Joos A A, König F, Frank U G, Kaschka W P, Mörike K E, Ewald R
University of Ulm, Department of Psychiatry I, Ravensburg-Weissenau, Germany.
Pharmacopsychiatry. 1997 Nov;30(6):266-70. doi: 10.1055/s-2007-979505.
A 53-year-old patient suffering from delusional disorder developed an anticholinergic syndrome 19 days after initiation of paroxetine in addition to a steady dose of clozapine. The clozapine plasma concentration had doubled and was in the toxic range. On re-exposition with a lower clozapine dosage the increase was significantly lower. The importance of a dose-dependent interaction of both drugs is emphasized and a possible pharmacological explanation described. With regard to interactions of SSRIs and clozapine, fluvoxamine, a potent inhibitor of cytochrome P450 1A2, gives rise to higher clozapine levels at an earlier time, compared to other SSRIs (paroxetine, fluoxetine and sertraline), which are potent cytochrome P450 2D6 inhibitors.
一名患有妄想症的53岁患者，在开始服用帕罗西汀并维持稳定剂量氯氮平19天后，出现了抗胆碱能综合征。氯氮平血浆浓度翻倍且处于中毒范围。再次以较低剂量服用氯氮平时，浓度升高明显较低。强调了两种药物剂量依赖性相互作用的重要性，并描述了可能的药理学解释。关于选择性5-羟色胺再摄取抑制剂（SSRI）与氯氮平的相互作用，与其他作为细胞色素P450 2D6强效抑制剂的SSRI（帕罗西汀、氟西汀和舍曲林）相比，强效细胞色素P450 1A2抑制剂氟伏沙明会在更早时间使氯氮平水平升高。
