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5 results

  • Drug–drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs

  • S. Petrykiv, M. Arts, L. De Jonge
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S454
    • Article
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      • Open access
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  • Introduction

    Psychotropic medications are frequently co-prescribed with antiretroviral therapy (ART). Hepatic metabolism both of AP and ART involves the cytochrome P450 enzyme system, potentially leading to a multitude of pharmacokinetic (PK) interactions and serious adverse side effects. The magnitude and clinical impact of PK-interactions can vary significantly.

    Objectives

    The scope of this review is to summarize the currently available data regarding drug-drug interactions (DDI) between AP and ART, and to provide recommendations for their management.

    Methods

    A formal search of Embase, Cochrane and Medline was performed, searching for human studies from inception till 2017 on PK-interactions between AP and ART and reporting clinical toxicity as outcomes. Authors also provide their expertise on magnitude and clinical relevance of DDI using PK interaction chart.

    Results

    Ten case reports including total of 13 patient were analyzed, comprising following AP: aripiprazole (N=2), risperidone (N=4), quetiapine (N=3) and lurasidone (N=1) in combination with various ART regiments. Significant PK-interactions were to occur in cases when aripiprazole was combined with ritonavir and/or cobicistat or efavirenz and/or darunavir; risperidone with indinavir of ritonavir; quetiapine with ritonavir and atazanavir/ritonavir; lurasidone with atazanavir. Adverse events occurred in combinations of aripiprazole with ritonavir/darunavir, risperidone with ritonavir or indinavir, quetiapine with atazanavir and lurasidone with atazanavir.

    Conclusions

    Psychotropics and antiretrovirals may be used safely, particularly when known DDIs are proactively managed. Clinicians should be aware of the pharmacokinetic and pharmacodynamic properties of these agents to best direct therapy and to provide optimal patient care

    Disclosure

    No significant relationships.

  • The interactions between COVID-19 drugs and psychotropic agents

  • C. Hiemke
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S15
    • Article
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      • Open access
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  • Coronavirus disease (COVID-19) is a systemic infection targeting multiple organs. Interstitial pneumonia is the landmark feature of this condition. Severe acute respiratory symptoms requiring intensive care support arises for about one out of twenty symptomatic cases. Aminochinolone, antiviral, antibiotic, corticoid, anticoagulant and immunobiological drugs are used, mostly to treat symptoms. Only remdesivir exhibiting weak antiviral activity is approved for COVID-19. Psychotropic medications may interact with medical treatments for COVID-19. The aim of this presentation is to highlight pharmacokinetic and pharmacodynamic drug-drug interactions to be expected for medical treatments of COVID-19. Remdesivir and favipiravir exhibit hepatotoxic properties which may be enhanced under combinations with tricyclic antidepressants or agomelatine. Favipiravir, hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir have QT interval prolongation potential and must be considered for combinations with antidepressant and antipsychotic drugs. For hydroxychloroquine, hypoglycemic activity may give rise to endocrine disturbances. Pharmacokinetic drug-drug interactions can be expected for lopinavir/ritonavir which inhibit cytochrome P-450 (CYP) 3A4 and induce CYP2C9 and CYP2C19. Combinations with psychotropic drugs that are substrates of these enzymes (victim drugs) will affect drug concentrations in blood and lead to supra- or subtherapeutic levels. Moreover, it must be assumed that the COVID-19 infection is associated with an enhanced production of cytokines which has a known impact on CYP enzyme activities. Though studies on interactions between psychotropic medications and medical treatments for COVID-19 are lacking, multiple drug interactions can be predicted and expected considering the side effect profiles and CYP inhibitory, inducing and substrate properties of combined drugs.

    Disclosure

    No significant relationships.

  • Chapter 86 - Hydrocephalus and porencephaly

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 612-617

  • Summary

    This chapter discusses the etiology, diagnosis, and principles of management of epilepsy in patients diagnosed with meningiomas. It presents cases that demonstrate the broad spectrum of meningioma-related epileptogenesis and the challenges associated with their surgical management. In terms of the medical management of epilepsy related to meningiomas, the choice of antiepileptic drugs (AEDs) depends on various factors including age, drug-drug interactions, and comorbid conditions. Meningiomas along the convexities are often readily accessible and so surgical resection is often indicated for treatment of the underlying neoplasm. When cortical tissue is involved and cortical resection is anticipated, intraoperative electrocorticography (ECoG) may be performed to define the interictal irritative zone. Careful surgical technique during the initial tumor resection may help to prevent some of these cases, but when seizures occur or persist after surgery, and are not controlled by AEDs, the patient should be considered for further surgery to control the epilepsy.

  • 7 - Interactions between antiepileptic drugs

  • from Part II - Pharmacokinetic interactions
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book:
    Antiepileptic Drugs
    Published online:
    07 September 2009
    Print publication:
    26 May 2005, pp 111-138

  • Summary

    Old and new antiepileptic drugs (AEDs) are associated with a wide range of pharmacokinetic drug-drug interactions. Classical pharmacokinetic interactions are enzyme induction, enzyme inhibition and displacement from protein binding. Numerous studies have been performed showing that phenobarbital (PB) decreases concentrations of other concomitantly given AEDs. The interaction of phenytoin (PHT) with valproic acid (VPA) is somewhat complex as it primarily concerns protein binding. In the last decade, a series of new AEDs have become available for the treatment of epileptic patients. The experience of several decades with the classic AEDs has shown that interactions may have severe clinical consequences. Reports on AED interactions usually focus on the increase or decrease of serum concentrations. Most interactions correspond to the pharmacokinetic properties of the compounds, but it should be borne in mind that rare interactions may also play an important role in the individual.

  • 14 - Chronic and refractory mood disorders in childhood and adolescence

  • from Part IV - Special patient populations
  • Edited by Jay D. Amsterdam, University of Pennsylvania, Mady Hornig, University of California, Irvine, Andrew A. Nierenberg
  • Book:
    Treatment-Resistant Mood Disorders
    Published online:
    25 March 2010
    Print publication:
    28 June 2001, pp 273-287

  • Summary

    All childhood and adolescent depression can be characterized as 'refractory' if the measurement used is scientific evidence of efficacious treatments. There have been a small number of systematic studies reported examining the efficacy of psychotherapy interventions for child and adolescent depression. Treatment resistance is a difficult concept to operationalize in young populations, and may apply to a substantial proportion of children and adolescents who are seen clinically. It is clearly established that pediatric major depression is a valid diagnostic entity which as clinical continuity with adult affective disorders. Potential for overdose is a significant concern in the treatment of mood disordered children and adolescents. Selective serotonin reuptake inhibitors (SSRIs) have a very low potential of lethality, while the lethality of tricyclic antidepressants (TCAs) is very high. SSRIs have potential drug-drug interactions with thioridazine, TCAs, and terfenadine.