Choosing among second-generation antidepressant treatments for depressed patients with cardiac diseases

Kasper, Siegfried

doi:10.1080/13651501.2018.1519080

Cited by 5 publications

(6 citation statements)

References 126 publications

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“…The paucity of comprehensive in vivo/vitro studies investigating DDIs interactions between statins and antidepressant drugs is the main limitation of this review. Only two studies covered the topic of DDIs between these classes of drugs. Additionally, the potential DDIs of clinical relevance are mainly speculative based on the drugs PK features.…”

Section: What Is New and Conclusionmentioning

confidence: 99%

“…In recent years, a number of comprehensive reviews of clinically relevant DDIs involving statins 5,[11][12][13][14][15][16][17] or antidepressants [18][19][20][21] have been published. To our knowledge, only two articles 22,23 covered the topic of DDIs between these drugs. The aim of the present review was to describe clinically relevant DDIs between statins and antidepressants and provide a comprehensive overview of their pharmacological features for appropriate multiple drug regimens.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

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Clinically relevant drug interactions between statins and antidepressants

et al. 2019

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What is known and objective Statins, also known as 3‐hydroxy‐3‐methylglutaryl‐CoA reductase inhibitors, and antidepressant drugs are frequently used in combination due to the high and growing incidence of cardiovascular diseases and psychiatric disorders worldwide. Several aspects on management, the risk of adverse events (AEs) occurrence and the potential clinically relevant pharmacokinetic (PK) and pharmacodynamic (PD) drug‐drug interactions (DDIs) between these two classes have not been well investigated. The aim of the present review was to describe the PK and PD interactions, of clinical relevance, between statins and antidepressant drugs and provide a comprehensive overview of their pharmacological features for appropriate multiple drug regimens. Methods Relevant studies were identified through a literature search of PubMed and the Cochrane databases focusing on clinically relevant DDIs between statins and antidepressants. Only papers in English were included in the search. Results and discussion Pharmacodynamic (PD) drug‐drug interactions (DDIs) are unlikely to occur as statins are highly selective inhibitors of HMG‐CoA reductase with no relevant effect on other enzymes or receptor systems. Despite the numerous PK studies on individual drugs belonging to statins and antidepressant agents, only a few case reports regarding specific DDIs are present in the literature and no clinical studies have been performed. PK data allow to speculate on potential DDIs, comparing the metabolic pathways, intestinal and liver transporters and elimination routes. Overall, second‐generation antidepressants, in particular citalopram, escitalopram, mirtazapine, reboxetine and venlafaxine, have weak inhibitory effects on various cytochrome (CYP) isozymes and seem to have a more advantageous DDIs profile in vivo. Conversely, nefazodone, fluoxetine, paroxetine and fluvoxamine influence considerably CYPs activity with potential effects on statins plasma levels, although pravastatin, pitavastatin and rosuvastatin are not susceptible to inhibition by any CYP. Albeit no studies have been performed on P‐glycoprotein (P‐gp), interactions of clinical relevance are unlikely. What is new and conclusion Although DDIs with antidepressants are potentially, but rarely clinically significant, the use of antidepressants with a more favourable drug interaction profile is advisable. An evaluation on DDIs between these drugs can be useful for future PK/PD studies on drug‐drug interaction to provide clinicians with more data for appropriate multiple drug regimens.

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Section: What Is New and Conclusionmentioning

confidence: 99%

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

Clinically relevant drug interactions between statins and antidepressants

et al. 2019

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“…W ostatnich latach coraz częściej przepisywane są leki przeciwdepresyjne II generacji (second generation antidepressants, SGA). Grupa ta obejmuje selektywne inhibitory wychwytu zwrotnego serotoniny (selective serotonin reuptake inhibitors, SSRI), inhibitory wychwytu zwrotnego noradrenaliny (noradrenaline reuptake inhibitors, NRI), selektywne inhibitory wychwytu zwrotnego serotoniny i noradrenaliny (selective serotonin and noradrenalin reuptake inhibitors, SNRI) oraz mirtazapinę, bupropion, agomelatynę i wortioksetynę (Kasper, 2019). Uważa się, że leki przeciwdepresyjne II generacji powodują mniej objawów ubocznych niż trójpierścieniowe leki przeciwdepresyjne.…”

Section: Management Of Emergency Situationsunclassified

“…In recent years, second generation antidepressants (SGAs) have been prescribed with increasing frequency. This group includes selective serotonin reuptake inhibitors (SSRIs), noradrenaline reuptake inhibitors (NRIs), selective serotonin and noradrenaline reuptake inhibitors (SNRIs) as well as mirtazapine, bupropion, agomelatine, and vortioxetine (Kasper, 2019).…”

mentioning

confidence: 99%

“…Some of these symptoms resolve after a few days or weeks of treatment, but potentially severe side effects may persist during treatment or occur later in the course of therapy (Carvalho et al, 2016). SGAs show a safer profile in terms of the cardiovascular system as compared to older drugs; the main side effects of SGAs include accelerated heart rate, hypertension, orthostatic hypotonia, and QT prolongation (Carvalho et al, 2016;Kasper, 2019).…”

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confidence: 99%

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Second generation antidepressants and the risk of arrhythmia

Suwalska

Napierała

Proch

et al. 2021

Pharmacotherapy in Psychiatry and Neurology

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Objectives. Second generation antidepressants belong to the most commonly prescribed medications; they are used in the treatment of depression, anxiety disorder, and pain. The aim of the study is to evaluate their risk of QT prolongation, which can lead to potentially life-threatening ventricular arrhythmias. Literature review. Based on the Summary of Product Characteristics and CredibleMeds database, we present current knowledge about the risk of QT prolongation caused by second generation antidepressants. Recommendations concerning planning and conducting treatment using second generation antidepressants are discussed. Conclusions. As scientific research shows, newer antidepressants cause fewer side effects than tricyclic antidepressants, but they are not devoid of them. For some of them, there is a proven risk of QT prolongation and torsade de pointes, which can, very rarely, lead to patient’s death. Before prescribing new antidepressants, clinicians should evaluate the patient’s risk of QT prolongation and, in case of high risk, they should apply the lowest effective dose, regularly monitor the patient’s condition, and inform the patient to consult a cardiologist if any alarming symptoms, such as syncope or palpitations, occur.

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