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Sinus node dysfunction due to psychotropic agents' combination

Published online by Cambridge University Press:  24 June 2014

József Simkó*
Affiliation:
Department of Cardiology, Institute of Medicine, Semmelweis Health Care Center, Miskolc, Hungary
Gabriella Nagy
Affiliation:
Department of Cardiology, Institute of Medicine, Semmelweis Health Care Center, Miskolc, Hungary
Anikó Dózsa
Affiliation:
Department of Dermatology, Semmelweis Health Care Center, Miskolc, Hungary
István Lörincz
Affiliation:
Division of Emergency Medicine, First Department of Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
*
József Simkó, Department of Cardiology, Institute of Medicine, Semmelweis Health Care Center, Csabai kapu 9-11, Miskolc 3529, Hungary. Tel: +36 46 555666; Fax: +36 46 562592; E-mail: [email protected]

Extract

Background: Although sinus node dysfunction is primarily related to degenerative fibrosis of nodal tissue in the elderly, it may occur at any age secondary to other cardiac abnormalities or extrinsic causes. Pharmacologic agents including psychotropic drug therapy may also play a role.

Method: We present the case of a 53-year-old woman with bipolar affective disorder in whom antipsychotic agents were suspected of inducing sinus node dysfunction.

Result: The combination of psychotropic agents including lithium, quetiapine and carbamazepine (first occasion) or escitalopram (second occasion) has been implicated as a cause for sinus node dysfunction.

Conclusion: Patients with severe mental illness usually require long-term psychotropic drug therapy, often in combination. This may enhance efficacy but also involves an increased risk of adverse effects including cardiotoxicity.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2012

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References

1.Adán, V, Crown, LA.Diagnosis and treatment of sick sinus syndrome. Am Fam Physician 2003;67:17251732.Google ScholarPubMed
2.Ahrens, B, Müller-Oerlinghausen, B.Does lithium exert an independent antisuicidal effect? Pharmacopsychiatry 2001;34:132136.CrossRefGoogle ScholarPubMed
3.Müller-Oerlinghausen, B, Berghöfer, A, Ahrens, B.The antisuicidal and mortality-reducing effect of lithium prophylaxis: consequences for guidelines in clinical psychiatry. Can J Psychiatry 2003;48:433439.CrossRefGoogle ScholarPubMed
4.Brady, HR, Horgan, JH.Lithium and the heart. Unanswered questions. Chest 1998;93:166169.CrossRefGoogle Scholar
5.Shiraki, T, Kohno, K, Saito, D, Takayama, H, Fujimoto, A.Complete atrioventricular block secondary to lithium therapy. Circ J 2008;72:847849.CrossRefGoogle ScholarPubMed
6.Johnson, CD, Rivera, H, Jiménez, JE.Carbamazepine-induced sinus node dysfunction. P R Health Sci J 1997;16:4549.Google ScholarPubMed
7.Takayanagi, K, Yamaguchi, H, Hayashi, T, Morooka, S, Takabatake, Y.Carbamazepine-induced bradycardia- tachycardia syndrome with pharmacological analysis and concurrent ECG monitoring. J Electrocardiol 1990;23: 8588.CrossRefGoogle ScholarPubMed
8.Steckler, TL.Lithium- and carbamazepine-associated sinus node dysfunction: nine year experience in a psychiatric hospital. J Clin Psychopharmacol 1994;14:336339.Google ScholarPubMed
9.Mestre, M, Djellas, Y, Carriot, T, Cavero, I.Frequency-independent blockade of cardiac Na+ channels by riluzole: comparison with established anticonvulsants and class I anti-arrhythmics. Fundam Clin Pharmacol 2000;14:107117.CrossRefGoogle ScholarPubMed
10.Kasarskis, EJ, Kuo, CS, Berger, R, Nelson, KR.Carbamazepine-induced cardiac dysfunction. Characterization of two distinct clinical syndromes. Arch Intern Med 1992;152:186191.CrossRefGoogle ScholarPubMed
11.Gareri, P, De Fazio, P, De Fazio, S, Marigliano, N, Ferreri Ibbadu, G, De Sarro, G.Adverse effects of atypical antipsychotics in the elderly: a review. Drugs Aging 2006;23:937956.CrossRefGoogle ScholarPubMed
12.Gajwani, P, Pozuelo, L, Tesar, GE.QT interval prolongation associated with quetiapine (Seroquel) overdose. Psychosomatics 2000;41:6365.CrossRefGoogle ScholarPubMed
13.Nudelman, E, Vinuela, LM, Cohen, CI.Safety in overdose of quetiapine: a case report (letter). J Clin Psychiatry 1998;59:433.CrossRefGoogle Scholar
14.Janse, A, Marijnissen, RM.Quetiapine-induced bradycardia without QT interval prolongation in an elderly woman. Prim Care Companion J Clin Psychiatry 2009;11:172173.CrossRefGoogle ScholarPubMed
15.Chou, PH, Lin, CC, Lee, CP, Lan, TH, Chan, CH.Quetiapine-induced reversible sick sinus syndrome. Psychiatry Clin Neurosci 2010;64:444445.CrossRefGoogle ScholarPubMed
16.Bakken, GV, Rudberg, I, Christensen, H, Molden, E, Refsum, H, Hermann, M.Metabolism of quetiapine by CYP3A4 and CYP3A5 in presence of absence of cytochrome B5. Drug Metab Dispos 2009;37:254258.CrossRefGoogle ScholarPubMed
17.Grimm, SW, Richtand, NM, Winter, HR, Stams, KR, Reele, SB.Effects of cytochrome P450 3A modulators ketoconazole and carbamazepine on quetiapine pharmacokinetics. Br J Clin Pharmacol 2006;61:5869.CrossRefGoogle ScholarPubMed
18.Wang, EJ, Lew, K, Casciano, CN, Clement, RP, Johnson, WW.Interaction of common azole antifungals with P-glycoprotein. Antimicrob Agents Chemother 2002;46: 160165.CrossRefGoogle ScholarPubMed
19.Boulton, DW, Devane, CL, Liston, HL, Markowitz, JS.In vitro P-glycoprotein affinity for atypical and conventional antipsychotics. Life Sci 2002;71:163169.CrossRefGoogle ScholarPubMed
20.Kemp, A.Depression, antidepressant treatment and the cardiovascular system. Acta Neuropsychiatr 2011;23:8283.CrossRefGoogle Scholar
21.Hamplova-Peichlova, J, Krusek, J, Paclt, I, Slavicek, J, Lisa, V, Vyskocil, F.Citalopram inhibits L-type calcium channel current in rat cardiomyocytes in culture. Physiol Res 2002;51:317321.CrossRefGoogle ScholarPubMed
22.Pacher, P, Ungvari, Z, Nanasi, PP, Furst, S, Kecskemeti, V.Speculations on difference between tricyclic and selective serotonin reuptake inhibitor antidepressants on their cardiac effects. Is there any? Curr Med Chem 1999;6:469480.CrossRefGoogle Scholar
23.Padala, KP, Padala, PR, Wengel, SP.Dose-dependent bradycardia with citalopram in an elderly patient. Prim Care Companion J Clin Psychiatry 2010;12:PCC.09100789.Google Scholar
24.Beyenburg, S, Schönegger, K.Severe bradycardia in a stroke patient caused by a single low dose of escitalopram. Eur Neurol 2007;57:5051.CrossRefGoogle Scholar
25.Rao, N.The clinical pharmacokinetics of escitalopram. Clin Pharmacokinet 2007;46:281290.CrossRefGoogle ScholarPubMed