Excellent, this post has done wonders for me as a pharmacist who kind of refuses to freak out over stacking just a few QTc prolongers but was secretly worried he was stupid for seemingly being the only one.
I agree with this, but one part of the story that may be missing, which I hope an investigative journalist will write someday, is to what extent the QTC concerns were raised in bad faith by other drug companies in an attempt to de-value Geodon, which was viewed as a huge threat to the other atypical antipsychotics on the market due to its lack of metabolic side effects.
I can totally buy that other drug companies may have played up QTc concerns with Geodon specifically, but I'm a little skeptical that those sorts of corporate politics underlie the worries about QTc generally. The Beach 2020 paper has recommendations regarding IV haloperidol and QTc from the early 90s, well before ziprasidone's US approval in 2001.
A 1/33,000 risk of death is definitely worth paying attention to. At the ~$10M statistical value of life in the US, it's like the patient paying an extra $300 out of pocket.
Doesn't work out quite that easily I'm afraid. Mortality for those arrhythmias are only only 10%, so really it's 1/330,000 risk of death. You'd also need to compare this against the counterfactual, which is the detriment to the individual of not taking the medication.
Excellent, this post has done wonders for me as a pharmacist who kind of refuses to freak out over stacking just a few QTc prolongers but was secretly worried he was stupid for seemingly being the only one.
Next level, this is what becoming a physician is about, getting to this level of understanding
Thank you
Great post! When I was a psychiatry resident, I tried to push back against some of the QTc stuff in this letter to the editor
Routine Corrected QT Interval Monitoring With Antipsychotic Use in Consultation-Liaison Setting: Playing the Devil’s Advocate
https://www.sciencedirect.com/science/article/pii/S0033318216301359
I agree with this, but one part of the story that may be missing, which I hope an investigative journalist will write someday, is to what extent the QTC concerns were raised in bad faith by other drug companies in an attempt to de-value Geodon, which was viewed as a huge threat to the other atypical antipsychotics on the market due to its lack of metabolic side effects.
I can totally buy that other drug companies may have played up QTc concerns with Geodon specifically, but I'm a little skeptical that those sorts of corporate politics underlie the worries about QTc generally. The Beach 2020 paper has recommendations regarding IV haloperidol and QTc from the early 90s, well before ziprasidone's US approval in 2001.
A 1/33,000 risk of death is definitely worth paying attention to. At the ~$10M statistical value of life in the US, it's like the patient paying an extra $300 out of pocket.
Doesn't work out quite that easily I'm afraid. Mortality for those arrhythmias are only only 10%, so really it's 1/330,000 risk of death. You'd also need to compare this against the counterfactual, which is the detriment to the individual of not taking the medication.