Table 2 Cardiovascular Considerations in the Treatment of Bipolar Disorder
From: Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities
Drug + | EKG or Conduction Changes | Congestive Heart Failure | Orthostatic Hypotension | Post-Myocardial Infarction |
|---|---|---|---|---|
Lithium * (therapeutic level) | Sinus node dysfunction; T wave flattening/inversion; rare 1 stdegree AV block & aggravation of ventricular arrhythmias | May exacerbate symptoms of CHF; monitor level due to fluid/electrolyte changes | None | Monitor for electrolyte aberrations; in combination with ACE inhibitors, increased risk of arrhythmia |
(toxicity) | Sinoatrial block; AV block/dissociation bradyarrhythmias; ventricular tachycardia/fibrillation | Â | Â | Â |
Valproate * | Unlikely | May require decrease in valproate dose | None | Risk of liver injury in conjunction with lipid-lowering agents; risk of bleeding complications in conjunction with antiplatelet agents, warfarin, niacin |
Carbamazepine | Quinidine-like properties increase risk of complete heart block | May require decrease in carbamazepine dose | None | Induction of CYP3A4 increases metabolism of some anticoagulant & cardiovascular drugs |
Olanzapine * | Unlikely | May require decrease in olanzapine dose | Minimal | Increased cardiac risk factors: weight gain, metabolic changes and hyperlipidemia |
Ziprasidone | QT prolongation; risk of torsade de pointes | May require decrease in ziprasidone dose | Minimal | Should be avoided due to increased risk of arrhythmia |
Risperidone * | Unlikely | May require decrease in risperidone dose | Some orthostatic hypotenstion | Increased cardiac risk factors: some weight gain |
Quetiapine * | Unlikely | May require decrease in quetiapine dose | Significant orthostatic hypotension | Increased cardiac risk factors: weight gain |