Jefferson J W
Madison Institute of Medicine, Wis 53717, USA.
J Clin Psychiatry. 1998;59 Suppl 16:31-9; discussion 40-2.
An explosion of information about drug and diet interactions has greatly complicated and confused the use of antidepressant drugs, yet if clearly understood, such information will actually enhance the safety and efficacy of these medications. The background against which antidepressants are discussed includes an overview of the cytochrome P450 (CYP) system (which now contains over 500 P450 genes), the concepts of enzyme specificity and selectivity, the roles of genetics and nonpharmacologic environmental factors, and examples of beneficial and detrimental drug and diet interactions. The comparative profiles of the various antidepressants are then presented with consideration given to their roles as substrates, inhibitors, and inducers of P450 enzymes such as CYP1A2, 2B6, 2C, 2D6, and 3A4. Examples of clinically important antidepressant drug/drug and drug/diet interactions are provided.
关于药物与饮食相互作用的信息爆炸式增长，极大地使抗抑郁药物的使用变得复杂和混乱，但如果能清楚理解，这些信息实际上会提高这些药物的安全性和有效性。讨论抗抑郁药物的背景包括细胞色素P450（CYP）系统的概述（该系统现在包含500多个P450基因）、酶特异性和选择性的概念、遗传学和非药物环境因素的作用，以及有益和有害的药物与饮食相互作用的例子。然后介绍了各种抗抑郁药物的比较概况，并考虑了它们作为CYP1A2、2B6、2C、2D6和3A4等P450酶的底物、抑制剂和诱导剂的作用。还提供了临床上重要的抗抑郁药物/药物和药物/饮食相互作用的例子。
