A Practical Approach to Avoiding Cardiovascular Adverse Effects of Psychoactive Medications

Publication date: Available online 11 September 2017 Source:Canadian Journal of Cardiology Author(s): Judith Brouillette, Stanley Nattel Drugs that act on mental state, generally termed “psychoactive agents”, are among the most widely used medications in medicine. Psychoactive agents can affect the cardiovascular system and must be used carefully to avoid negative cardiovascular consequences. The present paper reviews the potential adverse cardiovascular consequences of psychoactive medications and provides suggestions for practical approaches to avoiding them. We consider adverse reactions in terms of 1) arrhythmias (particularly acquired long QT syndrome); 2) blood pressure; 3) ventricular function; 4) impact on risk factors; 5) teratogenicity; and 6) drug interactions. Minimizing QT liability requires a consideration of patient-specific risk factors and the risk profile of drugs available to treat the psychiatric condition. Drugs with QT-prolonging properties can be used safely, provided that appropriate precautions are taken. Fear of QT-prolongation should not deprive patients of needed psychiatric therapy. For example, one large study reported substantially increased all-cause mortality/hospitalization, death/depression-hospitalization and death/arrhythmia-hospitalization in patients for whom citalopram dosage was reduced over QT-concerns following the Food and Drug Administration Black Box Warning. In general, attention to drug-specific cardiac adverse effect ri...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research