Should psychiatric medications like Risperidone, Carbamazepine, and Memantine be discontinued first in a patient with Acute Coronary Syndrome (ACS) Non-ST-Elevation Myocardial Infarction (NSTEMI)?

From the Guidelines

In managing a patient with ACS NSTEMI, it is generally not recommended to abruptly discontinue psychiatric medications like risperidone, carbamazepine, or memantine, as this can lead to withdrawal symptoms, psychiatric decompensation, or worsening of underlying conditions, which could complicate cardiac recovery. These medications should be continued during acute cardiac care unless there are specific contraindications or drug interactions that pose immediate risks. Psychiatric medication management should be coordinated with cardiology and psychiatry teams to ensure both cardiac and mental health needs are addressed. For risperidone, be aware it may prolong QT interval, so ECG monitoring is advisable 1. Carbamazepine requires attention due to potential interactions with cardiac medications like calcium channel blockers and certain anticoagulants. Memantine typically has fewer cardiac concerns but should still be maintained for cognitive stability. The priority should be treating the NSTEMI with standard protocols (antiplatelet therapy, anticoagulation, beta-blockers, etc.) while carefully monitoring for any adverse effects from continuing psychiatric medications.

Some key considerations in the management of NSTEMI include:

• Initiating or continuing high-intensity statin therapy in patients with no contraindications 1
• Administering supplemental oxygen only with oxygen saturation <90%, respiratory distress, or other high-risk features for hypoxemia 1
• Using beta-blockers, unless contraindicated, to reduce morbidity and mortality 1
• Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) except for aspirin due to increased risk of adverse cardiac events 1

Overall, the management of a patient with ACS NSTEMI requires careful consideration of both cardiac and psychiatric factors to optimize outcomes and minimize risks. Continuing psychiatric medications like risperidone, carbamazepine, or memantine, unless contraindicated, is a key part of this approach.

From the Research

Management of Psychiatric Medications in ACS NSTEMI

• The provided studies do not directly address the management of psychiatric medications like Risperidone, carbamazepine, and Memantine in patients with ACS NSTEMI 2, 3, 4, 5, 6.
• The studies focus on the diagnosis, treatment, and management of ACS NSTEMI, including antiplatelet, antithrombotic, and anti-ischemic therapies, as well as revascularization strategies 2, 3, 4, 5, 6.
• There is no mention of psychiatric medications or their management in the context of ACS NSTEMI in the provided studies.
• Therefore, there is no evidence to suggest whether it is wise to stop psychiatric medications like Risperidone, carbamazepine, and Memantine first in patients with ACS NSTEMI.

General Considerations

• Patients with ACS NSTEMI require intensive medical therapy, including antianginal, antiplatelet, antithrombotic, and statin agents 6.
• The management of ACS NSTEMI involves a comprehensive approach, including diagnosis, treatment, and risk stratification 2, 3, 4, 5, 6.
• The use of high-sensitivity troponin assays and computer tomography angiography has improved the diagnosis and risk stratification of patients with ACS NSTEMI 4, 5.