Siwek Marcin, Woroń Jarosław, Wrzosek Anna, Gupało Jarosław, Chrobak Adrian Andrzej
Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland.
Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Front Pharmacol. 2023 Sep 27;14:1271776. doi: 10.3389/fphar.2023.1271776. eCollection 2023.
We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review. A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms. Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: : reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); : duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); : bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); : citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); : mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); : mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); : agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); : duloxetine (back pain); : sertraline (upper gastrointestinal bleeding); : mianserin (restless legs syndrome); and : bupropion (seizures). Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.
我们旨在通过一项回顾性病历审查，系统评估与适应原和抗抑郁药物相互作用相关的不良事件的发生率及临床特征。共评估了1816份不良事件报告。如果药物流行病学分析显示适应原与抗抑郁药物相互作用和不良事件发生之间存在高度因果关系的可能性，则将病例纳入分析。从报告中提取了以下数据：年龄、性别、抗抑郁药、含适应原的植物产品、其他合并用药，以及相互作用的临床后果及其可能机制。适应原参与了9%与抗抑郁药及其他制剂联合使用相关的不良事件。我们确定了30份报告，其中副作用与抗抑郁药和适应原的使用存在因果关系。在此，我们列出适应原与相应抗抑郁药及其相互作用引起的副作用：瑞波西汀（睾丸疼痛和射精功能障碍）、舍曲林（严重腹泻）、艾司西酞普兰（肌痛、上腹部疼痛、恶心、呕吐、不宁腿综合征和严重咳嗽）、帕罗西汀（全身性肌痛、眼痛和高眼压）；度洛西汀（上消化道出血）、帕罗西汀（鼻出血）、舍曲林（阴道出血）、阿戈美拉汀（易怒、激动、头痛和头晕）；安非他酮（关节痛和血小板减少）、阿米替林（谵妄）、氟西汀（排尿困难）；西酞普兰（全身性瘙痒）、艾司西酞普兰（溢乳）、曲唑酮（银屑病复发）；米安色林（心律失常）、米氮平（下肢水肿和肌痛）、氟西汀（男子乳腺增生）；米安色林（不宁腿综合征）、帕罗西汀（男子乳腺增生和乳房疼痛）、文拉法辛（低钠血症）；阿戈美拉汀（背痛和多汗症）、吗氯贝胺（心肌梗死）；度洛西汀（背痛）；舍曲林（上消化道出血）；米安色林（不宁腿综合征）；安非他酮（癫痫发作）。临床医生应监测精神障碍患者中与适应原和抗抑郁药物联合使用相关的不良事件。这些药物之间副作用和药代动力学相互作用（对细胞色素P450和P-糖蛋白的抑制）的聚集可能导致具有临床意义的不良事件。
