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Efectos Psiquiatricos de Drogas No Psiquiatricas PDF
Efectos Psiquiatricos de Drogas No Psiquiatricas PDF
Efectos Psiquiatricos de Drogas No Psiquiatricas PDF
ACEIs
E.g. captopril, enalapril3,6 Fatigue, hallucinations, delirium, mood
disturbances
Analgesics
Opiates7 Sedation, dysphoria, confusion, mood Psychiatric reactions are relatively
changes including euphoria, sleep disturbances, common with opiates
hallucinations, psychosis, delirium, dependence
5-HT1 agonists (sumatriptan)6 Fatigue, anxiety, panic attacks
Antibiotics
Cephalosporins, penicillins, Sleep disturbances (insomnia and All antibiotics can cause delirium.
quinolones,6 tetracyclines somnolence), delirium, hallucinations Patients with underlying medical
conditions may be at higher risk
of developing psychiatric ADRs.
Of the quinolones, ciprofloxacin
causes the most psychiatric ADRs,
including mood disturbances8
agitation and confusion6
Anti-epileptics6
Carbamazepine Depression, agitation, sedation, psychosis, Psychosis has also been reported
cognitive impairment, delirium with oxcarbazepine
Ethosuximide Mood changes, irritability, sleep disturbances,
psychosis, delirium
Levetiracetam Irritability, sedation, psychosis
Phenytoin Agitation, insomnia, delirium, psychosis Psychosis has also been reported
with fosphenytoin
Topiramate9 Psychosis, depression and emotional lability, Psychosis is much more common
cognitive dysfunction, paraesthesia, behavioural with topiramate (6%) than with other
changes anti-epileptics
Paraesthesia and cognitive complaints
are the most common central nervous
system ADRs; paraesthesia is dose-related
Sodium valproate Sedation, hallucinations, depression, delirium
Vigabatrin Agitation, lethargy, irritability, depression, Psychosis is more common with
psychosis, cognitive impairment vigabatrin (2e4%) than with other
anti-epileptics although it may be transient
Antimuscarinics
E.g. biperiden, orphenadrine, Anxiety, agitation, insomnia, psychosis,
procyclidine, trihexyphenidyl6 delirium, visual hallucinations
Antimalarials
Chloroquine, mefloquine3,6,7,10 Anxiety, depression, suicidality, panic attacks, Symptoms begin very early in treatment
hallucinations, psychosis
Antiparkinsonian treatments
Levodopa6 Visual hallucinations, depression, hypomania,
sleep disturbances, abnormal dreams, cognitive
impairment, agitation, psychosis, delirium
Dopamine agonists6 Sedation, psychomotor agitation, anxiety, These are associated with more
akathisia, sleep disturbances, psychosis, psychiatric adverse effects than levodopa11
cognitive impairment, delirium, visual
hallucinations
Amantadine6 Decreased concentration, sleep disturbances,
visual hallucinations, irritability, anxiety,
depression, euphoria, fatigue, psychosis, delirium
Table 2 (continued )
Drug Psychiatric ADR Comment
Table 2 (continued)
Drug Psychiatric ADR Comment
Others agents
Interferons e a and b4,5 Depression, loss of efficacy of previously Psychiatric ADRs are relatively unlikely with
effective antidepressants, suicidal ideation, interferon- b, but are much more widely
delirium, non-specific psychiatric symptoms reported with interferon-a
Rare case reports of psychosis and mania Interferon-a-associated depression responds
with interferon-a16 to antidepressants, use of which can be
preventative4
Isotretinoin17,20 Depression, suicide, psychosis The increased risk of suicide continues
for up to 6 months after discontinuing
treatment. The risk is not higher in those
with suicide attempts before initiating
isotretinoin. The effect is not related to
dose or duration of treatment.18 If psychiatric
changes occur it should be discontinued
and psychiatric advice sought14
Naltrexone12 Dysphoria, fatigue, sleep disturbances,
suicidal ideation, hallucinations, delirium
Postoperative cognitive Confusion, agitation, anxiety, poor Onset is usually straight after surgery,
dysfunction (POCD)18 concentration, memory loss, sleep usually resolving within a few days.
