Psychotropic Drug Use in the Medically Ill: Part! ALAN STOUDEMIRE. M.D. MICHAEL
G.
MORAN. M.D.
BARRY S. FOGEL. M.D.
Underlying medical illness and drug interactions may make the use ofpsyclwtropic agellts in some physically ill patients prohlematic. This {)I·e/Tiew. puhlished in two parts. discusses six major classes ofpsychotropic medications (cyclic antidepressallts. monoamine oxidase inhihitors. hen::.odia::.epines. neuroleptics.lithium. psychostimulallts. and carhama::.epine) and examines their use in the setting ofspecij/c types olmedical illnesses (e.g .. cardiol'ascular. pulmonary. hepatic. and renal disease). Practical comiderations in using psychotropic medications in medical-surgical patiellts. particularly those who are elderly or medically dehilitated. receil'e special emphasis. /n part /. the use of cyclic alltidepressants. monoamine oxidase inhihito/'S. hen::.odia::.epines. and huspirone are disCllssed.
'l X71 th the general aging of the American popY Y ulation and prolonged survival of patients with chronic diseases. physicians increasingly will be called upon to treat patients with concurrent medical and psychiatric illnesses. Prescribing psychotropic medications in medically ill patients. particularly those who are physiologically unstable. requires careful risk-benefit assessment. Special psychopharmacologic considerations in the medical-psychiatric population include: a) potential interactions of psychotropic medications with drugs used for medical disorders. b) impaired renal. hepatic. or gastrointestinal functioning that may alter psychotropic drug metabolism. and c) psychotropic medication side effects that may aggravate preexisting medical conditions. This article will consider the use of psychotropic drugs in the medically ill and suggest appropriate prescribing patterns based on evaluation of their side-effect profiles, drug interactions, and pharmacokinetic properties. Because of space limitations, only VOLL:ME 3\ • NUMBER
~.
FAll. \990
potential drug interactions of major clinical importance will be discussed in detail. with others listed in the tables. Discussions of relatively wellknown drug interactions may be found in review articles in the reference list I.~ more recent reviews are referenced separately in the tables. This paper will serve primarily as a basic overview of special considerations in the use of psychotropic agents in medically fragile patients. More extensive critical reviews of the use of psychotropic agents may be found in our more
Received August X. I
G.
MORAN. M.D.
BARRY S. FOGEL. M.D.
Underlying medical illness and drug interactions may make the use ofpsyclwtropic agellts in some physically ill patients prohlematic. This {)I·e/Tiew. puhlished in two parts. discusses six major classes ofpsychotropic medications (cyclic antidepressallts. monoamine oxidase inhihitors. hen::.odia::.epines. neuroleptics.lithium. psychostimulallts. and carhama::.epine) and examines their use in the setting ofspecij/c types olmedical illnesses (e.g .. cardiol'ascular. pulmonary. hepatic. and renal disease). Practical comiderations in using psychotropic medications in medical-surgical patiellts. particularly those who are elderly or medically dehilitated. receil'e special emphasis. /n part /. the use of cyclic alltidepressants. monoamine oxidase inhihito/'S. hen::.odia::.epines. and huspirone are disCllssed.
'l X71 th the general aging of the American popY Y ulation and prolonged survival of patients with chronic diseases. physicians increasingly will be called upon to treat patients with concurrent medical and psychiatric illnesses. Prescribing psychotropic medications in medically ill patients. particularly those who are physiologically unstable. requires careful risk-benefit assessment. Special psychopharmacologic considerations in the medical-psychiatric population include: a) potential interactions of psychotropic medications with drugs used for medical disorders. b) impaired renal. hepatic. or gastrointestinal functioning that may alter psychotropic drug metabolism. and c) psychotropic medication side effects that may aggravate preexisting medical conditions. This article will consider the use of psychotropic drugs in the medically ill and suggest appropriate prescribing patterns based on evaluation of their side-effect profiles, drug interactions, and pharmacokinetic properties. Because of space limitations, only VOLL:ME 3\ • NUMBER
~.
FAll. \990
potential drug interactions of major clinical importance will be discussed in detail. with others listed in the tables. Discussions of relatively wellknown drug interactions may be found in review articles in the reference list I.~ more recent reviews are referenced separately in the tables. This paper will serve primarily as a basic overview of special considerations in the use of psychotropic agents in medically fragile patients. More extensive critical reviews of the use of psychotropic agents may be found in our more
Received August X. I
