Psychiatric Drugs and Anesthesia


T. Peck, A. Wong, E. Norman. Anaesthetic implications of psychoactive drugs. Continuing Education in Anesthesia. Crit Care Pain, 10 (2010), pp. 177–181

Summary of perioperative advice for patients taking psychotropic drugs

Drug group Examples of drug Perioperative concerns Withdrawal symptoms Preoperative discontinuation recommendations
TCAs Amitriptyline, imipramine, dosulepin Muscarinic, histaminergic, and α-adrenergic blocking effect Yes Discontinue
SSRIs Venlafaxine, fluoxetine Anti-cholinergic effect Yes Can continue
Avoid serotonin crisis precipitants
MAOIs Phenelzine, moclobemide Avoid indirect-acting sympathomimetics Yes Irreversible MAOI—discontinue 2 weeks before surgery
Avoid serotonin crisis precipitants Reversible MAOI—discontinue on day of surgery
Mood stabilizers Lithium Prolongation of NMB drugs No Discontinue 24 h before surgery
Reduction in anaesthetic agent requirements
Avoid NSAIDs
Carbamazepine Inducer of cytochrome P450 system No Can continue
Valproate Interferes with platelet function No Can continue
Typical antipsychotics Prochlorperazine, chlorpromazine Cholinergic, α1-adrenergic, and histaminergic blocking effect Yes Can continue
Caution desflurane
Atypical antipsychotics Quatiepine, risperidone α1-adrenergic blocking effect Yes Can continue
BDZs Lorazepam, temazepam Sedative Yes Can continue

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