Unprescribed and unnoticed: Retrospective chart review of adverse events of interactions between antidepressants and over-the-counter drugs

Abstract

Aim: To systematically evaluate prevalence and clinical characteristics of adverse effects of antidepressants and OTC drugs interactions in a retrospective chart review.Methodology: Dataset of 1,145 registered adverse events were evaluated. Reports were selected for further analysis if pharmacoepidemiological avaluation indicated the presence of high probability of a causal relationship between antidepressants and OTC interaction and the occurrence of side effect. Following variables were extracted from the records: sex, age, medical comorbidities, antidepressant and other concomitant medications, clinical consequences ant the possible interaction mechanisms.Results: 368 showed causal relationship with the simultaneous use of antidepressant with another drug. 15 adverse events (4%) were related to the use of OTC medicine, particularly omeprazole, diphenhydramine, Japanese ginkgo biloba, ibuprofen, diclofenac and sildenafil. All of the analysed side effects were categorized as the result of pharmacokinetic interactions. Here we report identified OTC drugs with corresponding antidepressants and clinical manifestations of DDI. Omeprazole: agomelatine (nausea, abnormal dreams), fluoxetine (extrapyramidal symptoms, paresthesias), sertraline (vertigo, yawning), escitalopram (oral vesiculation). Diphenhydramine: sertraline (diaphoresis, insomnia, vertigo), paroxetine (pruritus, headache), duloxetine (oropharyngeal pain). Japanese ginkgo biloba: citalopram (bradycardia), trazodone (vertigo, taste pervesion), mianserine (restless legs syndrome). Diclofenac: escitalopram (oral vesiculation), and fluoxetine (restless legs syndrome). Ibuprofen: agomelatine (anxiety and nausea), sertraline and omeprazole (QTc prolongation). Sildenafil: fluoxetine (genital oedema) and sertraline (myocardial infarction).Conclusion: The use of OTC drugs by the patients should be monitored. Pharmacokinetic interactions between nonprescribed medicines and antidepressants may increase concentration and severity of side effects of latter ones.

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

“…Clinicians should be aware that the risk of the occurrence of herb–drug interactions may be age-related. The mean age of the patients described in the reports was 57 ± 14.3 years, which stays in line with the results of our previous studies ( Woroń and Siwek, 2018 ; Woroń et al, 2019 , 2022 ; Siwek et al, 2020 ).…”

“…The simultaneous use of herbal medicines and prescribed medication is a common phenomenon (Agbabiaka et al, 2018), and the application of adaptogens is becoming popular. Intriguingly, the prevalence of interactions between those preparations and antidepressant drugs was twofold higher than the occurrence of adverse events caused by the interactions of antidepressants with over-the-counter drugs (4%) that were presented in our previous study (Woroń et al, 2022). In clinical practice, the prevalence of those interactions may be much higher.…”

“…Due to the increasing number of reported side events associated with the use of psychotropic drugs, this unit cooperates with the Department of Affective Disorders of Jagiellonian University Medical College. Approximately 850–1,100 consultations are made per year ( Woroń et al, 2022 ).…”

Escitalopram-induced sinus bradycardia in coronary heart disease combined with depression: a case report and review of literature

“…Although there are many possibilities that may affect bradycardia, physicians should remain aware of cardiac ADR in patients with cardiovascular diseases, and clinical pharmacists should provide full-process pharmaceutical care for screening and timely treatment of cardiovascular adverse events. Pharmacokinetic interactions between over-the-counter drugs and antidepressants including escitalopram may further increase the severity of side effects of the latter, which, clinically, is worth highlighting ( 42 ). It is also recommended that early and close ECG surveillance is necessary for early identification and treatment of arrhythmias induced by escitalopram.…”

Distinctive Patterns of 5-Methylcytosine and 5-Hydroxymethylcytosine in Schizophrenia

“…Combination therapy involves the simultaneous use of two or more medications and is a common approach in clinical psychiatry [ 96 ]. However, since schizophrenia involves multiple genetic and epigenetic loci, treatment responses and side effects vary among individuals, emphasizing the need to find complete and effective treatments [ 97 ].…”