Psychotropic ECG Indication Tool

Clinical Decision Support Algorithm

Medicolegal Disclaimer: This algorithm is provided for educational and informational purposes only. It is intended to be used by qualified healthcare providers as an adjunct to, not a replacement for, clinical judgment. Using this tool does not establish a doctor-patient relationship. Individual patient circumstances may warrant deviations from this algorithm.

Steps 1-3: Acute Presentation

Does the patient present with any of the following?

Concern for Acute Ingestion (Overdose) Altered Mentation or Delirium Acute Cardiac Symptoms (e.g., chest pain, acute shortness of breath)

Step 4: Target Medication

Select the medication being prescribed or continued:

Steps 5-6: Patient & Family History

Personal Risk Factors (Select all that apply):

Bradycardia Structural heart disease Cardiac arrhythmias Known prolonged QTc Hepatic dysfunction History of syncope

Family Risk Factors (Select all that apply):

Sudden unexplained deaths in family Congenital Long QT Syndrome (LQTS)

Step 8: Methadone Dosing

Is the patient receiving High-Dose Methadone?

Methadone dose ≥ 120 mg/day

Step 10: Concomitant Risks

Are any of the following present alongside the selected medication?

Concomitant use of Antiarrhythmics or QT prolonging drugs → Search QT Drugs on CredibleMeds Concomitant use of p450 inhibitor Risk of Electrolyte abnormalities

(e.g., eating disorder, diuretics use, hypokalemia, hypomagnesemia, hypocalcemia)