Drug-induced Sudden Cardiac Death: Reply

Patients with schizophrenia are at higher risk for medical illnesses than people in the general population. The risk of atherosclerosis and cardiac death in these patients is markedly higher and parallels the severity of the disease. Last but not least, one should mention the role of the treating physician in the unwanted occurrence of abnormal QTc prolongation and SCD, mostly resulting from torsade de pointes (TdP). There is no question that the most effective way of preventing complications due to drug-induced QTc prolongation is to avoid the use of these drugs. However, there are many QTcprolonging drugs which have certain therapeutic advantages which the physician usually does not want to miss. In these cases, a systematic approach seems advisable. First of all, the physician prescribing such a drug must be familiar with the problem of drug-induced TdP. Moreover, the physician should also know that the risk for abnormal QTc prolongation and TdP varies between patients; although some patients may have a high propensity to the development of drug-associated TdP, the risk may be low in others. Risk factors for the occurrence of the arrhythmia have been identified (e.g. female gender, bradycardia, and hypokalaemia). Thus, although the role of regulatory authorities in pharmacology is crucial, we should not forget the role of the prescribing physician.