Key result
Adverse interactions between antipsychotics and cardiovascular medications most frequently involved beta-blockers (25% of cases) and statins (23% of cases), leading to arrhythmias, hypotension, and muscle disorders.
Why the study?
High comorbidity between bipolar disorder or schizophrenia and cardiovascular diseases may lead to drug-drug interactions, prompting the evaluation of harmful interactions between antipsychotics and cardiovascular medications.
Observational (n=52)
No
The combination of antipsychotics and cardiovascular medications carries a high risk of adverse drug interactions, particularly with beta-blockers, statins, and anti-arrhythmics, necessitating careful safety analysis.
May warrant vigilance for interactions with beta-blockers and statins; leaves open quantification of risks in prospective studies.
BACKGROUND: High level of comorbidity between bipolar disorder or schizophrenia and cardiovascular diseases (CVD) in clinical practice may contribute to drug-drug interactions between medications used in these conditions. The aim of this study was to evaluate harmful interactions between antipsychotics and medications used in treatment of CVD. METHODS: The analysis of 52 cases of adverse reactions with a clinical picture indicates that they were the result of the combination of antipsychotic with cardiovascular medications. RESULTS: The highest number of interactions with antipsychotics was recorded among beta-blockers (n = 13, 25% of all cases), including cardiac arrhythmias [atrial fibrillation (n = 1): risperidone plus atenolol; bradycardia (n = 1): perphenazine with metoprolol; ventricular arrhythmias: sertindole with metoprolol (n = 1) and ziprasidone with sotalol (n = 3)] and hypotension [chlorprotixene with nebivolol or metoprolol (n = 2)]. 12 cases concerned statins-myalgia, myopathy, or creatine kinase elevation appeared after combination of atorvastatin with haloperidol (n = 1), quetiapine (n = 3) or risperidone (n = 1), and simvastatin with quetiapine (n = 5) or risperidone (n = 2). There were also cases of interactions observed for the use of antipsychotics with anti-arrhythmic drugs (amiodarone, flecainide, propafenone) (n = 11), calcium channel blockers (n = 6), and other cardiac medications: clonidine, dabigatran, doxazosin, ivabradine, and losartan (n = 10). CONCLUSIONS: Due to a high risk of interactions and related adverse effects, particular attention should be paid while using cardiovascular medications with antipsychotics. Clinical decisions should be preceded by a detailed analysis of safety, risk-benefit ratio to search for, as safe as possible, drug combinations.
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Siwek et al. (2020) conducted an observational in Adverse drug reactions from polypharmacy (n=52). Combination of antipsychotics and cardiovascular medications was evaluated on Occurrence and type of adverse drug interactions. Adverse interactions between antipsychotics and cardiovascular medications most frequently involved beta-blockers (25% of cases) and statins (23% of cases), leading to arrhythmias, hypotension, and muscle disorders.
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