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.
Similar content being viewed by others
References
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
Axelrod, J., Weinshilboum, R.: Catecholamines. New Engl. J. Med.28, 237–242 (1972)
Ayd, F. J.: Levodopa plus tricyclic antidepressants. Intern. Drug. Ther. Newsletter6, 1–2 (1971)
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
Briant, R. H., Reid, J. L.: Desmethylimipramine and the hypotensive action of clonidine in the rabbit. Brit. J. Pharmacol.46, 563–564 (1972)
Cairncross, K. D.: On the peripheral pharmacology of amitriptyline. Arch. int. Pharmacodyn.154, 438–448 (1965)
Cairncross, K. D., Gershon, S.: A pharmacological basis for the cardiovascular complications of imipramine medication. Med. J. Aust.2, 372–375 (1972)
Treating depression in patients with hypertension. Drug Ther. Bull.13, 25–26 (1975)
Eckmann, J. F., Schwalb, H., Hanika, R.: Psychopharmaka und Veränderungen in EKG. Pharmakopsychiat.8, 57–68 (1975)
Emele, J. F., Shanaman, J., Warren, M. R.: Analgesic of MAO-inhibitors. Fed. Proc.18, 387 (1959)
Hollister, L. E.: Clinical use of psychotherapeutic drugs: Antidepressants. Springfield, Illinois: Charles C. Thomas, 1974
Hong Ki, W., Mauer, P., Hochman, R., Caslowitz, J. G., Paraskos, J. A.: Amitriptyline cardiotoxicity. Chest66, 304–306 (1974)
Iversen, L. L.: Inhibition of noradrenaline uptake by drugs. J. Pharm. Pharmacol.17, 62–64 (1965)
James, T. N., Isobe, J. H., Urthaler, F.: Analysis of components in a cardiogenic hypertensive chemioreflex. Circulation52, 179–192 (1975)
Jefferson, J. M.: A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom. Med.37, 160–179 (1975)
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)
May, V.: Therapeutische Kombination von Psychopharmaka und Beta-Sympathicolytica. Nervenarzt46, 268–271 (1975)
Merideth, J., Mendez, C., Müller, W. J., Moe, G. K.: Electrical excitability of atrioventricular nodal cells. Circulat. Res.23, 69–85 (1968)
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)
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)
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
Müller, J., Möller, R., Schmidt, K.: Kasuistischer Beitrag zur kardiotoxischen Wirkung trizyklischer Antidepressiva. Herz Kreisl.6, 491–494 (1974)
Osborne, M., Sigg, E. B.: Effects of imipramine on the peripheral autonomic system. Arch. int. Pharmacodyn.129, 273–289 (1960)
Reuter, H.: Divalent cations as charge carriers in excitable membranes. Progr. Biophys. molec. Biol.26, 1–43 (1973)
Reuter, H.: Exchange of Calcium ions in the mammalian myocardium. Mechanism and physiological significance. Circulat. Res.34, 599–605 (1974)
Schorer, C. E.: Interactions of antidepressant and antihypertensive drugs. Drug. Ther.3, (1973)
Simpson, F. O.: Tricyclic antidepressants and the vascular system. N. Z. med. J.75, 33–34 (1972)
Simpson, F. O., Waal-Manning, H. J.: Hypertension and depression: interrelated problems in therapy. J. roy. Coll. Physicians (Lond.)6, 14–24 (1971)
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)
Towers, M. K., Wood, P.: Use of iproniazid in ischemic angina pectoris. Brit. med. J.1958 I, 1067
Wallis, g. G.: Sympathomimetic amines and antidepressants. Brit. med. J.1973 I, 549–550
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
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)
Author information
Authors and Affiliations
Rights 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
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00566537