Cardiovascular Effects of Combining Subcutaneous or Intravenous Esketamine and the MAO Inhibitor Tranylcypromine for the Treatment of Depression: A Retrospective Cohort Study.

Publication date: Jul 20, 2021

(Es)ketamine and monoamine oxidase inhibitors (MAOIs), e. g., tranylcypromine, are therapeutic options for treatment-resistant major depression. Simultaneous administration is currently not recommended because of concern about hypertensive crises. Our objective was to evaluate whether changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) during esketamine administration differed between patients who concomitantly received tranylcypromine and those who did not. This was a retrospective cohort study utilizing cardiovascular monitoring data from inpatients treated for severe depression in unipolar, bipolar, and schizoaffective disorder. Primary outcomes were change in mean BP and HR during the first hour after intravenous or subcutaneous esketamine administration compared with baseline, controlled for confounders. Secondary analyses quantify differences in absolute BP during esketamine treatment and comparisons of BP peaks, temporal effects, and intraindividual comparisons before and after tranylcypromine initiation. Our analysis included 509 esketamine administrations in 43 patients, 14 of whom concomitantly received tranylcypromine. Controlling for creatinine and age, mean +/- standard deviation (SD) BP changes were significantly increased by concomitant tranylcypromine treatment (ΔSBP: F[1,503] = 86. 73, p 

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Concepts Keywords
Cardiovascular Esketamine
F1503 Sedatives
Inpatients Nicotinic antagonists
Monoamine Arylcyclohexylamines
Retrospective NMDA receptor antagonists
Psychoactive drugs
Monoamine oxidase inhibitor


Type Source Name
drug DRUGBANK Esketamine
drug DRUGBANK Tranylcypromine
disease MESH Depression
drug DRUGBANK Ketamine
disease MESH schizoaffective disorder
drug DRUGBANK Creatinine
drug DRUGBANK Tenocyclidine
drug DRUGBANK Trestolone
disease MESH anxiety
drug DRUGBANK Norepinephrine
drug DRUGBANK Dopamine
drug DRUGBANK Coenzyme M
drug DRUGBANK Tyramine
drug DRUGBANK Phenelzine
drug DRUGBANK Selegiline
disease MESH unipolar depression
disease MESH bipolar depression
disease MESH sympathomimetic
disease MESH hypertension
disease MESH diagnoses
drug DRUGBANK Flunarizine
disease MESH cardiovascular risk
disease MESH sitting
drug DRUGBANK Psilocybine
drug DRUGBANK L-Aspartic Acid
disease MESH treatment resistant depression
disease MESH relapse

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