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Antipsychotics and hemodialysis: A systematic review
Roshan Sutar1, Mahendra Kumar Atlani2, Pooja Chaudhary1
1Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, India.
Asian Journal of Psychiatry
|December 20, 2020
Summary
This review examines antipsychotic use in hemodialysis patients, finding modest evidence for specific oral and long-acting formulations. Careful consideration of drug properties and dialysis parameters is crucial for safe and effective management of behavioral symptoms.
Area of Science:
- Pharmacology
- Nephrology
- Psychiatry
Background:
- Antipsychotics manage behavioral issues in hemodialysis patients.
- Limited data exists on antipsychotic pharmacokinetics during hemodialysis.
- Current guidelines offer minimal specific advice beyond avoiding certain drugs or dosage increases in renal failure.
Purpose of the Study:
- To systematically review the safety and efficacy of antipsychotics in patients undergoing hemodialysis.
- To analyze available literature on antipsychotic pharmacokinetics in this specific patient population.
Main Methods:
- Systematic analysis of online data from 1981 to 2019.
- Inclusion criteria focused on studies reporting safety and efficacy outcomes (adverse effects, symptom relapse) of antipsychotics in hemodialysis patients.
- Outcome assessment involved reviewing 14 case reports and 1 case series.
Main Results:
- Several oral antipsychotics (aripiprazole, ziprasidone, olanzapine, risperidone) and long-acting formulations (risperidone, paliperidone) were studied.
- Blood levels of antipsychotics were unaffected in some studies, while others suggested dose timing relative to dialysis sessions.
- Schizophrenia exacerbation was the most common psychiatric issue reported in patients undergoing hemodialysis.
Conclusions:
- Modest evidence supports multiple dosing regimens for oral aripiprazole, ziprasidone, olanzapine, and risperidone.
- Long-acting risperidone and paliperidone are well-tolerated; a reduced paliperidone dose may suffice.
- Antipsychotic selection requires considering protein binding, dialysis clearance, dialysis duration, administration route, and bowel absorption in hemodialysis patients.
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