Skip to main content
Log in

Interactions between cardioactive drugs and antidepressants

  • Special Article
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

The most important cardiovascular interactions between cardioactive drugs and monoamino-oxidase inhibitors or tricyclic antidepressants are reviewed. Post-ganglion blocking agents (e.g., guanethidine), clonidine, reserpine, and α-methyldopa should not be used in patients needing antidepressant therapy. For hypertension, diuretics, β-blokkers, and vasodilators should be used. In patients with cardiac disease negative interactions between membrane-stabilizing antiarrhythmic agents and tricyclic antidepressants may be observed. Caution is recommended when using both drugs. On the other hand, the use of digitalis is relatively free of negative interactions. Some of the mechanisms possibly involved are discussed. The practical implications of such effects are presented and some clinically useful guidelines are suggested.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Asberg, M., Cronholm, B., Sjöquist, F., Tuck, D.: Correlation of subjective side-effects with plasma concentration of nortriptyline. Brit. med. J.1970 IV, 18–21

    Google Scholar 

  2. Axelrod, J., Weinshilboum, R.: Catecholamines. New Engl. J. Med.28, 237–242 (1972)

    Google Scholar 

  3. Ayd, F. J.: Levodopa plus tricyclic antidepressants. Intern. Drug. Ther. Newsletter6, 1–2 (1971)

    Google Scholar 

  4. Boakes, A. J., Laurence, D. R., Teoh, P. C., Barar, F. S. K., Bewedikter, L. T., Prichard, B. N. C.: Interactions between sympathomimetic amines and antidepressants in man. Brit. med. J.1973 I, 311–315

    Google Scholar 

  5. Briant, R. H., Reid, J. L.: Desmethylimipramine and the hypotensive action of clonidine in the rabbit. Brit. J. Pharmacol.46, 563–564 (1972)

    Google Scholar 

  6. Cairncross, K. D.: On the peripheral pharmacology of amitriptyline. Arch. int. Pharmacodyn.154, 438–448 (1965)

    Google Scholar 

  7. Cairncross, K. D., Gershon, S.: A pharmacological basis for the cardiovascular complications of imipramine medication. Med. J. Aust.2, 372–375 (1972)

    Google Scholar 

  8. Treating depression in patients with hypertension. Drug Ther. Bull.13, 25–26 (1975)

    Google Scholar 

  9. Eckmann, J. F., Schwalb, H., Hanika, R.: Psychopharmaka und Veränderungen in EKG. Pharmakopsychiat.8, 57–68 (1975)

    Google Scholar 

  10. Emele, J. F., Shanaman, J., Warren, M. R.: Analgesic of MAO-inhibitors. Fed. Proc.18, 387 (1959)

    Google Scholar 

  11. Hollister, L. E.: Clinical use of psychotherapeutic drugs: Antidepressants. Springfield, Illinois: Charles C. Thomas, 1974

    Google Scholar 

  12. Hong Ki, W., Mauer, P., Hochman, R., Caslowitz, J. G., Paraskos, J. A.: Amitriptyline cardiotoxicity. Chest66, 304–306 (1974)

    Google Scholar 

  13. Iversen, L. L.: Inhibition of noradrenaline uptake by drugs. J. Pharm. Pharmacol.17, 62–64 (1965)

    Google Scholar 

  14. James, T. N., Isobe, J. H., Urthaler, F.: Analysis of components in a cardiogenic hypertensive chemioreflex. Circulation52, 179–192 (1975)

    Google Scholar 

  15. Jefferson, J. M.: A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom. Med.37, 160–179 (1975)

    Google Scholar 

  16. Kantor, S. J., Bigger, J. T., Glassman, A. H., Macken, D. L., Perel, J. M.: Imipramine induced heart block. J. Amer. med. Ass.,231, 1364–1366 (1975)

    Google Scholar 

  17. May, V.: Therapeutische Kombination von Psychopharmaka und Beta-Sympathicolytica. Nervenarzt46, 268–271 (1975)

    Google Scholar 

  18. Merideth, J., Mendez, C., Müller, W. J., Moe, G. K.: Electrical excitability of atrioventricular nodal cells. Circulat. Res.23, 69–85 (1968)

    Google Scholar 

  19. Meyer, J. F., McAllister, C. K., Goldberg, L. I.: Insidous and prolonged antagonism of guanethidine by amitriptyline. J. Amer. med. Ass.213, 1487–1488 (1970)

    Google Scholar 

  20. Mitchell, J. R., Cavanaugh, J. H., Arvas, L., Dingell, J. V.: Guanethidine and related agents. III. Antagonism by drugs which inhibit the norepinephrine pump in man. J. clin. Invest.49, 1596–1604 (1970)

    Google Scholar 

  21. Moir, D. C., Crooks, J., Cornwell, W. B., Dingwall-Fordyce, J., O'Malley, K., Turnbull, M. J., Weir, R. D.: Cardiotoxicity of amitriptyline. Lancet1972 II, 561–564

    Google Scholar 

  22. Müller, J., Möller, R., Schmidt, K.: Kasuistischer Beitrag zur kardiotoxischen Wirkung trizyklischer Antidepressiva. Herz Kreisl.6, 491–494 (1974)

    Google Scholar 

  23. Osborne, M., Sigg, E. B.: Effects of imipramine on the peripheral autonomic system. Arch. int. Pharmacodyn.129, 273–289 (1960)

    Google Scholar 

  24. Reuter, H.: Divalent cations as charge carriers in excitable membranes. Progr. Biophys. molec. Biol.26, 1–43 (1973)

    Google Scholar 

  25. Reuter, H.: Exchange of Calcium ions in the mammalian myocardium. Mechanism and physiological significance. Circulat. Res.34, 599–605 (1974)

    Google Scholar 

  26. Schorer, C. E.: Interactions of antidepressant and antihypertensive drugs. Drug. Ther.3, (1973)

  27. Simpson, F. O.: Tricyclic antidepressants and the vascular system. N. Z. med. J.75, 33–34 (1972)

    Google Scholar 

  28. Simpson, F. O., Waal-Manning, H. J.: Hypertension and depression: interrelated problems in therapy. J. roy. Coll. Physicians (Lond.)6, 14–24 (1971)

    Google Scholar 

  29. van Spanning, H. W., van Zwieten, P. A.: The interference of tricyclic antidepressants with the central hypotensive effect of clonidine. Europ. J. Pharmacol.24, 402–404 (1973)

    Google Scholar 

  30. Towers, M. K., Wood, P.: Use of iproniazid in ischemic angina pectoris. Brit. med. J.1958 I, 1067

    Google Scholar 

  31. Wallis, g. G.: Sympathomimetic amines and antidepressants. Brit. med. J.1973 I, 549–550

    Google Scholar 

  32. Weinstein, L.: Drugs used in the chemotherapy of tuberculosis and leprosy. In: Goodman L. S. and Gilman A.: The pharmacological basis of therapeutics. 5th Edition pp. 1201–1223. New York: MacMillan 1975

    Google Scholar 

  33. Zipes, D. P., Fischer, J. C.: Effects of agents which inhibit the slow channel on sinus node automaticity and A–V conduction in the dog. Circulat. Res.34, 184–192 (1974)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cocco, G., Agué, C. Interactions between cardioactive drugs and antidepressants. Eur J Clin Pharmacol 11, 389–393 (1977). https://doi.org/10.1007/BF00566537

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00566537

Key words

Navigation