Prudence au volant

Quels sont les médicaments à risque quand on conduit ?

Quels sont les médicaments à risque quand on conduit ?

Les antidépresseurs, anxiolytiques, somnifères, neuroleptiques sont en cause dans de nombreux accidents de voiture. Les boîtes de ces médicaments portent aujourd’hui un triangle qui alerte sur le risque encouru lorsqu’on conduit. Malgré son intérêt, cette signalisation peut manquer de précisions. Voici ce qu’il faut savoir quand on prend l’un de ces traitements.

La France est l’un des premiers pays à avoir adopté ce système de signalisation sur les médicaments :

  • Le triangle jaune : « Soyez prudent. Ne pas conduire sans avoir lu la notice ». Sur les boîtes d'antihistaminiques, de certains anti-inflammatoires, antalgiques et antigrippaux.
  • Le triangle orange : « Soyez très prudent. Ne pas conduire sans l'avis d'un professionnel de santé ». Sur les boîtes d'antidépresseurs, de neuroleptiques, de 70% des anxiolytiques, et de 90% des anticonvulsivants.
  • Le triangle rouge : « Attention, danger, ne pas conduire. Pour la reprise de la conduite, demander l'avis d'un médecin ». Il correspond aux hypnotiques et aux anxiolytiques fortement dosés ou injectables.

Si vous prenez un traitement comportant un antihistaminique (attention aux médicaments anti-rhume qui en contiennent souvent) mais surtout si vous prenez des antidépresseurs, anxiolytiques, somnifères, neuroleptiques, voici ce qu'il faut savoir pour éviter les accidents de voiture.

Les antidépresseurs

La prise d'antidépresseurs augmenterait le risque d'accident de la route de 34 %, selon une étude française de 2012. Mais il faut distinguer entre les antidépresseurs qui font dormir (antidépresseurs tricycliques, miansérine, mirtazapine) et ceux qui n’influent pas sur l’éveil.

Les antidépresseurs sédatifs, surtout au début du traitement, ont le même effet qu’une alcoolémie de 0,8 mg/l. Il est donc conseillé de ne pas conduire lorsqu’on prend depuis peu de temps un antidépresseur sédatif. La conduite est possible au cas par cas après une semaine de traitement.

Pour les antidépresseurs non sédatifs (inhibiteurs sélectifs de la recapture de la sérotonine, inhibiteurs sélectifs de la recapture de la noradrénaline, moclobémide), la conduite est possible en début de traitement au cas par cas, et pendant la phase d'entretien chez tout le monde.

Retrouvez à la fin de l'article un tableau regroupant les antidépresseurs sédatifs et les non sédatifs pour voir à quoi correspond le vôtre.

Les benzodiazépines et les somnifères

La plupart des benzodiazépines utilisées comme anxiolytiques ont un triangle orange. Les recommandations sont les mêmes que pour les antidépresseurs sédatifs. Il n'est pas recommandé de conduire au début du traitement, lorsque le traitement change et pendant le sevrage.

La conduite est possible au cas par cas pendant la phase d'entretien de l'anxiolytique. La conduite sous benzodiazépines est déconseillée aux fortes doses, après 65 ans quelle que soit la phase du traitement. En cas d'association alcool-benzodiazépine, il est interdit de conduire quelle que soit la dose.

Si vous avez pris un somnifère, vous ne pourrez conduire que le surlendemain de la prise. Ils sont classés niveau 3 : triangle rouge.

Les neuroleptiques et régulateurs de l'humeur

Les neuroleptiques oraux ont un triangle orange. Ceux par voie injectable sont ont un triangle rouge. La conduite est interdite pendant les phases d'introduction ou de modification de traitement quel que soit le neuroleptique.

Les régulateurs de l'humeur (lithium et anticonvulsivants) ont un triangle orange. La conduite est à éviter pendant les phases d'initiation ou de modification de traitement que ce soit pour le lithium ou pour les anticonvulsivants (valproate, carbamazépine).

(D’après une communication du Dr Bertrand Claudel (Hôpital de la Pitié-Salpêtrière, France) aux Entretiens de Bichat 2013)

 

Les antidépresseurs sédatifs et non sédatifs
Antidépresseurs sédatifsAntidépresseurs non sédatifs
Amitriptiline (Laroxyl®, Elavil®) (++)Citalopram (Citalopram Mylan®, Seropram®)
Amoxapine (Defanyl® ) (++)Escitalopram (Seroplex®)
Clomipramine (Anafranil®, Clomipramine® ) (+)Fluoxetine (Prozac®, Fluoxétine®)
Dosulétine (Prothiaden® ) (+)Fluvoxamine (Floxyfral®, Fluvoxamine®)
Doxépine (Quitaxon®) (++)Paroxétine (Déroxat®, Paroxétine®)(+/-)
Imipramine (Tofranil®) (+)Sertraline (Zoloft®, Sertraline®)
Maprolitine (Ludiomil®) (++)Duloxétine (Cymbalta®)
Trimipramine (Surmontil®) (+++)Minalcipran (Ixel®, Minalcipran®)
Agomelatine (Valdoxan®, Agomelatine®)(+/-)Venlafaxine (Effexor®, Venlafaxine®)
Miansérine (Miansérine® )(+++)Moclobémide (Moclamine®, Moclobémide®)
Mirtazapine (Norset®, Mirtazapine® ) (+++)
Tianeptine (Stablon®) (+/-)
Iproniazine (Marsilid®) (+)
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