INTRODUCTION: Despite substantial progress in the pharmacological treatment of 
schizophrenia, antipsychotic drugs are associated with insufficient effects on 
negative and cognitive symptoms, adverse events, poor compliance and drug 
discontinuation. Sertindole , first withdrawn from the market for cardiovascular 
safety concerns, is currently available in many countries. It has high affinity 
for dopamine D2, serotonin 5-HT2A, 5-HT2C and a1-adrenergic receptors, and a low 
potential for extrapyramidal symptoms.
AREAS COVERED: The pharmacodynamics, pharmacokinetics, clinical efficacy, safety 
and tolerability, and cost-effectiveness of sertindole are covered in this 
article, based on a literature review (PubMed) from 1990 to 2014.
EXPERT OPINION: The reviewed studies suggest a beneficial effect of sertindole 
on positive, negative and cognitive symptoms, and on relapse prevention. 
Although generally well tolerated, sertindole is associated with a dose-related 
QT-interval prolongation; thus, its administration requires electrocardiogram 
screening and monitoring. The presence of congenital long QT syndrome, 
prolongated QTc at baseline, cardiac disease and drug interactions should be 
carefully considered before prescribing sertindole. Further direct 
'head-to-head' comparisons with other second-generation antipsychotics (SGAs), 
trials on special populations and further clarification on cardiac safety are 
needed to better define the role of sertindole in the treatment of 
schizophrenia.