Major Cardiac-Psychiatric Drug-Drug Interactions: a Systematic Review of the Consistency of Drug Databases
João Mauricio Castaldelli-Maia1,2,3,4, Caio Hofmann5, Antonio Carlos Palandri Chagas6
1Clima Clinic, Alameda Franca 267 Cj 82, São Paulo, 01422001, SP, Brazil. jmcmaia2@gmail.com.
Insights
Treating major depressive disorder (MDD) and anxiety disorders (AD) in cardiac patients is vital. This review found significant cardiac-psychiatric drug interactions, highlighting the need for careful management.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Pharmacology
Background:
- Major depressive disorder (MDD) and anxiety disorders (AD) are common in patients with cardiovascular diseases.
- Low treatment rates for MDD and AD in cardiac patients necessitate improved diagnostic and therapeutic support.
- Managing cardiac and psychiatric conditions concurrently is complicated by potential drug interactions.
Purpose of the Study:
- To systematically review cardiac-psychiatric drug interactions across major pharmacological databases.
- To identify the prevalence and nature of drug interactions in patients with comorbid cardiac and psychiatric conditions.
Main Methods:
- A systematic review was conducted.
- Cardiac-psychiatric drug combinations were analyzed using data from Micromedex, Up to Date, and ClinicalKey.
- The review focused on identifying significant drug interactions and their clinical implications.
Main Results:
- Out of 4914 cardiac-psychiatric drug combinations, 293 (6.0%) significant interactions were identified.
- Psychiatric medications were more likely to have problematic interactions (76.9%) than cardiac medications (32.6%).
- Common interactions involved antiarrhythmics, leading to cardiotoxicity (e.g., QT prolongation), altered drug metabolism (CYP2D6), and renal clearance issues (OCT2).
Conclusions:
- Significant inconsistencies exist among drug interaction databases, underscoring the importance of clinical judgment.
- A multidisciplinary approach, involving pharmacists, is crucial for alerting prescribers to potential interactions.
- Safe pharmacologic treatment of MDD and AD in cardiac patients is achievable with collaboration between cardiologists and psychiatrists.
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.
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