Sayal K S, Duncan-McConnell D A, McConnell H W, Taylor D M
The Maudsley Hospital, London, UK.
Acta Psychiatr Scand. 2000 Oct;102(4):250-5. doi: 10.1034/j.1600-0447.2000.102004250.x.
Improving knowledge about the cytochrome p450 system means that potential drug interactions can be predicted. Interactions involving warfarin may be thus avoidable. As many patients who have suffered from a stroke or other thromboembolic events may also develop psychiatric disorder, knowledge about possible interactions with psychotropics is essential for prescribers.
A Medline and hand search of published literature was complemented by contacting manufacturers.
The antidepressants citalopram, nefazodone and sertraline have relatively low interaction potential with warfarin; fluoxetine and fluvoxamine relatively high. Carbamazepine appears to reduce warfarin's anticoagulant effect. Other antipsychotics, antidepressants and anxiolytics have only a theoretical risk of interaction. Lithium, gabapentin, sulpiride and amisulpride are predominantly renally excreted and so are not likely to interact with warfarin.
Many psychotropics are involved in predictable interactions with warfarin. Drugs with a known low interaction potential should be chosen instead of those known or predicted to interact.
增进对细胞色素P450系统的了解有助于预测潜在的药物相互作用。涉及华法林的相互作用因此或许可以避免。由于许多曾患中风或其他血栓栓塞事件的患者也可能患上精神障碍，对于开处方者而言，了解与精神药物可能存在的相互作用至关重要。
通过联系制造商对已发表文献进行医学文献数据库检索及手工检索作为补充。
抗抑郁药西酞普兰、奈法唑酮和舍曲林与华法林的相互作用可能性相对较低；氟西汀和氟伏沙明相对较高。卡马西平似乎会降低华法林的抗凝作用。其他抗精神病药、抗抑郁药和抗焦虑药仅有理论上的相互作用风险。锂盐、加巴喷丁、舒必利和氨磺必利主要经肾脏排泄，因此不太可能与华法林相互作用。
许多精神药物与华法林存在可预测的相互作用。应选择已知相互作用可能性低的药物，而非已知或预测会发生相互作用的药物。
