选择性5 -羟色胺再摄取抑制剂和中枢神经系统药物的相互作用。一个关键评审的证据。
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Sproule BA、Naranjo CA Brenmer KE,哈桑PC
选择性5 -羟色胺再摄取抑制剂和中枢神经系统药物的相互作用。一个关键评审的证据。
Pharmacokinet。1997年12月,33 (6):454 - 71。doi: 10.2165 / 00003088-199733060-00004。
- PubMed ID
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9435993 (在PubMed]
- 文摘
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潜在的精神病患者的药物之间的相互作用是非常高的组合psychopharmacotherapy用于治疗伴发精神障碍,治疗药物的副作用,增加药物的效果或治疗伴随医疗疾病。交互可以药效学和药代动力学性质。本文着重于代谢动力学之间的相互作用选择性5 -羟色胺再摄取抑制剂(SSRIs)和其他中枢神经系统(CNS)的药物。这些交互的证据和临床意义进行了综述,特别强调抗精神病药、三环类抗抑郁药和苯二氮卓类。许多精神性药物有亲和力的细胞色素P450 (CYP)酶促进消除脂溶性物质转化成更多的极性化合物。SSRIs服务这两个酶的底物和抑制剂。体外研究提供了一种筛选方法,评估药物对底物亲和力,CYP酶的抑制剂或诱发者。尽管体外数据是重要的起点预测这些代谢动力学药物的相互作用,案例报告和控制人类的实验研究需要充分评估其临床意义。几个因素必须考虑当评估一个潜在的相互作用的临床意义包括:(a)的自然药物的活动在酶(衬底、抑制剂或诱导物);(b)的力量估计抑制剂/诱导物; (c) the concentration of the inhibitor/inducer at the enzyme site; (d) the saturability of the enzyme; (e) the extent of metabolism of the substrate through this enzyme (versus alternative metabolic routes); (f) the presence of active metabolites of the substrate; (g) the therapeutic window of the substrate; (h) the inherent enzyme activity of the individual, phenotyping/genotyping information; (i) the level of risk of the individual experiencing adverse effects (e.g. the elderly) and (j) from an epidemiological perspective, the probability of concurrent use. This paper systematically reviews both the in vitro and in vivo evidence for drug interactions between SSRIs and other CNS drugs. As potent inhibitors of CYP2D6, both paroxetine and fluoxetine have the potential to increase the plasma concentrations of antipsychotic medications metabolised through this enzyme, including perphenazine, haloperidol, thioridazine and risperidone in patients who are CYP2D6 extensive metabolisers. Controlled studies have demonstrated this for perphenazine with paroxetine and haloperidol with fluoxetine. Fluvoxamine, as a potent inhibitor of CYP1A2, can inhibit the metabolism of clozapine, resulting in higher plasma concentrations. Drug interactions between the SSRIs and tricyclic antidepressants (TCAs) can occur. Fluoxetine and paroxetine, as potent inhibitors of CYP2D6, can increase the plasma concentrations of secondary and tertiary tricyclic antidepressants. Sertraline and citalopram are less likely to have this effect. Fluvoxamine can increase the plasma concentrations of tertiary TCAs. Fluvoxamine inhibits, via CYP3A. CYP2C19 and CYP1A2, the metabolism of several benzodiazepines, including alprazolam, bromazepam and diazepam. Fluoxetine increases the plasma concentrations of alprazolam and diazepam by inhibiting CYP3A and CYP2C19, respectively. The clinical importance of the interaction with diazepam is attenuated by the presence of its active metabolite. Sertraline inhibits these enzymes only mildely to moderately at usual therapeutic doses. Therefore the potential for interactions is less; however, the in vivo evidence is minimal. Paroxetine and citalopram are unlikely to cause interactions with benzodiazepines. The evidence is conflicting for an interaction between carbamazepine and the SSRIs fluoxetine and fluvoxamine. These combinations should be used cautiously, and be accompanied by monitoring for adverse events and carb
beplay体育安全吗DrugBank数据引用了这篇文章
- 药物酶
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药物 酶 类 生物 药理作用 行动 Bromazepam 细胞色素P450 1 a2 蛋白质 人类 未知的底物细节 Bromazepam 细胞色素P450 2 c19 蛋白质 人类 未知的底物细节 - 药物的相互作用Learn More" title="" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
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药物 交互 整合药物之间
在您的软件的交互西酞普兰 肉毒杆菌毒素B型 不利影响的风险或严重性可以增加当B型肉毒毒素结合西酞普兰。 西酞普兰 A型肉毒毒素 不利影响的风险或严重性可以增加当肉毒杆菌毒素类型结合西酞普兰。 西酞普兰 Ethchlorvynol 不利影响的风险或严重性可以增加当Ethchlorvynol结合西酞普兰。 西酞普兰 琥珀酰胆碱 不利影响的风险或严重性可以增加当琥珀酰胆碱结合西酞普兰。 西酞普兰 安氟醚 不利影响的风险或严重性可以增加当安氟醚结合西酞普兰。 西酞普兰 Butabarbital 不利影响的风险或严重性可以增加当Butabarbital结合西酞普兰。 西酞普兰 Butalbital 不利影响的风险或严重性可以增加当Butalbital结合西酞普兰。 西酞普兰 依托咪酯 不利影响的风险或严重性可以增加当依托咪酯结合西酞普兰。 西酞普兰 Talbutal 不利影响的风险或严重性可以增加当Talbutal结合西酞普兰。 西酞普兰 Tolcapone 不利影响的风险或严重性可以增加当Tolcapone结合西酞普兰。
