Tricyclic Antidepressant-Induced Anticholinergic Delirium in a Young Healthy Male Individual

King, Matthew W.; Ashraf, Nauman

doi:10.1007/s40800-017-0069-5

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…In our study, we have found four cases of adverse events related to the use of this adaptogen. We hypothesize that through the inhibition of CYP2B6, CYP2C9, CYP2C9, CYP2C19, and CYP3A4, Schisandra chinensis preparations increased the concentration and side effects of bupropion (thrombocytopenia ( Altintas et al, 2013 ) and generalized arthralgia ( Ornetti et al, 2004 )), amitriptyline (delirium ( King and Ashraf, 2018 )), and fluoxetine (dysuria ( Fluoxetine Side Effects, 2023 )).…”

Section: Discussionmentioning

confidence: 99%

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Siwek,

Woroń,

Wrzosek

et al. 2023

Front. Pharmacol.

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Aim: We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review.Methodology: A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms.Results: Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: Withania somnifera: reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); Eleutherococcus senticosus: duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); Schisandra chinensis: bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); Tribulus terrestris: citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); Coptis chinensis: mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); Cimicifuga racemosa: mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); Bacopa monnieri: agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); Gynostemma pentaphyllum: duloxetine (back pain); Cordyceps sinensis: sertraline (upper gastrointestinal bleeding); Lepidium meyenii: mianserin (restless legs syndrome); and Scutellaria baicalensis: bupropion (seizures).Conclusion: Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.

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Section: Discussionmentioning

confidence: 99%

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Siwek,

Woroń,

Wrzosek

et al. 2023

Front. Pharmacol.

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“…The prescription of TCAs with high anticholinergic activity exhibits a number of anticholinergic signs and symptoms, such as dry mouth, blurred vision, urinary retention, constipation and hallucinations. 38,39 In addition, in TCA overdose, there are likely symptoms that raise suspicion for cardiovascular toxicity, such as arrhythmias and refractory hypotension. 40 Nevertheless, it has been shown to be extraordinarily beneficial to improve global IBS symptoms.…”

Section: Tca Strongly Inhibits the Mechanical Activity Of Human Colon...mentioning

confidence: 99%

Inhibition of TRPC4 channel activity in colonic myocytes by tricyclic antidepressants disrupts colonic motility causing constipation

Jeong

Sung

Jeon

et al. 2022

J Cellular Molecular Medi

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Tricyclic antidepressants (TCAs) have been used to treat depression and were recently approved for treating irritable bowel syndrome (IBS) patients with severe or refractory IBS symptoms. However, the molecular mechanism of TCA action in the gastrointestinal (GI) tract remains poorly understood. Transient receptor potential channel canonical type 4 (TRPC4), which is a Ca2+‐permeable nonselective cation channel, is a critical regulator of GI excitability. Herein, we investigated whether TCA modulates TRPC4 channel activity and which mechanism in colonic myocytes consequently causes constipation. To prove the clinical benefit in patients with diarrhoea caused by TCA treatment, we performed mechanical tension recording of repetitive motor pattern (RMP) in segment, electric field stimulation (EFS)‐induced and spontaneous contractions in isolated muscle strips. From these recordings, we observed that all TCA compounds significantly inhibited contractions of colonic motility in human. To determine the contribution of TRPC4 to colonic motility, we measured the electrical activity of heterologous or endogenous TRPC4 by TCAs using the patch clamp technique in HEK293 cells and murine colonic myocytes. In TRPC4‐overexpressed HEK cells, we observed TCA‐evoked direct inhibition of TRPC4. Compared with TRPC4‐knockout mice, we identified that muscarinic cationic current (mIcat) was suppressed through TRPC4 inhibition by TCA in isolated murine colonic myocytes. Collectively, we suggest that TCA action is responsible for the inhibition of TRPC4 channels in colonic myocytes, ultimately causing constipation. These findings provide clinical insights into abnormal intestinal motility and medical interventions aimed at IBS therapy.

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“…Peripheral system adverse effects include constipation, urinary retention, and mouth dryness. Central system adverse effects include the risk of agitation, confusion, delirium, falls, and increased cognitive impairment . Older adults are especially vulnerable to negative anticholinergic effects resulting from decreased clearance and age‐related cholinergic deficits .…”

Section: Introductionmentioning

confidence: 99%

“…Central system adverse effects include the risk of agitation, confusion, delirium, falls, and increased cognitive impairment. [2][3][4][5][6] Older adults are especially vulnerable to negative anticholinergic effects resulting from decreased clearance and age-related cholinergic deficits. 7 Although various ACs are classified as potentially inappropriate medications (PIMs) for older adults, the prevalence of certain diseases for which ACs are indicated is predominant in this population group.…”

Section: Introductionmentioning

confidence: 99%

Features of anticholinergic prescriptions and predictors of high use in the elderly: Population‐based study

Joung

Shin

Cho

2019

Pharmacoepidemiology and Drug

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Purpose Older people are especially vulnerable to negative anticholinergic effects. Although anticholinergic drugs are commonly used among older people, drugs with potent antimuscarinic properties are considered as potentially inappropriate medications for older people. Here, we examined features of anticholinergic use and investigated predictors for the high use of strong anticholinergic agents (ACs) in the elderly. Methods A total of 388,629 Korean elderly aged ≥70 years were recruited from the 2012 National Health Insurance Service Elderly cohort database. The use of ACs in 2012 was quantitatively assessed by calculating standardized prescribed doses. Multivariate logistic regression was conducted to identify predictors of the high use of strong ACs (≥90 doses). Results Almost half of the subjects (47.2%) used more than 15 doses of strong ACs during 2012. 17.0% of the subjects had an annual cumulative use of strong ACs over 90 doses. Morbidities such as depression (odds ratio [OR], 95% confidence interval [CI] = 2.56, 2.48–2.63), Parkinson's disease (2.41, 2.26–2.56), genitourinary diseases (2.12, 2.07–2.16), polypharmacy (3.28, 3.21–3.36), and low income (1.29, 1.25–1.33) were strong predictors of their high use. Antihistamines (chlorpheniramine) and antidepressants (amitriptyline) greatly contributed to the total prescription of strong ACs. Conclusions Despite the vulnerability of older people to the adverse reactions of strong ACs, their use seems to be at a high level in terms of cumulative usage among some elderly. More attention should be paid to older people with predictive factors of high use of strong ACs.

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Tricyclic Antidepressant-Induced Anticholinergic Delirium in a Young Healthy Male Individual

Cited by 6 publications

References 14 publications

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Inhibition of TRPC4 channel activity in colonic myocytes by tricyclic antidepressants disrupts colonic motility causing constipation

Features of anticholinergic prescriptions and predictors of high use in the elderly: Population‐based study

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