Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika st. 21 A, 31-501, Kraków, Poland.
Department of Clinical Pharmacology, Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland.
Pharmacol Rep. 2020 Apr;72(2):350-359. doi: 10.1007/s43440-020-00058-6. Epub 2020 Mar 2.
High level of comorbidity between bipolar disorder or schizophrenia and cardiovascular diseases (CVD) in clinical practice may contribute to drug-drug interactions between medications used in these conditions. The aim of this study was to evaluate harmful interactions between antipsychotics and medications used in treatment of CVD.
The analysis of 52 cases of adverse reactions with a clinical picture indicates that they were the result of the combination of antipsychotic with cardiovascular medications.
The highest number of interactions with antipsychotics was recorded among beta-blockers (n = 13, 25% of all cases), including cardiac arrhythmias [atrial fibrillation (n = 1): risperidone plus atenolol; bradycardia (n = 1): perphenazine with metoprolol; ventricular arrhythmias: sertindole with metoprolol (n = 1) and ziprasidone with sotalol (n = 3)] and hypotension [chlorprotixene with nebivolol or metoprolol (n = 2)]. 12 cases concerned statins-myalgia, myopathy, or creatine kinase elevation appeared after combination of atorvastatin with haloperidol (n = 1), quetiapine (n = 3) or risperidone (n = 1), and simvastatin with quetiapine (n = 5) or risperidone (n = 2). There were also cases of interactions observed for the use of antipsychotics with anti-arrhythmic drugs (amiodarone, flecainide, propafenone) (n = 11), calcium channel blockers (n = 6), and other cardiac medications: clonidine, dabigatran, doxazosin, ivabradine, and losartan (n = 10).
Due to a high risk of interactions and related adverse effects, particular attention should be paid while using cardiovascular medications with antipsychotics. Clinical decisions should be preceded by a detailed analysis of safety, risk-benefit ratio to search for, as safe as possible, drug combinations.
在临床实践中，双相情感障碍或精神分裂症与心血管疾病（CVD）之间存在较高的共病率，这可能导致这些疾病中使用的药物之间发生药物相互作用。本研究旨在评估抗精神病药物与 CVD 治疗药物之间的有害相互作用。
分析了 52 例临床表现表明是抗精神病药物与心血管药物联合使用所致的不良反应。
与抗精神病药物相互作用最多的是β受体阻滞剂（n=13，占所有病例的 25%），包括心律失常[心房颤动（n=1）：利培酮加阿替洛尔；心动过缓（n=1）：奋乃静加美托洛尔；室性心律失常：曲司氯铵加美托洛尔（n=1）和齐拉西酮加索他洛尔（n=3）]和低血压[氯普噻吨加比索洛尔或美托洛尔（n=2）]。12 例与他汀类药物-肌痛、肌病或肌酸激酶升高有关，这些病例出现在阿托伐他汀与氟哌啶醇（n=1）、喹硫平（n=3）或利培酮（n=1）以及辛伐他汀与喹硫平（n=5）或利培酮（n=2）联合使用后。还有一些使用抗精神病药物与抗心律失常药物（胺碘酮、氟卡尼、普罗帕酮）（n=11）、钙通道阻滞剂（n=6）以及其他心脏药物：可乐定、达比加群、多沙唑嗪、伊伐布雷定和氯沙坦（n=10）的相互作用的病例。
由于相互作用和相关不良反应的风险较高，在使用心血管药物与抗精神病药物时应特别注意。在做出临床决策之前，应详细分析安全性、风险-效益比，以尽可能安全地寻找药物组合。
