Psychiatric Medications and Troponin Elevation

Introduction to Risk Factors

• The American Academy of Child and Adolescent Psychiatry suggests that concomitant use of other QT-prolonging medications with psychiatric medications can have additive effects and increase the risk of troponin elevation 1

Monitoring and Prevention

• The American College of Cardiology recommends distinguishing troponin elevation due to psychiatric medications from other causes, as troponin can be elevated in various conditions including tachyarrhythmia, hypertension, cardiac trauma, heart failure, and severe non-cardiac conditions 2
• Baseline ECG and troponin measurement should be considered before initiating treatment with antipsychotics known to have cardiac effects, particularly clozapine, as suggested by guidelines from medical societies 3
• Particular vigilance is needed when prescribing citalopram at doses exceeding 40 mg/day due to risk of QT prolongation and potential cardiac complications that may lead to troponin elevation, according to the Journal of the American Academy of Child and Adolescent Psychiatry 1