Korean J Psychosom Med.  2011 Dec;19(2):57-65.

Drug Interactions between Cardiovascular Agents and Psychotropic Drugs

• Park JE
• Jung KH

Abstract

There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.

Keyword

Drug interaction; Cytochrome P450; Cardiovascular agents; Psychotropic drugs

MeSH Terms

Amiodarone
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Anti-Arrhythmia Agents
Bupropion
Calcium Channel Blockers
Cardiovascular Agents
Chlorpromazine
Cholesterol
Cytochrome P-450 CYP2D6
Cytochrome P-450 Enzyme System
Cytochromes
Digoxin
Diltiazem
Diuretics
Drug Interactions
Drug Toxicity
Fluvoxamine
Haloperidol
Lithium
Psychotropic Drugs
Quinidine
Serotonin Uptake Inhibitors
Triazoles
Verapamil
Warfarin
Amiodarone
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Anti-Arrhythmia Agents
Bupropion
Calcium Channel Blockers
Cardiovascular Agents
Chlorpromazine
Cholesterol
Cytochrome P-450 CYP2D6
Cytochrome P-450 Enzyme System
Cytochromes
Digoxin
Diltiazem
Diuretics
Fluvoxamine
Haloperidol
Lithium
Psychotropic Drugs
Quinidine
Serotonin Uptake Inhibitors
Triazoles
Verapamil
Warfarin