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

Prevalence and Risk of QT-Prolonging Antipsychotic Drug Combinations in Hospitalized Psychiatric Patients in Sana’a, Yemen | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence and Risk of QT-Prolonging Antipsychotic Drug Combinations in Hospitalized Psychiatric Patients in Sana’a, Yemen Mohammed A. Al-Khawlani, Wafa M. Al-Madhagi, Olla Sharhan, Rayan N. Al-Obydi, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8928654/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract 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. Health sciences/Cardiology Health sciences/Diseases Biological sciences/Drug discovery Health sciences/Health care Health sciences/Medical research QT prolongation drug–drug interaction torsades de pointes antipsychotic drug Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Apr, 2026 Reviews received at journal 18 Apr, 2026 Reviews received at journal 15 Apr, 2026 Reviews received at journal 03 Apr, 2026 Reviews received at journal 31 Mar, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers invited by journal 26 Feb, 2026 Editor assigned by journal 26 Feb, 2026 Editor invited by journal 26 Feb, 2026 Submission checks completed at journal 24 Feb, 2026 First submitted to journal 24 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8928654","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":599449208,"identity":"2a02f8b5-16ac-41f5-bc5d-4befcce2a0ff","order_by":0,"name":"Mohammed A. 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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\u0026ndash;drug interaction (DDI) risk among hospitalized psychiatric patients.\u003c/p\u003e \u003cp\u003eA retrospective cross-sectional study was conducted using medical records of inpatients admitted to two psychiatric hospitals in Sana\u0026rsquo;a, Yemen, between November 2023 and June 2024. A total of 191 male patients aged 17\u0026ndash;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.\u003c/p\u003e \u003cp\u003eOverall, 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Prevalence and Risk of QT-Prolonging Antipsychotic Drug Combinations in Hospitalized Psychiatric Patients in Sana’a, Yemen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-03 17:34:16","doi":"10.21203/rs.3.rs-8928654/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-23T05:39:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T08:55:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T13:19:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-03T05:25:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-31T20:59:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189708922894240759989650861518106361254","date":"2026-03-30T07:51:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145078440815587578429358290029333552079","date":"2026-03-29T00:30:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248079710236991802230752717835904590572","date":"2026-03-28T13:30:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226307265034436095265551330299327428436","date":"2026-03-26T18:57:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-26T17:36:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-26T17:27:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-26T09:42:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-24T13:59:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-24T13:54:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7f70c34c-1950-4108-92bb-b1a965351a31","owner":[],"postedDate":"March 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":63785862,"name":"Health sciences/Cardiology"},{"id":63785863,"name":"Health sciences/Diseases"},{"id":63785864,"name":"Biological sciences/Drug discovery"},{"id":63785865,"name":"Health sciences/Health care"},{"id":63785866,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-18T13:38:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-03 17:34:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8928654","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8928654","identity":"rs-8928654","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}