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Update on Psychotropic Medication Use in Renal Disease

Received Oct. 28, 2002; revision received March 27,2003; accepted April 15, 2003. From the Psychiatric Consultation Service and Renal Transplantation Service, Baystate Medical Center; Springfield, Mass.; the Department of Psychiatry, Tufts University School of Medicine, Boston; Physicians Assistant Program, Springfield College, Springfield, Mass.; ARxGOS Consulting., Keene, N.H.; and Kingsboro Psychiatric Center, Brooklyn, N.Y. Address reprint requests to Dr. Cohen, Tufts University School of Medicine, c/o Baystate Medical Center, S2669, Chestnut St., Springfield, MA 01199; lewis.cohen{at}bhs.org (e-mail).

Renal failure is a common medical condition, and many patients have comorbid psychiatric disorders. In this review, which is intended as a resource for consultation psychiatrists, the authors discuss pharmacokinetic considerations and provide information about the use of individual psychotropic medications in patients with renal disease. Most psychotropic medications are fat soluble, easily pass the blood-brain barrier, are not dialyzable, are metabolized primarily by the liver, and are excreted mainly in bile. Consequently, the majority of these drugs can be safely used with the end-stage renal disease population.

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