Prevalence and Risk of QT-Prolonging Antipsychotic Drug Combinations in Hospitalized Psychiatric Patients in Sana’a, Yemen

Prolongation of the QT interval is associated with serious and potentially life-threatening cardiac complications, requiring careful clinical attention. Psychiatric patients frequently receive multiple antipsychotic medications, some of which increase the risk of QT prolongation and torsades de pointes (TdP). This study aimed to assess the prevalence of QT-prolonging antipsychotic drug combinations and the associated drug–drug interaction (DDI) risk among hospitalized psychiatric patients. A retrospective cross-sectional study was conducted using medical records of inpatients admitted to two psychiatric hospitals in Sana’a, Yemen, between November 2023 and June 2024. A total of 191 male patients aged 17–65 years who received antipsychotic drug combinations for at least one week were included. Electrocardiogram (ECG) monitoring at admission was available for 47 patients. Prescribed medications were screened for QT-prolonging potential and interaction severity using the Arizona Center for Education and Research on Therapeutics (AZCERT) database. Overall, 395 QT-prolonging antipsychotic prescriptions were identified. Among patients receiving antipsychotic combinations, 36% were prescribed at least one strong-to-moderate QT-prolonging combination. Of the 47 patients who underwent ECG monitoring, 39.3% received drugs classified by AZCERT as having a known risk of TdP. Borderline QTc intervals were observed in 10.6% of patients, while 6.4% exhibited prolonged QTc intervals. The concurrent use of multiple QT-prolonging antipsychotic drugs substantially increases the risk of QT prolongation and TdP. Enhanced clinical vigilance, routine ECG monitoring, and careful selection of antipsychotic combinations are strongly recommended, particularly for patients with additional risk factors.