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

• Published in: Cardiovascular drugs and therapy Vol. 35; no. 3; pp. 441 - 454
• Main Authors: Castaldelli-Maia, João Mauricio, Hofmann, Caio, Chagas, Antonio Carlos Palandri, Liprandi, Alvaro Sosa, Alcocer, Alejandro, Andrade, Laura H., Wielgosz, Andreas
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2021; Springer Nature B.V
• Subjects: Antipsychotic Agents - adverse effects; Antipsychotic Agents - pharmacokinetics; Antipsychotic Agents - pharmacology; Anxiety disorders; Arrhythmia; Cardiology; Cardiotoxicity; Cardiovascular Agents - adverse effects; Cardiovascular Agents - pharmacokinetics; Cardiovascular Agents - pharmacology; Cardiovascular diseases; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - epidemiology; Congestive heart failure; Coronary artery disease; CYP2D6 protein; Cytochrome; Cytochrome P-450 CYP2D6 - drug effects; Cytochrome P450; Cytochromes P450; Databases, Pharmaceutical - statistics & numerical data; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - epidemiology; Drug interaction; Drug Interactions; Dyslipidemia; Health services; Heart diseases; Humans; Hypertension; Ischemia; Medical treatment; Medicine; Medicine & Public Health; Mental depression; Metabolic Clearance Rate; Myopathy; Oct-2 protein; Organic cation transporter; Organic Cation Transporter 2 - drug effects; Patients; Pharmacology; Prolongation; Review Article; Rhabdomyolysis; Substrates; Systematic review; Torsades de pointes; Depression; Anxiety; Cardiology; Psychiatry; Interaction
• ISSN: 0920-3206; 1573-7241; 1573-7241
• DOI: 10.1007/s10557-020-06979-x

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.