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Interactions between antipsychotic and antihypertensive drugs
J S Markowitz1, B G Wells, W H Carson
1Department of Hospital Pharmacy Practice and Administration, Medical University of South Carolina, USA.
The Annals of Pharmacotherapy
|June 1, 1995
Summary
Concurrent use of antipsychotics and antihypertensives requires careful consideration due to potential interactions. While no combination is strictly contraindicated, diuretics are safest, and beta-blockers with certain antipsychotics should be avoided.
Area of Science:
- Pharmacology
- Psychiatry
- Cardiology
Background:
- Hypertension is prevalent in psychiatric patients.
- Concurrent use of antipsychotics and antihypertensives is common.
Purpose of the Study:
- Review pharmacokinetic and pharmacodynamic interactions between antipsychotics and antihypertensives.
- Provide recommendations for antihypertensive selection in patients on antipsychotic therapy.
Main Methods:
- MEDLINE search for English-language literature.
- Inclusion of human and animal studies, reviews, and case reports.
- Assimilation of case reports and extraction of pertinent data.
Main Results:
- Antipsychotics can reduce the efficacy of guanethidine.
- Potential for additive hypotensive effects with chlorpromazine and methyldopa.
- Increased thioridazine and chlorpromazine concentrations with beta-blockers (propranolol, pindolol).
- Hypotension reported with chlorpromazine/captopril and clozapine/enalapril.
Conclusions:
- No antipsychotic-antihypertensive combination is absolutely contraindicated but carries risks.
- Diuretics may be the safest antihypertensive choice.
- Avoid combining beta-antagonists (propranolol, pindolol) with thioridazine or chlorpromazine.
- Close patient monitoring for drug effects is essential.