Antidepressant drugs cardiac disease

Amantadine is used cautiously in patients with seizure disorders, psychiatric problems, renal impairment, and cardiac disease. Amantadine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. Concurrent use of antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, and quinidine may increase the anticholinergic effects (dry mouth, blurred vision, constipation) of amantadine... 

Several factors increase the risk of thioridazine toxicity pre-existing cardiac disease, hypokalemia, a glucose load, alcohol, exercise, and concomitant therapy with tricyclic antidepressants, erythromycin, co-trimoxazole, cisapride, risperidone, hydroxyzine, and drugs that inhibit CYP2D6 (some SSRIs, fluphenazine, and perphenazine) (11). 

Geriatric Considerations - Summary Bupropion has several advantages as an antidepressant agent for use in older adults. It has neither the anticholinergic or cardiac toxicities of the tricyclic antidepressants, and has fewer sexual side effects than selective serotonin reuptake inhibitors. Because this drug may lower seizure threshold, it should be used with caution in older adults with increased risk of seizures (e.g., previous stroke, early-onset Alzheimer s disease). 

Epinephrine usually Is administered slowly by Intravenous (IV) Injection to relieve acute asthmatic attacks not controlled by other treatments. Intravenous Injection produces an Immediate response. Use of EPI with drugs that enhance cardiac arrhythmias (digitalis or quinidine) Is not recommended. Tricyclic antidepressants and MAO Inhibitors will potentiate the effects of EPI on the heart. Epinephrine should be used with caution In Individuals suffering from hyperthyroidism, cardiovascular disease, hypertension, or diabetes. Adverse effects Include palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, dizziness, tremor, apprehension, and anxiety. 

A series of 8 patients is reported who developed cardiac complications following medication with a variety of psychotropic drugs, mainly phenothiazines and tricyclic antidepressants. Most of the patients showed arrhythmias, disorders of conduction, or both. Five of the patients, all of whom were receiving thioridazine, developed ventricular tachycardia or fibrillation. Many of the patients described showed no evidence of preexisting heart disease and 3 were below the age of 35, when the complications developed. In one female patient of 35 years ventricular tachycardia was fatal. 

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