evaluated, and electrolytes, HBA1C, lipids, and weight must be monitored while encouraging patients to engage in physical activity.
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