DeVane C L, Markowitz J S, Liston H L, Risch S C
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425-0742, USA.
Psychopharmacol Bull. 2001 Spring;35(2):50-61.
A prospective antidepressant drug interaction surveillance program was established and collected data for over 4 years in Charleston, SC (Charleston Antidepressant Drug Interactions Surveillance Program, CADISP). One hundred and seventy patients were enrolled. The plasma concentrations and/or clinical effects of drug combinations were monitored in psychiatric patients who received therapy with a selective serotonin reuptake inhibitor (SSRI) or one of the other newer antidepressants (nefazodone, venlafaxine) when combined with other drugs metabolized by the cytochrome P-450 (CYP) enzyme system. Patient data were evaluated to estimate the occurrence and significance of antidepressant-induced metabolic drug interactions. Plasma drug concentrations in the presence and absence of treatment with an antidepressant served as the primary assessment variable. Contrary to the hypothesis that pharmacokinetic drug-drug interactions occur but go undetected, little evidence was found for occultly occurring drug interactions with newer antidepressants. The presence of commonly predicted drug interactions was documented. These data do not eliminate the need for caution when prescribing antidepressants with the potential for causing metabolic interactions, but do help allay the fear that such interactions are highly prevalent and routinely hazardous.
在南卡罗来纳州查尔斯顿市建立了一个前瞻性抗抑郁药物相互作用监测项目（查尔斯顿抗抑郁药物相互作用监测项目，CADISP），并收集了4年多的数据。该项目纳入了170名患者。对接受选择性5-羟色胺再摄取抑制剂（SSRI）或其他新型抗抑郁药（奈法唑酮、文拉法辛）治疗的精神科患者，监测其与细胞色素P-450（CYP）酶系统代谢的其他药物联合使用时药物组合的血浆浓度和/或临床效果。对患者数据进行评估，以估计抗抑郁药引起的代谢性药物相互作用的发生率和重要性。使用和未使用抗抑郁药治疗时的血浆药物浓度作为主要评估变量。与药代动力学药物-药物相互作用会发生但未被发现的假设相反，几乎没有证据表明新型抗抑郁药存在隐匿性药物相互作用。记录了常见预测药物相互作用的存在情况。这些数据并没有消除在开具可能导致代谢相互作用的抗抑郁药时谨慎用药的必要性，但确实有助于减轻人们对这类相互作用非常普遍且常规情况下具有危险性的担忧。
