The Cardiovascular Effects of Bupropion and Nortriptyline in Depressed Outpatients

Kiev, Ari; Masco, H. L.; Wenger, T.; Johnston, J. Andrew; Batey, Sharyn R.; Holloman, Lisa C.

doi:10.3109/10401239409148989

Cited by 47 publications

(26 citation statements)

References 16 publications

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“…In the two comparator trials with general adults, nortriptline-induced changes differed. In one study [70], QTc initially increased but then decreased below baseline levels, while in the other, QTc was clearly increased after both 2 and 6 weeks of treatment (+16.6, +14.4 ms, both p < 0.001) [71]. In these studies, net changes in PR (6 weeks: +5, +0.6 ms), QRS (6 weeks: +3, +4.4 ms, p < 0.05) and HR (6 weeks: +8 ms, p < 0.001, +18 ms, p < 0.05) occasionally reached significance.…”

Section: Fluvoxaminementioning

confidence: 95%

“…At 12 h, the QTc was 495 ms and it resolved slowly, with a QTc of 480 ms after 24 h. There have been three studies of bupropion versus comparators that looked at the impact on QTc [58,70,71]. All three indicated a benefit over the comparator; in two that provided specific data, there were associated net decreases following treatment [71,73].…”

Section: Bupropionmentioning

confidence: 97%

“…There are five reports concerning the effects of nortriptyline on cardiovascular parameters, of which one is in children [67], two are in older patient groups [68,69] and two involve the use of comparators in a treatment design [70,71]. The posttreatment QTc in children and adolescents (separately as well as together) was significantly elongated (p < 0.01); similar lengthening was found in both adolescents and children in PR interval (+12.2 ms, p < 0.01), in QRS (+7.4 ms, p < 0.01) and in HR (+20.…”

Section: Amitriptyline Cr Depression Odmentioning

confidence: 99%

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Psychotropic drugs and the ECG: focus on the QTc interval

Goodnick

Jerry²,

Parra³

2002

Expert Opinion on Pharmacotherapy

100

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The QT interval measuring depolarisation and repolarisation has, when lengthened, been implicated as a risk factor for the development of torsades de pointes and sudden death, particularly in patients predisposed to these complications due to cardiovascular impairment. Since some of the medications used in psychiatry have been implicated, an extensive review of available literature was made of the major classes, including antipsychotics, antidepressants, lithium, anticonvulsants and benzodiazepines. Further, where no publications were found on a particular medication, the pharmaceutical firms responsible for these items were contacted concerning possibly unpublished data. Results of the survey indicate that there may be difficulty in one of three situations: immediate (in the first minutes to hours after oral or parenteral administration), short-term use of 4 - 12 weeks or long-term use of 6 months. Based on this approach, the greatest concern is directed at the immediate application of haloperidol, droperidol, pimozide and trazodone, the short-term use of thioridazine, pimozide, sertindole, nortriptyline, clomipramine, doxepin and the long-term use of clozapine, olanzapine and carbamazepine. It is of interest that a reduction in QTc is reported with aripiprazole. Among the antidepressants, the tertiary tricyclic antidepressants (imipramine, amitriptyline and doxepin) appear to have a more general impact, while the secondary tricyclic antidepressants (nortriptyline, desipramine) may impact more on children and the elderly. Among other antidepressants, the only reports of torsades de pointes appeared to occur with mirtazapine. It was also of interest to find data showing no effect or reductions in QTc produced by sertraline, citalopram, paroxetine and bupropion in multiple studies. Effects of medications on other heart parameters are also briefly reviewed. In particular, the safety of sertraline in post-MI patients and of bupropion in heart disease patients is highlighted. Little information was available on other classes of medications used in psychiatric disorders. What is available concerning lithium, the anticonvulsants and the benzodiazepines indicates little effect on the QTc, although there may be effects on other cardiovascular parameters.

