Interactions between anticonvulsant and psychoactive drugs.
This review considers the relevance of pharmacokinetic interactions between antiepileptic drugs (AEDs) and psychoactive drugs in the treatment of mood disorders in patients with epilepsy. The determination of plasma levels of some of these drugs (mainly the AEDs) has enabled clinicians to evaluate the kinetic modifications during the course of such combined therapies and to adjusting the dosages in cases of subtherapeutic or toxic levels. In general, phenobarbital, phenytoin, and carbamazepine stimulate the catabolic degradation of tricyclic antidepressants (TCAs), and TCAs have an inhibitory effect on the elimination of AEDs. The newer antidepressants that selectively inhibit the reuptake of serotonin (SSRIs), although in different fashions for the different substances (fluoxetine, fluvoxamine, paroxetine) may cause an increase of plasma AED levels through inhibition of the isoenzyme P450 2D6. Similarly, antipsychotics (APs) are more rapidly metabolized when AEDs are co-administered, whereas AED metabolism is scarcely influenced by AP. Finally, plasma levels of tranquilizers are lowered by AED co-therapy. As the concomitant administration of AED and psychoactive drugs becomes increasingly used for treatment of mood disorders in patients with or without epilepsy, therapeutic drug monitoring may be useful in designing correct and rational therapy.
Monaco
F
F
Neurological Clinic, Università Amedeo Avogadro del Piemonte Orientale, Novara, Italy.
Cicolin
A
A
D000927:Anticonvulsants / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D015897:Comorbidity; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000378:metabolism; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy* / Q000453:epidemiology; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use
D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D011619:Psychotropic Drugs; D003577:Cytochrome P-450 Enzyme System