João Mauricio Castaldelli-Maia1,2,3,4, Caio Hofmann5, Antonio Carlos Palandri Chagas6, Alvaro Sosa Liprandi7, Alejandro Alcocer8, Laura H Andrade5, Andreas Wielgosz9,10. 1. Clima Clinic, Alameda Franca 267 Cj 82, São Paulo, 01422001, SP, Brazil. jmcmaia2@gmail.com. 2. Department of Neuroscience, ABC Health University Center, Santo André, SP, Brazil. jmcmaia2@gmail.com. 3. Nucleo de Epidemiologia Psiquiatrica - LIM 23, Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil. jmcmaia2@gmail.com. 4. Cardiology Division Medical School ABC, Santo André, SP, Brazil. jmcmaia2@gmail.com. 5. Nucleo de Epidemiologia Psiquiatrica - LIM 23, Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil. 6. Cardiology Division Medical School ABC, Santo André, SP, Brazil. 7. Section of Cardiology, Sanatorio Guemes, Buenos Aires, Argentina. 8. Section of Cardiology, 1st October Hospital, ISSSTE, Mexico City, DF, Mexico. 9. Faculty of Medicine, University of Ottawa, Ottawa, Canada. 10. InterAmerican Heart Foundation, Dallas, TX, USA.
Abstract
PURPOSE: Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging. METHODS: The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey). RESULTS: Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis. CONCLUSION: Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists. TRIAL REGISTRATION: PROSPERO Systematic Review Registration Number: CRD42018100424.
PURPOSE: Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging. METHODS: The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey). RESULTS: Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis. CONCLUSION: Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists. TRIAL REGISTRATION: PROSPERO Systematic Review Registration Number: CRD42018100424.
Authors: Judith H Lichtman; Erika S Froelicher; James A Blumenthal; Robert M Carney; Lynn V Doering; Nancy Frasure-Smith; Kenneth E Freedland; Allan S Jaffe; Erica C Leifheit-Limson; David S Sheps; Viola Vaccarino; Lawson Wulsin Journal: Circulation Date: 2014-02-24 Impact factor: 29.690
Authors: Joost P van Melle; Peter de Jonge; Titia A Spijkerman; Jan G P Tijssen; Johan Ormel; Dirk J van Veldhuisen; Rob H S van den Brink; Maarten P van den Berg Journal: Psychosom Med Date: 2004 Nov-Dec Impact factor: 4.312