Summertime and Our Meds

Part 1: Heatstroke

Certain medications can make heatstroke more likely in hot weather
Certain medications can make heatstroke more likely in hot weather. Sam Edwards/OJO Images/Getty Images

Summer's sunny days and hot weather can mean grilling out, picnics in the park, 4th of July fireworks, and camping with friends. For many, summer is a carefree time. But for those of us that take psychotropic medications, it means taking special precautions to ensure our health and safety. In the first part of this article, we will talk about heatstroke and how our meds can increase our chances of a heat related illness.

In Part 2, we will talk about how our meds can increase our risk of sunburn.

Heatstroke is the most severe of the heat-related illnesses, and is a medical emergency. It occurs when the body's temperature-regulating system breaks down. The victim can't sweat and is unable to cool himself. Internal body temperature can rise as high as 108 degrees, which can cause irreversible brain damage and death. High internal temperatures can injure almost every organ, including the liver, kidneys, lungs, heart, and muscle.

A Few Facts About Heatstroke:

  • It's more likely when the outside temperature is very hot. A heat wave is defined by the National Weather Service as three or more consecutive days of temperatures at or above 90°F (32.2°C ). (More: Weather and Heatroke)
  • Hyperpyrexia (core temperature greater than 105°F [40.6°C]) and central nervous system impairment causing delirium or coma are characteristic.
  • The death rate for heatstroke ranges from 10% to 75%, depending on several variables, including how promptly treatment is sought.
  • Mentally ill patients are a high-risk group. Some may not have the cognitive abilities to protect themselves; others may be taking psychotropic medications that affect heat regulation.

    The risk of heatstroke is with several types of medications. Some of these are listed below:

    1. Antipsychotics:
      • Chlorpromazine (Thorazine)
      • Thioridazine (Mellaril)
      • Mesoridazine (Serentil)
      • Clozapine (Clozaril)
      • Risperidone (Risperdal)
      • Olanzapine (Zyprexa)
      • Quetiapine (Seroquel)
      • Ziprasidone (Geodon)
    2. Antiparkinson drugs, such as:
      • Benztropine (Cogentin)
      • Trihexyphenidyl (Artane)
      • Procyclidine (Arpicolin, Kemadrin)
      • Biperiden
    3. Antihistamines, such as:
      • diphenhydramine (Benadryl)
      • chlorpheniramine (Chlor-Trimeton, Sinutab Sinus Allergy)
    4. Antidepressants, especially tricyclics, such as:
      • Imipramine (Tofranil)
      • Amitriptyline (Elavil)
      • Nortriptyline (Pamelor)
      • Doxepin (Sinequan)
      • Desipramine (Norpramin)
      • Protriptyline (Vivactil)

    To Help Prevent Heatstroke, DO:

    • Sleep in a cool place.
    • Drink extra fluids. Water is best because the body absorbs cooler solutions fast. Other fluids you can try include juice, Gatorade, and caffeine-free soda.
    • Increase salt intake if there are no medical contraindications.
    • If you take lithium, be sure to remain well-hydrated.
    • Spend time in cool places (shopping malls, movies, etc.)
    • Wear loose, light-colored, summer-weight clothing.
    • Use fans or air conditioning.
    • When feeling warm, use cool, wet compresses or sit in a tub of cool water.
    • Remain with another person.

    To Avoid Heatstroke, DON'T:

    • Engage in strenuous exercise in the heat.
    • Drink alcoholic beverages, coffee, and soda with caffeine (caffeine and alcohol increase water loss).
    • Spend excessive time outside in the sun.
    • Sleep or spend prolonged time in hot conditions.

    Warning Signs of Heatstroke:

    • Nausea, headache, feeling poorly, weakness
    • Irritability, anxiety
    • Fast pulse, rapid breathing, dizziness
    • Hot OR dry skin, confusion, vomiting, diarrhea

    Next: Medications and Sunburn

    Sunburn can be a lot more serious than just the discomfort and pain associated with it. It can lead to skin cancer, your risk of which can increase from only one serious burn. Other effects include premature aging, wrinkles, freckles, and sun spots.

    One factor that is capable of increasing your risk for sunburn is medications. Several drugs cause a photosensitivity reaction. Although continuing the medication is crucial to your health, there are several ways to help protect yourself from sunburn.

    • ALWAYS wear sunscreen. Don't forget your face, ears, and the back of your neck. A minimum of SPF 30 is recommended.
    • Try to keep as much of your body covered as possible when out in the sun.
    • Wear light-colored, lightweight, loose-fitting clothing.
    • Use waterproof or sport sunscreen if you will be active.

    Medications that may increase sunburn risk include:

    1. Anti-anxiety - Alprazolam (Xanax)
    2. Antidepressants, such as:
      • Amitriptyline (Elavil)
      • Nortriptyline (Pamelor)
      • Paroxetine (Paxil)
      • Sertraline (Zoloft)
      • Fluoxetine (Prozac)
      • Mirtazapine (Remeron)
      • Venlaflaxine (Effexor)
      • Amoxepin (Asedin)
      • Clomipramine (Anafranil)
      • Desipramine (Norpramin)
      • Imipramine (Tofranil)
      • Maprotiline (Ludiomil)
      • Phenylizine (Nardil)
      • Protriptyline (Vivactil)
      • Trazodone (Desyrel)
      • Trimipramine (Surmontil)
    3. Anti-convulsants (mood stabilizers), such as:
      • Carbamazepine (Tegretol)
      • Valproic acid (Depakene)
      • Divalproex (Depakote)
      • Lamotrigine (Lamictal)
      • Topiramate (Topamax)
    1. Antipsychotics, such as:
      • Risperidone (Risperdal)
      • Chlorpromazine (Thorazine)
      • Haloperidol (Haldol)
      • Thioridazine (Mellaril)

    Please note that these lists are not complete, but are intended to provide you with a handful of drugs, both over-the-counter and prescription, that may cause a photosensitivity reaction or increase your chances of heatstroke.

    If your medication is not listed, or if you are not sure if your medication causes a problem, please consult your pharmacist or psychiatrist.

    Remember, it is very important that you do not stop taking your medicine! It was prescribed for your particular condition, and you should continue to take it.

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