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COMPLEXITIES OF POLYPHARMACY:

 

 

The following article on pharmacology are detailed and technical and may be unnecessarily complex for some visitors to this site.

Nonetheless because the use of multiple medications has become the standard of care for bipolar disorder, both in children and in adults, it may be important for some parents or professionals to master these complexities in order to understand what makes some combinations safe and others dangerous.

In most cases the prescribing physician or the pharmacist can give you a warning about drugs that interact dangerously. Still, some parents want to know for themselves.

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DRUG INTERACTIONS

Part I: METABOLISM OF PSYCHIATRIC MEDICATIONS

The CYP-450 System:

For the most part, psychiatric drugs are metabolized in the liver. In order to be psycho-active a drug must have a certain chemical activity and must be partially fat soluble, so it can pass through the blood-brain barrier and on into the central nervous system where it can affect the action of neurons.

Metabolism in the liver inactivates and eliminates a drug: that is, the enzymes in the liver change a drug’s chemical activity and make it water soluble in preparation for elimination either by the kidneys in urine or in the bowel in feces.

There are, however, different pathways for the metabolism of different drugs. One set of pathways is made up of an array of different enzymes, present in the gut and the liver, known as the CYP-450 system. Different drugs are metabolized by different CYP-450 enzymes, and some drugs are metabolized by more than one enzyme. When several medications are being used, it is important to know if their metabolisms interact in some way: to know if one drug slows down, inhibits, or speeds up the metabolism of the other.

Below is a chart showing some of the most important CYP-450 Enzymes and the drugs they metabolize. The chart also indicates which drugs inhibit the enzyme and which drugs induce an enzyme.

  • If two drugs are metabolized by the same enzyme they compete for metabolism. The drugs must take turns with one another, waiting on line to be metabolized.
  • If one drug inhibits the enzyme, the line moves more slowly for that drug and for any other drug metabolized by that enzyme.
  • If a drug induces the enzyme the line moves more quickly for that drug and any other drug metabolized by that enzyme.
  • An enzyme can also be inhibited or induced by a substance that is not usually considered to be a drug: for example grapefruit juice strongly inhibits one enzyme (3A4) and cigarette smoke induces another (1A2).

When an enzyme is inhibited or when two drugs compete for metabolism the circulating levels of those drugs go up. In some cases this can be dangerous or uncomfortable, so the dose of one or both medications may need to be lowered.

When an enzyme is induced, the circulating levels of drugs metabolized by that enzyme fall. That fall can cause a medication to lose its therapeutic effect. So the dose of those drugs metabolized by the enzyme may need to be raised.

For example:

Fluoxitine (Prozac) strongly inhibits the enzyme (2D6) that metabolizes metoprolol (Lopressor) a drug that lowers blood pressure and slows heart rate. The combination of these drugs will cause an increase in the level of metoprolol and consequently lower blood pressure; the increased level of metoprolol will also slow the heart rate possibly leading to a dangerously low blood pressure and even circulatory collapse.

Carbamazepine (Tegretol) induces the enzyme (2D6) that metabolizes hormones contained in oral contraceptives. When carbamazepine is combined with an oral contraceptive in a sexually active woman an unexpected pregnancy can occur.

Grapefruit juice strongly inhibits an enzyme (3A4) that metabolizes erythromycin and a similar antibiotic clarithromycin (Biaxin). If the level of either of those medicines is raised sharply nausea and vomiting can result, which can be uncomfortable but not dangerous.

In order to use the chart:

  • Locate the medications being used (generic names are given).
  • Determine if they are metabolized by the same enzyme (compete).
  • or if one inhibits or induces another’s metabolism
  • This can be done with two or three or more medications.
  • If more information is desired use the links below the chart.

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METABOLISM BY CYTOCHROME P450 ENZYMES

(an asterisk * indicates a drug is metabolized by more than one enzyme)

1A2 2C9 2C19 2D6 2E1 3A4
PSYCHOACTIVEAntidepressantsamitriptyline*

clomipramine*

fluvoxamine*

imipramine=>N-DeMe*

Major Tranquilizers

clozapine*

haloperidol*

olanzepine*

——-

cyclobenzaprine

riluzole

verapamil*

OTHER SUBSTRATES:

acetaminophen-

=>NAPI*

caffeine

estradiol*

mexilletine

naproxen

ondansetron

phenacetin=>

propafenone*

propranolol*

ropivacaine

tacrine

theophylline *

tizanidine

(R)warfarin

zileuton

zolmitriptan

propranalol*

theophyll

INDUCED BY

broccoli

brussel sprouts

chargrilled-meat

insulin

methyl-

cholanthrene

modafinil

nafcillin

beta-naptho-flavone

omeprazole

tobacco

INHIBITED BY

amiodarone

cimetidine

ciprofloxacin

fluoro-quinolones

furafylline

interferon

methoxsalen

mibefradil

PSYCHOACTIVE Antidepressantsamitrypteline*

fluoxitene*

OTHER SUBSTRATES:

