Version June 2024
| Class | Mechanism |
| Analgesics | |
| Acute kidney injury particularly in older adults and patients who are dehydrated |
| Anticholinergics | |
| Centrally impaired thermoregulation, impaired sweating, hypotension, reduced cardiac output, sedation, cognitive impairment |
| Antihistamines H1 (first-generation) and antivertigo antiemetics | |
| Anticholinergic effects*, impaired sweating, sedation |
| Antiparkinson | |
| Anticholinergic effects*, impaired sweating, cognitive impairment |
| Antiseizure medications | |
| Anticholinergic effects*, impaired sweating, sedation, cognitive impairment |
| Carbonic anhydrase inhibition, impaired sweating |
| Bladder antispasmodics (also known as antimuscarinics) | |
| Anticholinergic effects*, impaired sweating, cognitive impairment |
| Cardiovascular | |
| Syncope, hypotension (particularly new start RASI in combination with a diuretic), altered peripheral vascular response (Clonidine by central adrenergic effect) |
| Diuresis, hypovolemia, dehydration, syncope, reduced thirst sensation, altered peripheral vascular response, electrolyte derangements, acute kidney injury |
| Muscle relaxants | |
| Anticholinergic effects*, impaired sweating, sedation, cognitive impairment |
| Psychotropic | |
| Centrally impaired thermoregulation, impaired sweating, hypotension, reduced cardiac output |
| Increased sweating promoting dehydration, electrolyte derangements (eg, hyponatremia) |
| Centrally impaired thermoregulation, increased higher core temperature, vasoconstriction, impaired perception of fatigue/exertion |
| Anticholinergic effects*, impaired sweating¶, hypotension, reduced cardiac output |
| Anticholinergic effects*, impaired sweating, increased metabolism |
| Substances of misuse | |
| Increased sweating, diuresis Impaired heat and thirst perception |
| Impaired sweating and cutaneous vasodilation Impaired heat perception |
| Reduced sweating, impaired vasodilation, impaired heat perceptions |
ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; CNS: central nervous system; M3R: muscarinic acetylcholine receptor M3; MAOI: monoamine oxidase inhibitor; MDMA: methylenedioxymethamphetamine; NSAIDs: nonsteroidal antiinflammatory drugs; RASi: renin angiotensin system inhibitor; SNRI: serotonin-norepinephrine reuptake inhibitors; SSRI: selective serotonin reuptake inhibitors.
Medications and other substances can increase risk of heat-related illness through a range of mechanisms. Advanced age, comorbidity, organ impairment, and environmental factors can further increase risk. Comparative risk within each class can vary by specific agent or may not be well distinguished[1]. Clinicians should consider the effects of other medications or substances of abuse not listed above with sedative effects or that cause cognitive impairment (eg, opioids, benzodiazepines, other antiseizure drugs); such medications impair alertness, perception of hot weather, and judgment. Some substances of abuse such as sympathomimetics increase heat generation through neuromuscular activity.
Patients who are dehydrated are at increased risk of toxicities due to reduced kidney clearance of drugs, electrolyte derangements, and acute kidney injury. For additional information, refer to UpToDate topics on heat illness including nonexertional hyperthermia and climate emergencies.* Anticholinergic drugs exert variable effects on CNS thermal regulation and cognitive function as well as peripheral sweat production through M3 sub-receptor antagonism; effect(s) vary depending on the receptor affinity of the drug, the extent to which it penetrates CNS, dose, and route of administration[2,3]. Refer to separately available table of anticholinergic activity of medications. Those labeled "high" are more likely to impair physiologic heat adaptation.
¶ Tricyclic antidepressants can increase sweating in some individuals thereby contributing to dehydration[2].آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