disturbances, psychotic symptoms Most common in the elderly
Varenicline6,19 Exacerbation of pre-existing psychiatric Suicidal ideation and behaviour in patients
disorders, changes in behaviour, with no pre-existing psychiatric disorder
hostility, acute psychosis, agitation, Patients with a psychiatric history are at a
depressed mood or worsening of greater risk of developing psychiatric ADRs
depression, suicidal ideation and A large postmarketing study showed 3%
behaviour, attempted suicide of patients experienced symptoms of
depression6
ACEI, angiotensin-converting enzyme inhibitor; ADR, adverse reaction; COMT, catechol-O-methyltransferase; MAO, monoamine oxidase.
Table 2
psychotropic associated with depression in the top 10 drugs lis- 4 Patten SB. Psychiatric side effects of interferon treatment. Curr Drug
ted in the US Food and Drug Administration database. Suicide Saf 2006; 1: 143e50.
has not been associated with other treatments for acne (i.e. 5 Bygdell M, Brunlo € f G, Wallerstedt SM, Kindblom JM. Psychiatric
antimicrobials). adverse drug reactions reported during a 10-year period in the
Swedish pediatric population. Pharmacoepidemiol Drug Saf 2011;
Corticosteroids15,20 21: 79e81.
It has been long established that corticosteroids can cause 6 Tome AM, Filipe A. Quinolones: review of psychiatric and neurological
numerous and complex psychiatric ADRs. The most common are adverse reactions. Drug Saf 2011; 34: 465e88.
affective (mania, depression, mood lability and mixed affective 7 Turjanski N, Lloyd GG. Psychiatric side-effects of medications: recent
states) as well as euphoria. Mania is usually seen in patients developments. Adv Psychiatr Treat 2005; 11: 58e70.
taking short courses, whereas depression tends to be seen during 8 Luykx JJ, Carpay JA. Nervous system adverse responses to topiramate
longer courses (>6 months). Psychosis and delirium have been in the treatment of neuropsychiatric disorders. Expert Opin Drug Saf
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previous experience of psychiatric illnesses, and the dose does clinical trials of varenicline. Drug Saf 2010; 33: 289e301.
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ADR. Depression and mania have frequently been reported when events associated with the use of mefloquine and combination of
decreasing or ceasing corticosteroids. Psychiatric ADRs may chloroquine and proguanil as antimalarial prophylaxis: postal survey
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11 British National Formulary. 62 edn. London: British Medical Associ-
Post-operative cognitive dysfunction18 ation and Royal Pharmaceutical Society, September 2011.
Confusion after a major operation is relatively common, and 12 Arendt G, de Nocker D, von Gliesen H-J, Molting T. Neuropsychiatric
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At the time of an operation lots of factors and influences may Papadimitriou GN. Isotretinoin and psychopathology: a review. Ann
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Varenicline
18 The Royal College of Anaesthetists. Risks associated with your
Although some early varenicline data did not find any significant
anesthetic. Information for patients 2010.
increase in psychiatric ADRs compared with placebo when used
19 Harrison-Woolrych M, Ashton J. Psychiatric adverse events associated
in people without any psychiatric disorders, there were limita-
with varenicline: an intensive postmarketing prospective cohort
tions to these data.9 Subsequent post-licensing monitoring has
study in New Zealand. Drug Saf 2011 Sep 1; 34: 763e7.
shown an association of neuropsychiatric symptoms (e.g.
20 Warrington TP, Bostwick JM. Psychiatric adverse effects of cortico-
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steroids. Mayo Clin Proc 2006; 81: 1361e7.
of varenicline.19 A 21 Novartis Pharmaceuticals UK Ltd. Clozaril 25 mg and 100 mg Tablets
Summary of Product Characteristics. Last updated on the eMC:
09/06/2010.
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