Pharmacologic Treatment of Depression in Older Patients with COPD

 

CLINICAL RECOMMENDATIONS:

 

(1) ANTIDEPRESSANT DOSING:

 

  • ‘start low and go slow’ with antidepressants.

  • Try not reach a therapeutic dose in patients with adequate tolerance.

 


(2) DRUG INTERACTIONS:

 

(A) Antidepressants with COPD treatment (Beta-2 Adrenergic Agonists: albuterol, indacaterol, and salmeterol):

 

  • Beta-2 adrenergic agonists can cause dose-related prolongation of the QT interval and potassium loss.

  • Avoid antidepressants with risk of QTc prolongation.

 

  • Beta-2 adrenergic agonists have cardiovascular side effects such as hypertension, palpitation, and chest pain.

  • Tricyclic antidepressants (TCAs) can potentiate these cardiovascular adverse effects.

 

(B) Antidepressants with COPD treatment (Anticholinergic Bronchodilators: tiotropium, iptratropium):

 

  • Tricyclic antidepressants (TCAs) + Anticholinergic bronchodilators = additive anticholinergic side effects including dry mouth, tachycardia, urinary retention, constipation, mydriasis, blurred vision, heat intolerance, confusion, fever, and exacerbation of glaucoma.

 


Do you consider these interactions while prescribing antidepressants to patients with co-morbid COPD. Please do share relevant articles on this topic. 

 


SOURCE:
  • Drugs Aging. 2014 July ; 31(7): 483–492.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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