Antipsychotics and hemodialysis: A systematic review

Background:Until now, target-controlled infusion of remifentanil with midazolam in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for percutaneous transluminal balloon angioplasty under monitored anesthesia care.Methods:A prospective, randomized controlled trial including patients who received a percutaneous transluminal balloon angioplasty between March 2019 and March 2021 was conducted. Group 1 and Group 2 were, respectively, administered an initial effect-site concentration of remifentanil of 1.0 and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL with intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4, mean arterial pressure and heart rate at baseline levels ± 30%, and patient comfort (remaining moveless). The primary outcome was to determine the appropriate effect-site concentration of remifentanil for the procedure in terms of patient comfort (remaining moveless), hemodynamic conditions, and adverse events. Secondary endpoints included the total dosage of anesthetics and total times of target-controlled infusion pump adjustments.Results:A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between 2 groups, except Group 1 having higher peripheral oxygen saturation, while local anesthetic injection compared with Group 2. In addition, Group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 6, P = .034), less remifentanil consumption (189.65 ± 69.7 vs 243.8 ± 76.1 μg, P = .001), but more intraoperative movements affecting the procedure (14 vs 4; P = .016), total times of target-controlled infusion pump adjustment [2 (1-4) vs 1 (1–2), P < .001] compared with Group 2.Conclusion:In percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided appropriate hemodynamic conditions, sufficient sedation and analgesia, and acceptable apnea with desaturation.

show abstract

“…[ 20 ] Avoiding ketamine in hemodialysis patients who are predisposed to psychotic behavior such as is suggested. [ 20 , 21 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2 effect-site concentrations of remifentanil with midazolam during percutaneous transluminal balloon angioplasty under monitored anesthesia care

Lai¹,

Tsai

Huang³

et al. 2021

Medicine

View full text Add to dashboard Cite

show abstract

“…Its bioavailability ranges between 60 and 70%, volume of distribution between 14 and 21 L/kg, it is 90–92% protein bound, and its half-life ranges between 15 and 37 h ( 36 , 60 , 61 ). It is metabolized in the liver via CYP3A4 and CYP2D6, and excreted (1% unchanged) in the urine and bile ( 35 ).…”

Section: Antipsychoticsmentioning

confidence: 99%

“…Due to its protein binding and volume of distribution it is unlikely to be removed by HD. Some variations in plasma levels could be due to changes in volume status and hypoalbuminemia that occur during HD sessions, where some reports have noticed a need for slightly higher dosing in HD, although it is usually recommended to start with lower doses in patients with an estimated GFR < 10 ml/min ( 35 , 61 , 62 ). The most predominant among its adverse effects are extrapyramidal symptoms (dystonia, parkinsonian-like syndrome, and tardive dyskinesia).…”

Section: Antipsychoticsmentioning

confidence: 99%

“…It is metabolized in the liver via CYP3A4, and excreted in 73% (<5% unchanged) in the urine and in 21% in the feces as inactive metabolites ( 35 ). The available pharmacokinetic studies have shown no important difference in patients with CKD, however, no studies have been carried out regarding pharmacokinetics of quetiapine in HD ( 61 ). A small cross-sectional study from India reported the use of quetiapine in some HD patients, however, did not mention adverse effects and reported use of lower doses ( 65 ).…”

Section: Antipsychoticsmentioning

confidence: 99%

“…This goes for regular and LAI risperidone. Additionally, researchers observed higher plasma concentrations in patients on HD, which could be due to accumulation in CKD ( 61 , 66 ). On the other hand, some report that about 25% of risperidone is removed after a 5-h dialysis session with a dialysate flow of 500 ml/min.…”

Section: Antipsychoticsmentioning

confidence: 99%

See 2 more Smart Citations

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

et al. 2022

View full text Add to dashboard Cite

Hemodialysis (HD) is the most common method of chronic kidney failure (CKF) treatment, with 65% of European patients with CKF receiving HD in 2018. Regular two to three HD sessions weekly severely lower their quality of life, resulting in a higher incidence of depression and anxiety, which is present in one third to one half of these patients. Additionally, the age of patients receiving HD is increasing with better treatment and care, resulting in more cognitive impairment being uncovered. Lastly, patients with other mental health issues can also develop CKF during their life with need for kidney replacement therapy (KRT). All these conditions need to receive adequate care, which often means prescribing psychotropic medications. Importantly, many of these drugs are eliminated through the kidneys, which results in altered pharmacokinetics when patients receive KRT. This narrative review will focus on common issues and medications of CKF patients, their comorbidities, mental health issues, use of psychotropic medications and their altered pharmacokinetics when used in HD, polypharmacy, and drug interactions, as well as deprescribing algorithms developed for these patients.

show abstract

Bioequivalence of 200 mg Amisulpride Tablets in Healthy Chinese Volunteers under Fasting and Fed Conditions

Cao,

2023

Clinical Pharm in Drug Dev

View full text Add to dashboard Cite

In this study, we compared the pharmacokinetics and safety of a new generic product and a branded reference product of amisulpride tablets. Additionally, we assessed the bioequivalence of the 2 products in healthy Chinese volunteers to acquire sufficient evidence for the marketing approval of the generic drug. Thirty volunteers under fasting and fed conditions were randomly administered a single dose of the test or reference drug orally, followed by a 7‐day washout period. The pharmacokinetic parameters were obtained by the concentration‐time profiles, including the area under the plasma concentration‐time curve (AUC) over the dosing interval, AUC from time zero to infinity, maximum plasma concentration, time to achieve maximum plasma concentration, and elimination half‐life. AUC from time zero to infinity of amisulpride in the postprandial group was reduced by approximately 25%, suggesting that a high‐fat diet can affect this parameter. In the aspect of safety, no serious adverse events occurred. This study demonstrated that generic and reference products of amisulpride tablets were bioequivalent in healthy Chinese volunteers under fasting and fed conditions.

show abstract

Antipsychotics and hemodialysis: A systematic review

Cited by 9 publications

References 33 publications

Comparison of 2 effect-site concentrations of remifentanil with midazolam during percutaneous transluminal balloon angioplasty under monitored anesthesia care

Comparison of 2 effect-site concentrations of remifentanil with midazolam during percutaneous transluminal balloon angioplasty under monitored anesthesia care

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

Bioequivalence of 200 mg Amisulpride Tablets in Healthy Chinese Volunteers under Fasting and Fed Conditions

Contact Info

Product

Resources

About