Psychotropic Drug Use in the Medically Ill

Abstract

Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients--particularly those who are elderly or medically debilitated--will receive special emphasis.

Depression in patients with cancer

“…can precipitate and worsen some types of cardiac conduction problems. In addition, the cardiovascular effects on cardiac rhythm and blood pressure make them relatively unsafe for patients with recent myocardial infarctions or those taking other medications with similar pharmacology (Stoudemire et a/. , 1990).…”

Cardiac arrhythmias related to psychiatric medication

“…Antipsychotics may cause significant cardiac side effects by affecting cardiac conduction. They can cause prolongation of the QT interval (19,20). First generation antipsychotics such as haloperidol, thioridazine, sertindole, pimozide, droperidol, as well as second-generation AP, such as quetiapine, risperidone, olanzapine, iloperidone, and most markedly ziprasidone and amisulpride have been associated with QT prolongation in clinical studies, meta-ana-lyses and and case reports (20,21).…”

Heart and mind: (2) psychotropic and cardiovascular therapeutics

“…Chloral hydrate is contraindicated in severe heart disease, particularly in heart failure, where it has been shown to react with frusemide. 34 …”

“…Although the quinidine-like effects of the neuroleptics are usually negligible, they can become significant in patients already taking type I antiarrhythmics, in those with hypokalaemia, or with clinically significant conduction delays. 46 When administering a low potency neuroleptic along with an antiarrhythmic, electrocardiography should be used to monitor for conduction delays. When these agents are used together with antihypertensive agents there is more chance of orthostatic hypotension.…”

“…46 Haloperidol in particular has been frequently used with safety and efficacy in severely ill cardiac patients. Oral haloperidol does not significantly affect the electrocardiogram, and intravenous haloperidol is used in acute emergencies such as agitated deliria.…”