Abstract
This chapter is an overview of general principles of prescribing psychotropic medications in people with preexisting medical conditions. Effects of failure in major organ systems that affect drug absorption, metabolism, and excretion are reviewed.
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Appendix
Appendix
Selected psychiatric adverse effects of nonpsychotropic medications [4]
Medication class | Adverse effect |
|---|---|
Steroids | Dose-dependent risk of depression, mania and rarely, psychosis |
Hormonal contraceptives | Risk of depression, mood instability, especially with higher progestin content |
Opiates | Associated with acute delirium and psychosis |
Varenicline | Case reports of depression and suicidal ideation but not replicated in large cohorts |
Beta blockers | Associated with depression but low risk; not replicated in large cohorts |
Anticonvulsants | Delirium and psychosis, possibly depression |
Interferon | High risk of depression (less commonly used now with advent of directly acting antiviral agents for hepatitis C) |
Antiretroviral medications (e.g., efavirenz, zidovudine) | Depression, suicidal ideation, personality changes |
Selected psychotropic and nonpsychotropic drug interactions
Psychotropic | Interaction with nonpsychotropic |
|---|---|
Lithium | Thiazide diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs) increase lithium concentration by tubal reabsorption |
Benzodiazepines | Opiate concurrent use carries risk of severe respiratory suppression |
Selective serotonin reuptake inhibitors (SSRIs) | Serotonergic agents (e.g., triptans, tramadol, opiates) use increases risk for serotonin syndrome |
Antipsychotics that increase risk of QTc prolongation | Antibiotics (e.g., quinolones, macrolide agents) carry additive risk |
Low-potency antipsychotics, tricyclic antidepressants (TCAs) | Antihypertensives, especially multiple agents, increase risk for orthostasis |
Carbamazepine | Phenytoin decreases medication level and some medications (e.g., macrolide antibiotics, azole antifungals, isoniazid) increase medication level Oral contraceptive levels and efficacy may be lowered when used with carbamazepine |
Psychotropic medications and pregnancy [5, 6]
Medication class | Effects in pregnancy |
|---|---|
Antidepressants | Low risk of teratogenicity with all classes Selective serotonergic reuptake inhibitors (SSRIs) associated with increased risk of premature birth, neonatal pulmonary hypertension though extent of risk is small Paroxetine possibly carries higher risk |
Antipsychotics | Low risk of teratogenicity Some risk of gestational diabetes and related complications Possible neonatal sedation and transient extrapyramidal symptoms |
Mood stabilizers | Risk of Ebstein’s anomaly with lithium is low; possible risk of neonatal hypothyroidism Carbamazepine and valproate associated with significant risk of neural tube defects and are relatively contraindicated Lamotrigine is likely the safest agent in this category |
Benzodiazepines | Low risk of teratogenicity Possible sedation and neonatal withdrawal syndrome |
Stimulants | Low risk of teratogenicity Possible premature birth, low birth weight, neonatal withdrawal syndrome |
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Annamalai, A. (2017). Psychotropic Prescribing in Medically Ill Patients. In: Medical Management of Psychotropic Side Effects. Springer, Cham. https://doi.org/10.1007/978-3-319-51026-2_1
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DOI: https://doi.org/10.1007/978-3-319-51026-2_1
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