Adverse effects of interactions between antidepressants and medications used in treatment of cardiovascular disorders
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Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Farmakologii, Zakład Farmakologii Klinicznej
Szpital Uniwersytecki w Krakowie, Kliniczny Oddział Anestezjologii i Intensywnej Terapii nr 1, Oddział Kliniczny Chorób Wewnętrznych i Geriatrii
Uniwersytecki Ośrodek Monitorowania i Badania Niepożądanych Działań Leków w Krakowie
Uniwersytet Jagielloński Collegium Medicum, Katedra Psychiatrii, Zakład Zaburzeń Afektywnych
Uniwersytet Jagielloński Collegium Medicum, Katedra Psychiatrii
Submission date: 2018-07-22
Final revision date: 2018-09-25
Acceptance date: 2018-09-25
Online publication date: 2019-10-30
Publication date: 2019-10-30
Corresponding author
Marcin Siwek   

Zakład Zaburzeń Afektywnych, Katedra Psychiatrii UJ CM, Kraków, Kopernika 21a, 31-501 Kraków, Polska
Psychiatr Pol 2019;53(5):977-995
To evaluate harmful interactions between antidepressants and medications used in treatment of cardiovascular disorders.

The analysis of 66 cases of adverse reactions with a clinical picture indicating, to a degree that is probable or certain, that they were the result of the combination of antidepressant with cardiovascular medication.

The most common side effect (n = 25, 37.9%) was bradycardia (and other side effects of beta blockers) as a consequence of addition of metoprolol or propranolol to SSRI or bupropion. In one case combination of fluoxetine with propranolol resulted in cardiac arrest. We observed 8 cases of intensified side effects of amlodipine (swelling of lower limbs, headaches) after its combination with: fluoxetine, sertraline and paroxetine, and occurrence of myalgia, elevated aminotransferase levels, polyuria and hypotension after combination of lercanidipine with some of the SSRIs. We also found i.a. worsening of propafenone tolerance in combination with venlafaxine or bupropion, 2 cases of granulopenia associated with duloxetine–propafenone combination, 2 cases of hemorrhagic complications associated with the combination of vortioxetine–warfarin, 1 case of hyponatremia associated with the combination of vortioxetine and hydrochlorothiazide, as well as antagonizing clonidine’s hypotensive effect by mirtazapine, and peripheral thrombosis following the combination of warfarin with trazodone.

Because of ahigh risk of interactions and related adverse effects, especially in older patients, each decision regarding combination of a particular antidepressant with a medication used in treatment of cardiovascular disorders should be preceded by a detailed analysis of safety and risk-benefit ratio, and also be associated with the search for the safest, alternative combinations of the above-mentioned medications.

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