Mihaljević-Peles Alma, Sagud Marina, Bozina Nada, Zivković Maja, Jovanović Nikolina
University Department, Clinical Hospital Centre Zagreb, Zagreb, Croatia.
Psychiatr Danub. 2009 Sep;21(3):399-400.
Patients who require long-term treatment for depression have an increased risk of experiencing drug interactions since they will take medications for intercurrent and/or co-morbid illness. Antidepressants can be the object of drug interactions by other substances, or they can precipitate interactions by inhibiting enzyme pathways. There is an increasing agreement about the importance of polymorphisms in cytochrome P450 enzymes and the effects of drug-drug interactions in relation to the incidence of adverse effects. Genetic test suitable for the routine laboratory are now available for some important metabolizing enzymes (e.g. CY2D6, CY2C19) identifying those individuals who are slow or fast metabolizers of certain drugs. Specific antidepressants differ in the interactions with CYP450 isoenzymes and in their susceptibility to drug-drug interactions. The main focus of this article is pharmacokinetic drug interactions of antidepressants. With that specific knowledge, clinicians can improve outcomes of depressed patients, by considering the possibility of drug interactions both before prescribing a specific antidepressant and while monitoring for response, adverse effects and patient compliance.
需要长期治疗抑郁症的患者发生药物相互作用的风险增加，因为他们会因并发疾病和/或共病而服用药物。抗抑郁药可能成为其他物质药物相互作用的对象，或者它们可能通过抑制酶途径引发相互作用。关于细胞色素P450酶多态性的重要性以及药物相互作用对不良反应发生率的影响，人们的共识越来越多。现在有适用于常规实验室的基因检测可用于某些重要的代谢酶（如CY2D6、CY2C19），以识别那些对某些药物代谢缓慢或快速的个体。特定的抗抑郁药在与CYP450同工酶的相互作用及其对药物相互作用的敏感性方面存在差异。本文的主要重点是抗抑郁药的药代动力学药物相互作用。有了这些具体知识，临床医生可以通过在开特定抗抑郁药之前以及监测反应、不良反应和患者依从性时考虑药物相互作用的可能性，来改善抑郁症患者的治疗效果。