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Section: Fluvoxaminementioning

confidence: 95%

Section: Bupropionmentioning

confidence: 97%

Section: Amitriptyline Cr Depression Odmentioning

confidence: 99%

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Psychotropic drugs and the ECG: focus on the QTc interval

Goodnick

Jerry²,

Parra³

2002

Expert Opinion on Pharmacotherapy

100

View full text Add to dashboard Cite

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“…[9] There is also a plateau pressed patients with and without cardiac disease. [89][90][91] Bupropion in the dose-response curve of nicotine and heart rate that suggests IR was found to infrequently raise blood pressure, particularly that higher doses of nicotine have minimal additional effects on among patients with pre-existing hypertension, but had no effect heart rate. [9,73] Despite these facts, practice guidelines remain on heart rate and cardiac conduction.…”

Section: Safety Of Nicotine Replacement Therapymentioning

confidence: 99%

Smoking Cessation for Patients with Cardiovascular Disease

Joseph

2003

American Journal of Cardiovascular Drugs

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Tobacco use remains the major preventable cause of early mortality and morbidity in the US and is a major risk factor for cardiovascular disease (CVD). Quitting smoking rapidly reduces the risk of cardiovascular events. In this review, we identify and discuss best approaches to assist smoking cessation among patients with CVD. Establishing office systems that reliably identify smokers to healthcare providers is an essential first step. Once the patient is identified as a smoker, providers should inquire about their willingness to quit and advise them to quit or provide motivation to get ready to make a quit attempt. Behavioral (counseling) and pharmacologic (nicotine replacement and non-nicotine medications) treatments double or triple long-term cessation rates and should be offered in combination to all patients with CVD who use tobacco. More intensive behavioral therapy is more effective and should be delivered when possible. The choice of pharmacotherapy will depend upon the clinical history of the patient and patient preference. Nicotine replacement and sustained release bupropion (bupropion SR) are first-line treatments for smoking cessation. Nicotine patches have been studied extensively in patients with stable CVD and have been shown to be safe. Bupropion SR has relatively few cardiovascular adverse effects and may be especially useful for patients with CVD; its safety is currently being studied. Special consideration is needed for hospitalized patients with acute coronary syndromes (e.g. myocardial infarction and unstable angina). The safety of pharmacotherapy in the acute setting is not yet established. Behavioral interventions, however, are very effective and should be delivered to all hospitalized smokers. Finally, it is important to create a clinical environment that is supportive of treating patients with tobacco dependence. Simple changes in office and hospital routines and procedures (routine screening to identify smokers, prompts to encourage intervention and links to more intensive tobacco dependence treatment programs) will substantially improve the identification, treatment, and outcomes of patients with CVD who use tobacco.

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“…Bupropion immediate release (IR) and bupropion sustained release (SR) are used frequently to treat geriatric depression, largely because of a favorable side-effect pro®le including few cardiovascular, gastrointestinal and sexual adverse effects (Kiev et al, 1994;Croft et al, 1999). While the precise mechanism of action of bupropion is unknown, it is postulated that it exerts its effects primarily through noradrenergic systems, although it may also have dopaminergic activity (Ascher et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Bupropion SR in the naturalistic treatment of elderly patients with major depression

Steffens

Doraiswamy

McQuoid

2001

Int J Geriat Psychiatry

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In this naturalistic 12-week study, geriatric MD patients with high and low medical comorbidity responded well to bupropion and bupropion SR. In elderly patients, four to eight week acute treatment periods may be insufficient. Our findings suggest that nearly 50% of elderly depressed subjects at a tertiary center may need combination therapy over the course of their illness. Controlled randomized studies to establish the long-term efficacy and optimal dose of the newer antidepressants in geriatric depression are urgently needed.

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The Cardiovascular Effects of Bupropion and Nortriptyline in Depressed Outpatients

Cited by 47 publications

References 16 publications

Psychotropic drugs and the ECG: focus on the QTc interval

Psychotropic drugs and the ECG: focus on the QTc interval

Smoking Cessation for Patients with Cardiovascular Disease

Bupropion SR in the naturalistic treatment of elderly patients with major depression

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