At least 170 approved drugs are linked to QT prolongation, which can lead to serious adverse drug reactions (ADRs), such as Torsade de Pointes (TdP). The aim of this study was to analyze the prevalence and type of pharmacodynamic drug–drug interactions (DDIs) between QT-prolonging drugs in psychiatry. The present retrospective analysis used data from a large pharmacovigilance study, conducted in 10 psychiatric hospitals in Germany. Patients medication lists were screened for QT-prolonging drugs, classified according to the Arizona Center for Education and Research on Therapeutics (AZCERT). In total, 27,396 patient cases (46% female) with a mean (± standard deviation) age of 47 ± 18 years were included in the study. Altogether, 83% of the cases received at least one and up to eight QT-prolonging drugs at the same time. Combination of drugs with a known or possible risk for TdP (according to the AZCERT) was detected in 13,670 cases (50%). Most frequently prescribed psychotropic high-risk drugs (n = 48,995) were the antipsychotics pipamperone (n = 6202), quetiapine (n = 5718), prothipendyl (n = 4298), and risperidone (n = 4265). The replacement of high-risk drugs such as tricyclic antidepressants, levomepromazine, melperone, and promethazine with more tolerable drugs could avoid 11% of QT-prolonging drugs and increase the tolerability of psychopharmacological treatment. More than 80% of psychiatric patients receive at least one QT-prolonging drug during their hospital stay, and almost 50% of these drugs are combined in clinical practice. For the prevention of cardiac ADRs, the physician should evaluate the risk for QT prolongation for each drug and patient-specific risk factors before prescribing these drugs or drug combinations.

至少有 170 种批准的药物与 QT 延长有关，这可能导致严重的药物不良反应 (ADR)，例如尖端扭转型室性心动过速 (TdP)。本研究的目的是分析精神病学中延长 QT 间期的药物之间药效学药物相互作用 (DDI) 的流行率和类型。本回顾性分析使用了在德国 10 家精神病医院进行的大型药物警戒研究的数据。根据亚利桑那州治疗教育和研究中心 (AZCERT) 对患者的药物清单进行了 QT 延长药物的筛选。该研究总共包括 27,396 例患者（46% 为女性），平均（± 标准差）年龄为 47 ± 18 岁。总共有 83% 的病例同时接受了至少一种和最多八种延长 QT 的药物。在 13,670 例 (50%) 中检测到已知或可能存在 TdP 风险的药物组合（根据 AZCERT）。最常用的精神科高危药物（n  = 48,995) 是抗精神病药哌哌酮 ( n  = 6202)、喹硫平 ( n  = 5718)、原噻菌胺 ( n  = 4298) 和利培酮 ( n = 4265）。将三环类抗抑郁药、左美丙嗪、美哌酮、异丙嗪等高危药物更换为耐受性更好的药物，可避免11%的延长QT间期的药物，提高精神药物治疗的耐受性。超过 80% 的精神病患者在住院期间至少接受一种延长 QT 的药物，其中近 50% 的药物在临床实践中联合使用。为了预防心脏 ADR，医生应在开出这些药物或药物组合之前评估每种药物的 QT 间期延长风险和患者特定的风险因素。