Clima Clinic, Alameda Franca 267 Cj 82, São Paulo, 01422001, SP, Brazil.
Department of Neuroscience, ABC Health University Center, Santo André, SP, Brazil.
Cardiovasc Drugs Ther. 2021 Jun;35(3):441-454. doi: 10.1007/s10557-020-06979-x.
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.
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).
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.
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.
PROSPERO Systematic Review Registration Number: CRD42018100424.
重度抑郁症（MDD）和焦虑症（AD）在心律失常、缺血性心脏病、心力衰竭、高血压和血脂异常患者中都非常普遍。由于治疗率较低，因此应该加强对心脏病患者 MDD 和 AD 的诊断和治疗的支持。然而，心脏-精神药物相互作用会使药物治疗变得具有挑战性。
本系统评价的目的是在三个广泛使用的药理学数据库（Micromedex、Up to Date 和 ClinicalKey）中调查心脏-精神药物相互作用。
在 4914 种心脏-精神药物组合中，发现了 293 种有显著相互作用的组合（6.0%）。当检测到有问题的相互作用时，可能更容易找到替代心脏药物（32.6%的药物存在一些相互作用）而不是精神科药物（76.9%）。抗心律失常药物是主要关注的类别。这些相互作用产生的最常见问题与心脏毒性（QT 延长、尖端扭转型室性心动过速、心脏骤停）、细胞色素 P450 2D6（CYP2D6）底物的暴露增加或有机阳离子转运体 2（OCT2）底物的肾清除减少有关，包括高血压危象、出血风险增加、肌病和/或横纹肌溶解症。
不幸的是，搜索的数据库之间存在相当大的不一致性，因此临床医生的判断力和临床经验仍然是管理合并有精神和心脏疾病的患者的宝贵工具。应该考虑存在相互作用的可能性。通过多学科方法，特别是涉及药剂师，应提醒处方者注意可能存在相互作用。通过心脏病专家和精神科医生的共同努力，心脏病患者的 MDD 和 AD 药物治疗可以安全地实施。
PROSPERO 系统评价注册编号：CRD42018100424。
