Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-06-25T10:44:42.396Z Has data issue: false hasContentIssue false
  • English
  • Français

Antidepressant Drug-Drug Interactions: Clinical Relevance and Risk Management

Published online by Cambridge University Press:  07 November 2014

Charles B. Nemeroff ,
Sheldon H. Preskorn  and
C. Lindsay DeVane
Charles B. Nemeroff
Affiliation:
Dr. Nemeroff is Reunette W. Harris Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine in Atlanta, Georgia. Dr. Nemeroff is a currently on the scientific advisory boards of Forest, Janssen/Ortho-McNeil, Quintiles, and NeuroPharmaboost; receives grant/research support from the American Foundation for Suicide Prevention, the National Alliance for Research on Schizophrenia and Depression, and the National Institute of Mental Health (NIMH); and is a major stockholder or owns equity in Corcept, CeNeRx, Revaax, and NovaDel.
Sheldon H. Preskorn
Affiliation:
Dr. Preskorn is Professor and Chair of Psychiatry and BehavioralSciences at the University of Kansas School of Medicine, and president and chief executive officer of the Clinical Research Institute in Wichita, Kansas. Dr. Preskorn is a consultant to Bristol-Myers Squibb, Comentis, Cyberonics, Eisai, Eli Lilly, EnVivo, Evotec, Johnson & Johnson, Memory, Otsuka, Pfizer, Predix, Shire, Somerset, and Wyeth; is on the advisory boards of Bristol-Myers Squibb, Eli Lilly, Johnson & Johnson, Pfizer, Shire, Somerset, and Wyeth; is on the speaker's bureaus of Bristol-Myers Squibb, Cyberonics, Forest, Otsuka, and Pfizer; and receives grants/research support from Bristol-Myers Squibb, Comentis, Cyberonics, Johnson & Johnson, Merck, Memory, the NIMH, Novartis, Organon, Otsuka, Pfizer, Predix, Sepracor, Somerset, and Wyeth.
Get access Rights & Permissions [Opens in a new window]

Abstract

Multiple medication use is a common phenomenon, especially in patients with comorbid conditions and those treated with psychiatric drugs such as antidepressants. Combination treatment may result in potentially harmful drug-drug interactions (DDIs). Results of DDIs range from nuisance side effects to serious adverse consequences. DDIs may also result in improved efficacy. Augmentation strategies, for example, are intentional therapeutic DDIs. Pharmacokinetic DDIs occur when a second drug alters the absorption, distribution, metabolism, or clearance of the first drug. Research has concentrated on the relative effects of antidepressants on cytochrome P450 enzymes and, more recently, on drug transporters as potential mediators of clinically important pharmacokinetic DDIs. The most common, clinically relevant pharmacokinetic DDIs involve alteration in oxidative drug metabolism. Pharmacodynamic DDIs occur when the effects of a second drug quantitatively or qualitatively alters those of the first drug. Pharmacodynamic DDIs are not typically studied in vivo because of the potential for a serious adverse effect. All antidepressants can interact pharmacodynamically with certain other drugs. The risk of harmful DDIs can be reduced by recognizing variables that affect dose-concentration-effect relationships. It is important for physicians to weigh the risks and benefits of potential DDIs against the risks that accompany timid or ineffective disease treatment.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S7 , 2007 , pp. 1 - 16
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Preskorn, S, Lacey, R. Polypharmacy: When is it rational? J Pract Psychiatr Behav Health. 1995;1:92–98.Google Scholar
2.HHS Report. Center for Disease Control. United States, 2004.Google Scholar
3.Preskorn, SH. Drug approvals and drug withdrawals over the last 60 years. J Psychiatr Pract. 2002;8(1):41–50.CrossRefGoogle ScholarPubMed
4.Silkey, B, Preskorn, SH, Golbeck, A, et al. Complexity of medication use in the Veterans Affairs Healthcare System: Part II. Antidepressant use among younger and older outpatients. J Psychiatr Pract. 2005;11(1):16–26.CrossRefGoogle ScholarPubMed
5.Preskorn, SH. Drugs are an acquired source of biological variance among patients. J Psychiatr Pract. 2006;12(6):391–396.CrossRefGoogle ScholarPubMed
6.Levy, RH, Thummel, KE, Trager, WF, Hansten, P, Eichelbaum, M. In: Metabolic Drug Interactions. Philadelphia, Lippincott, Williams & Wilkins; 2000.Google Scholar
7.Preskorn, SH. Clinical Pharmacology of Selective Serotonin Reuptake Inhibitors. Caddo, Okla: Professional Communications, Inc; 1996. www.preskorn.comGoogle Scholar
8.Preskorn, SH, Flockhart, DA. 2006 guide to psychiatric drug interactions. Primary Psychiatry. 2006;13(4):35–64.Google Scholar
9. Somerset Pharmaceuticals. Selegiline transdermal system (EMSAM). Available at: http://www.bms.com/cgi-bin/anybin.pl?sql=select%20PPI%20from%20TB_PRODUCT_PPI%20where%20PPI_SEQ=112&key=PPI. Accessed August 16, 2006.Google Scholar
10.Frankie, WG, Gil, R, Hackett, E, et al. Occupancy of dopamine D2 receptors by the atypical antipsychotic drugs risperidone and olanzapine: theoretical implications. Psychopharmacol Berl. 2004;175:473–480.Google Scholar
11.DeVane, CL. Antidepressant-drug interactions are potentially but rarely clinically significant. Neuropsychopharmacology. 2006;31(8):1594–1604.CrossRefGoogle ScholarPubMed
12.Preskorn, SH. Classification of neuropsychiatric medications by principal mechanism of action: a meaningful way to anticipate pharmacodynamically mediated drug interactions. J Psychiatr Pract. 2003;9(5):376–384.CrossRefGoogle ScholarPubMed
13.Hardman, JG, Limbird, LE, Gilman, AG. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw Hill; 2001.Google Scholar
14.Holschneider, DP, Shih, JC. In: Neuropsychopharmacology: The Fourth Generation of Progress. Available at: http://www.acnp.org/g4/GN401000046/CH046.html. Accessed August 16, 2006.Google Scholar
15.Holschneider, DP, Shih, JC. Monamine oxidase: basic and clinical perspectives. In: Neuropsychopharmacology: The Fourth Generation of Progress. Chapter 46. Available at: http://www.acnp.org/Default.aspx?Page=4thGenerationChapters. Accessed September 1, 2006.Google Scholar
16.Sternbach, H. The serotonin syndrome. Am J Psychiatry. 1991;148(6):705–713.Google ScholarPubMed
17.Strolin Benedetti, M, Dostert, P. Monoamine oxidase: from physiology and pathology to the design and clinical application of reversible inhibitors. Adv Drug Res. 1992;23:65–125.Google Scholar
18.Hoffman, BB, Lefkowitz, RJ. Catecholamines and sympathomimetics. In: AG, Gilman, TW, Rall, AS, Nies, eds. The Pharmacological Basis of Therapeutics. 8th ed. New York, NY: Pergamon Press; 1990:187.Google Scholar
19.Preskorn, S, Werder, S. Detrimental antidepressant drug-drug interactions: are they clinically relevant? Neuropsychopharmacology. 2006;31(8):1605–1612.CrossRefGoogle ScholarPubMed