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Major Cardiac-Psychiatric Drug-Drug Interactions: a Systematic Review of the Consistency of Drug Databases.

Authors
  • Castaldelli-Maia, João Mauricio1, 2, 3, 4
  • Hofmann, Caio5
  • Chagas, Antonio Carlos Palandri6
  • Liprandi, Alvaro Sosa7
  • Alcocer, Alejandro8
  • Andrade, Laura H5
  • Wielgosz, Andreas9, 10
  • 1 Clima Clinic, Alameda Franca 267 Cj 82, São Paulo, 01422001, SP, Brazil. [email protected] , (Brazil)
  • 2 Department of Neuroscience, ABC Health University Center, Santo André, SP, Brazil. [email protected] , (Brazil)
  • 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. [email protected] , (Brazil)
  • 4 Cardiology Division Medical School ABC, Santo André, SP, Brazil. [email protected] , (Brazil)
  • 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. , (Brazil)
  • 6 Cardiology Division Medical School ABC, Santo André, SP, Brazil. , (Brazil)
  • 7 Section of Cardiology, Sanatorio Guemes, Buenos Aires, Argentina. , (Argentina)
  • 8 Section of Cardiology, 1st October Hospital, ISSSTE, Mexico City, DF, Mexico. , (Mexico)
  • 9 Faculty of Medicine, University of Ottawa, Ottawa, Canada. , (Canada)
  • 10 InterAmerican Heart Foundation, Dallas, TX, USA.
Type
Published Article
Journal
Cardiovascular drugs and therapy
Publication Date
Jun 01, 2021
Volume
35
Issue
3
Pages
441–454
Identifiers
DOI: 10.1007/s10557-020-06979-x
PMID: 32424652
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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). 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. 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. PROSPERO Systematic Review Registration Number: CRD42018100424.

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