Pharmacokinetics of antidepressants in patients undergoing hemodialysis: a narrative literature review

Abstract

We conducted a narrative literature review on studies that specifically addressed the pharmacokinetics of antidepressants in patients on hemodialysis. The search included the MEDLINE, LILACS, and Web of Knowledge databases and combined Medical Subject Headings and free-text search terms for chronic kidney disease, end-stage renal disease, renal replacement therapy, depression, and antidepressants; it was limited to studies conducted in humans, with no language or time constraints. The search yielded 212 studies. After screening titles and abstracts, 32 studies were read in full and 11 ultimately met the inclusion criteria and were included in the review. Most of the studies showed no difference in the pharmacokinetics of antidepressant drugs between patients with normal renal function and patients undergoing hemodialysis. However, studies with fluvoxamine and amitriptyline showed that variations in albumin levels might affect serum concentrations of these agents. The included studies have several limitations, and there are many obstacles to the adequate treatment of depression in patients undergoing hemodialysis. Further studies on this topic are needed to support proper treatment of these patients, improving their quality of life and reducing mortality.

Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics

“…Iwagami et al also found that antidepressant use in dialysis patients is one-and-a-half times higher than in the general population. Despite this, there are very few studies supporting the efficacy and the safety of antidepressant use in patients with CKD, and the evidence that does exist is generally gleaned from small non-randomized samples [ 168 ]. European Renal Best Practice 2014 guidelines recommends the first-line use of selective serotonin reuptake inhibitors (SSRIs) for up to 12 weeks in dialysis patients with moderate/major depression [ 169 ].…”

A Narrative Review of Management Strategies for Common Symptoms in Advanced CKD

“…Serotonin reuptake inhibitors (e.g., citalopram, escitalopram, fluoxetine, paroxetine, sertraline) [139][140][141] Serotonin -norepinephrine reuptake inhibitors (e.g., Venlafaxine, duloxetine, mirtazapine) [139][140][141] Atypical antidepressants (e.g., bupropion, trazodone, nefazodone) [139][140][141] Tricyclic antidepressants (e.g., Amitriptyline) [139][140][141] Address contributing factors (e.g., pain, itching and mood disorders) Psychotherapy and cognitive behavioral therapy 131 24 Non-opioid analgesics (e.g., acetaminophen) and short acting non-steroidal anti-inflammatory drugs 23,24 For moderate pain, weak opioids (e.g., tramadol and oxycodone and hydromorphone) 23 For severe pain, higher doses of oxycodone and hydromorphone as well as long acting agents (e.g., fentanyl, buprenorphine or methadone) 24,25,28 Exercise, massage and physical therapy 27 Itching Gabapentin 100 mg daily along with continued assessment of symptom experience and titration by a medical provider [31][32][33] Difelikefalin at a dose of 0.5 mug per kilogram of body weight 36 Rehydrating emollients, aqueous gels, essential oils, topical capsaicin cream, gamma linolenic acid ointment, phototherapy and acupuncture 31,40 Nausea and vomiting For first line intervention for nausea, Ondansetron For second line intervention, metoclopramide 2.5 mg every 4 hours as needed if concern for gastroparesis or constipation. For third line intervention, olanzapine 2.5 mg every 8 hours as needed or haloperidol 0.5 mg every 8 hours as needed.…”

“…Serotonin reuptake inhibitors (e.g., citalopram, escitalopram, fluoxetine, paroxetine, sertraline) [139][140][141] Serotonin -norepinephrine reuptake inhibitors (e.g., Venlafaxine, duloxetine, mirtazapine) [139][140][141] Atypical antidepressants (e.g., bupropion, trazodone, nefazodone) [139][140][141] Tricyclic antidepressants (e.g., Amitriptyline) [139][140][141] Address contributing factors (e.g., pain, itching and mood disorders) Psychotherapy and cognitive behavioral therapy 131 Exercise 132,133 Acupuncture 134 Magnesium 135 Chinese herbal medicine 136 Electroconvulsive therapy 137 Social support 138 Address concerns related to spirituality and religion 138 Relaxation techniques 138 J o u r n a l P r e -p r o o f…”

“…Serotonin reuptake inhibitors (e.g., citalopram, escitalopram, fluoxetine, paroxetine, sertraline) 139 , 140 , 141 …”

“…Medications used to treat depression/anxiety in patients with CKD include selective serotonin reuptake inhibitors, tricyclic antidepressants, serotonin‒norepinephrine reuptake inhibitors, and atypical antidepressants. 139 , 140 , 141 …”