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Effects of Newer Atypical Antipsychotics on Autonomic Neurocardiac Function: A Comparison Between Amisulpride, Olanzapine, Sertindole, and Clozapine

Agelink, Marcus W. MD*; Majewski, T. MD; Wurthmann, C. MD, PhD; Lukas, K. MD*; Ullrich, H. MD*; Linka, T. MD*; Klieser, E. MD, PhD*

Journal of Clinical Psychopharmacology: February 2001 - Volume 21 - Issue 1 - p 8-13

As part of a prospective clinical study investigating the effects of atypical neuroleptics on autonomic neurocardiac function (ANF), serial standardized recordings of conventional electrocardiograms and computer-calculated measurements of 5-minute resting heart rate variability (HRV) were obtained from 51 medication-free inpatients with schizophrenia (DSM-III-R-diagnosed) before and after an average of 14.1 days of treatment with amisulpride 400 mg/day (N = 12), olanzapine 20 mg/day (N = 13), sertindole 12 mg/day (N = 13), or clozapine 100 mg/day (N = 13). Reference values for the HRV data were obtained from a large group of well-matched healthy controls (N = 70). The most important findings were the following: (1) clozapine, olanzapine, and sertindole all prolonged mean frequency-corrected QTc times, which, in the case of sertindole, proved to be significant (Wilcoxon test p <0.05); (2) sertindole and clozapine significantly increased the mean resting heart rate; and (3) only clozapine significantly reduced the parasympathetic resting tone. The results of the HRV studies are discussed considering the in vitro receptor profiles of the atypical neuroleptics under study. Potential implications for the cardiac safety and tolerance of these drugs are also discussed.

Departments of *Psychiatry and †Internal Medicine, Evangelical Hospital Gelsenkirchen, Ruhr-University of Bochum, Gelsenkirchen; ‡Department of Psychiatry, Philippus-Stift, University of Essen, Essen, Germany

Received July 13, 1999; accepted after revision December 27, 1999.

Address requests for reprints to: Marcus W. Agelink, MD, Evangelisches Krankenhaus Gelsenkirchen, Klinik für Psychiatrie der Ruhr-Universität Bochum, Munckelstr. 27, 45879 Gelsenkirchen, Germany.

© 2001 Lippincott Williams & Wilkins, Inc.