Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht University, Utrecht.
Academic Medical Center, University of Amsterdam, Amsterdam.
Ther Drug Monit. 2020 Feb;42(1):75-82. doi: 10.1097/FTD.0000000000000682.
Substance use disorder often coexists with other psychiatric disorders, resulting in the simultaneous use of recreational and prescription drugs. The authors aimed to identify potential pharmacokinetic and pharmacodynamic interactions between new psychoactive substances of the cathinone class and specific prescription drugs.
The authors performed a systematic literature review on interactions between synthetic cathinones (mephedrone, methylone, methylenedioxypyrovalerone, and alpha-pyrrolidinopentiophenone) and antidepressants (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine), attention deficit hyperactivity disorder (ADHD) medications (atomoxetine, dexamphetamine, methylphenidate, modafinil) or HIV medications.
Although no pharmacokinetic interactions have been reported in previous literatures, such interactions are likely to occur. Metabolic pathways of cathinones, antidepressants, and ADHD medications have been shown to overlap, including metabolism via cytochrome P450 enzymes and their inhibition. Consistent with this finding, interactions of bupropion (a cathinone) with antidepressants and ADHD medications have been found to increase their serum concentrations and half-lives. Additionally, limited pharmacodynamic interactions have been reported. However, as cathinones, antidepressants, and ADHD medications have been reported to increase the extracellular monoamine concentration by affecting reuptake transporters, interactions among these compounds are likely. Presumably, even higher monoamine concentrations could be observed when cathinones are combined with prescription drugs with a similar mode of action, as has been reported in animals exposed to duloxetine and bupropion. HIV medications have a different mode of action; thus, they have been reported to be less likely to have pharmacodynamic interactions with cathinones.
Clinicians should be aware of possible interactions between synthetic cathinones and prescription drugs, which may increase the risk of drug toxicity or reduce the therapeutic efficacy of the drugs. Qualitative drug screening for cathinones using mass spectrometry methods may aid the early detection of these agents.
物质使用障碍常与其他精神障碍共存，导致同时使用娱乐性和处方药物。作者旨在确定新精神活性物质类卡西酮与特定处方药物之间可能存在的药代动力学和药效学相互作用。
作者对合成卡西酮（苯丙胺、甲基酮、二甲氧基吡咯戊酮和α-吡咯戊苯酮）与抗抑郁药（西酞普兰、氟西汀、氟伏沙明、帕罗西汀、舍曲林和文拉法辛）、注意缺陷多动障碍（ADHD）药物（阿托西汀、右旋苯丙胺、哌甲酯、莫达非尼）或 HIV 药物之间的相互作用进行了系统的文献回顾。
尽管以前的文献中没有报道过药代动力学相互作用，但这种相互作用很可能发生。已证实卡西酮、抗抑郁药和 ADHD 药物的代谢途径存在重叠，包括细胞色素 P450 酶及其抑制剂介导的代谢。与此一致的是，发现丁胺苯丙酮（一种卡西酮）与抗抑郁药和 ADHD 药物的相互作用增加了它们的血清浓度和半衰期。此外，还报道了有限的药效学相互作用。然而，由于卡西酮、抗抑郁药和 ADHD 药物通过影响再摄取转运体来增加细胞外单胺浓度，这些化合物之间可能存在相互作用。据推测，当卡西酮与具有类似作用模式的处方药物联合使用时，可能会观察到更高的单胺浓度，正如在动物暴露于度洛西汀和丁胺苯丙酮时所报道的那样。HIV 药物的作用模式不同，因此，据报道它们与卡西酮的药效学相互作用不太可能发生。
临床医生应意识到合成卡西酮与处方药物之间可能存在相互作用，这可能会增加药物毒性的风险或降低药物的治疗效果。使用质谱方法进行定性药物筛选可能有助于早期发现这些药物。
