University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
PsyQ Haaglanden, Parnassia Psychiatric Institute, The Hague, the Netherlands.
Int J Neuropsychopharmacol. 2021 Oct 23;24(10):808-831. doi: 10.1093/ijnp/pyab039.
The use of ketamine for depression has increased rapidly in the past decades. Ketamine is often prescribed as an add-on to other drugs used in psychiatric patients, but clear information on drug-drug interactions is lacking. With this review, we aim to provide an overview of the pharmacodynamic interactions between ketamine and mood stabilizers, benzodiazepines, monoamine oxidase-inhibitors, antipsychotics, and psychostimulants.
MEDLINE and Web of Science were searched.
Twenty-four studies were included. For lithium, no significant interactions with ketamine were reported. Two out of 5 studies on lamotrigine indicated that the effects of ketamine were attenuated. Benzodiazepines were repeatedly shown to reduce the duration of ketamine's antidepressant effect. For the monoamine oxidase-inhibitor tranylcypromine, case reports showed no relevant changes in vital signs during concurrent S-ketamine use. One paper indicated an interaction between ketamine and haloperidol, 2 other studies did not. Four papers investigated risperidone, including 3 neuroimaging studies showing an attenuating effect of risperidone on ketamine-induced brain perfusion changes. Clozapine significantly blunted ketamine-induced positive symptoms in patients with schizophrenia but not in healthy participants. One paper reported no effect of olanzapine on ketamine's acute psychotomimetic effects.
Current literature shows that benzodiazepines and probably lamotrigine reduce ketamine's treatment outcome, which should be taken into account when considering ketamine treatment. There is evidence for an interaction between ketamine and clozapine, haloperidol, and risperidone. Due to small sample sizes, different subject groups and various outcome parameters, the evidence is of low quality. More studies are needed to provide insight into pharmacodynamic interactions with ketamine.
在过去几十年中，氯胺酮在抑郁症中的应用迅速增加。氯胺酮通常作为精神科患者使用的其他药物的附加药物开处方，但缺乏关于药物相互作用的明确信息。通过本综述，我们旨在概述氯胺酮与心境稳定剂、苯二氮䓬类药物、单胺氧化酶抑制剂、抗精神病药和精神兴奋剂之间的药效学相互作用。
检索了 MEDLINE 和 Web of Science。
共纳入 24 项研究。对于锂，没有报道表明与氯胺酮有显著相互作用。有 2 项关于拉莫三嗪的研究表明，氯胺酮的作用减弱。苯二氮䓬类药物反复显示可缩短氯胺酮抗抑郁作用的持续时间。对于单胺氧化酶抑制剂曲马普仑，病例报告显示同时使用 S-氯胺酮时生命体征无相关变化。一篇论文表明氯胺酮和氟哌啶醇之间存在相互作用，另外 2 项研究则没有。有 4 篇论文研究了利培酮，包括 3 项神经影像学研究表明利培酮可减弱氯胺酮引起的脑灌注变化。氯氮平可显著减轻精神分裂症患者的氯胺酮诱导的阳性症状，但对健康参与者则没有。一篇论文报道奥氮平对氯胺酮的急性致幻作用没有影响。
目前的文献表明，苯二氮䓬类药物可能还有拉莫三嗪可降低氯胺酮的治疗效果，在考虑氯胺酮治疗时应考虑到这一点。有证据表明氯胺酮与氯氮平、氟哌啶醇和利培酮之间存在相互作用。由于样本量小、不同的受试人群和各种结局参数，证据质量较低。需要更多的研究来深入了解与氯胺酮的药效学相互作用。
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