The effects of antiepileptic inducers in neuropsychopharmacology, a neglected issue. Part I: A summary of the current state for clinicians.
The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. This is part i of a comprehensive review on antiepileptic drug (AED) inducers using both mechanistic pharmacological and evidence-based medicine to provide practical recommendations to neurologists and psychiatrists concerning how to control for them. Carbamazepine, phenobarbital and phenytoin, are clinically relevant AED inducers; correction factors were calculated for studied induced drugs. These correction factors are rough simplifications for orienting clinicians, since there is great variability in the population regarding inductive effects. As new information is published, the correction factors may need to be modified. Some of the correction factors are so high that the drugs (e.g., bupropion, quetiapine or lurasidone) should not co-prescribed with potent inducers. Clobazam, eslicarbazepine, felbamate, lamotrigine, oxcarbazepine, rufinamide, topiramate, vigabatrin and valproic acid are grouped as mild inducers which may (i)be inducers only in high doses; (ii)frequently combine with inhibitory properties; and (iii)take months to reach maximum effects or de-induction, definitively longer than the potent inducers. Potent inducers, definitively, and mild inducers, possibly, have relevant effects in the endogenous metabolism of (i)sexual hormones, (ii) vitamin D, (iii)thyroid hormones, (iv)lipid metabolism, and (v)folic acid.
University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, Estados Unidos; Grupo de Investigación en Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada, Granada, España; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España. Electronic address: jdeleon@uky.edu.
Jose
J
de Leon
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy*; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods*
D000927:Anticonvulsants
Agentes antipsicóticos; Anticonvulsants; Anticonvulsivos; Antidepresivos; Antidepressants; Antipsychotic agents; Drug interactions; Enzyme induction; Enzyme inhibition; Inducción enzimática; Inhibición enzimática; Interacciones farmacológicas