NSAIDs:

diclofenac

ibuprofen

lornoxicam

meloxicam

S-naproxen
=>Nor

piroxicam

suprofen

tenoxicam

Oral Hypoglycemic Agents:

tolbutamide

glipizide

Angiotensin II Blockers:

losartan*

irbesartan

Sulfonylureas:

glyburide

glibenclamide

glipizide

glimepiride

tolbutamide

celecoxib

fluvastatin

glyburide

nateglinide

phenytoin=>4-OH

rosiglitazone

tamoxifen

torsemide

S-warfarin

dapsone

INDUCED BY

rifampin

secobarbital

INHIBITED BY

amiodarone

fenofibrate

fluconazole

fluoxitine 2+

fluvastatin

fluvoxamine

isoniazid

lovastatin

phenylbutazone

probenicid

sertraline

sulfamethoxazole

sulfaphenazole

teniposide

voriconazole

zafirlukast

PSYCHOACTIVE
Antidepressantsamytriptyline*citalopram

clomiprimine*

escitalopram

imiprimine=>N-DeMe*

meclobemide

——-

hexobarbital

R-mephobarbital

omeprazole

progesterone

Anti-epileptics

carbamazepine*

diazepam=>Nor*

oxcarbamazepine*

phenytoin(O)

S-mephenytoin

phenobarbitone

primidone

OTHER SUBSTRATES:

lansoprazole

omeprazole

pantoprazole

rabeprazole

E-3810

carisoprodol

cyclophosphamide

indomethacin

nelfinavir

nilutamide

progesterone

proguanil

propranalol*

teniposide

R-warfarin=>8-OH

tolbutamid

INDUCED BY

carbamazepine

norethindrone

prednisone

rifampin

INHIBITED BY

amiodarone

bupropion

celecoxib

chlorpromazine

chlorpheniramine

cimetidine

citalopram

clomipramine

cocaine

doxepin

doxorubicin

duloxetine

escitalopram

fluoxetine

halofantrine

red-haloperidol

levomepromazine

metoclopramide

methadone

mibefradil

midodrine

moclobemide

paroxetine

perphenazine

quinidine

ranitidine

ritonavir

sertraline

terbinafine

ticlopidine

Antihistamines

diphenhydramine

chlorpheniramine*

clemastine

hydroxyzine

tripelennamine

cimetadine

felbamate

fluoxitine 1+

fluvoxamine 4+

indomethacin

ketoconazole

modafanil

PSYCHOACTIVE amphetamineAntidepressants

amitriptyline*

clomiprimine*

desiprimine

duloxetine

fluoxitine*

fluvoxamine*

imiprimine

nortriptyline

paroxitine

venlafaxin

Major Tranquilizers

chlorpromazine

haloperidol*

perphenazine

quietapine

risperidone=>9OH

thioridazine

zuclopenthixol

OTHER SUBSTRATES:

Beta Blockers:

alprenalol

carvedilol

S-metoprolol

propafenone

timolol

atomoxetine

bufuralol

chlorpheniramine*

codeine* (=>O-desMe)

debrisoquine

dexfenfluramine

dextromethorphan*

encainide

flecainide

lidocaine

metoclopramide

methoxy-

amphetamine

mexilletine

minaprine

nebivolol

ondansetron

oxycodone

perhexiline

phenacetin

phenformin

promethazine

propafenone*

propranolol*

quanoxan

sparteine

tamoxifen

tramadol

INDUCED BY

dexamethasone

rifampin

INHIBITED BY

amiodarone

bupropion2+

celecoxib

chlorpromazine

chlorpheniramine

cimetidine

citalopram

clomipramine

cocaine

doxepin

doxorubicin

duloxetine 2+

escitalopram

fluoxetine 4+

halofantrine

red-haloperidol

levomepromazine

metoclopramide

methadone

mibefradil

midodrine

moclobemide

paroxetine 4+

quinidine

ranitidine

ritonavir

sertraline 1+

terbinafine

ticlopidine

Antihistamines

diphenhydramine

chlorpheniramine

clomastine

perphenazine

hydroxyzine

tripelennamine

PSYCHOACTIVE ethanolAnesthetics

enflurane

halothane

isoflurane

methoxyfluranes

evoflurane

——-

acetaminophen* =>NAPQI

aniline

benzene

chlorzoxazone

N,N-dimethyl formamide

theophylline=>8-OH*

INHIBITORS

diethyl- dithiocarbamate

disulfiram

INDUCERS

ethanol

isoniazid

PSYCHOACTIVE Antidepressantssertraline*

St. John’s Wort

trazodone

Minor Tranquilizers

alprazolam

diazepam*=>3OH

midazolam

triazolam

Hypnotics (for sleep)

zaleplon

zolipidem

Major Tranquilizers

aripiprisol

haloperidol*

quietepine

risperidone

ziprasidone

pimozide

Anti-epileptics

carbamazepine*

zonisamide

tiagabine

——-

buspirone

Narcotics

fentanyl

methadone*

OTHER SUBSTRATES:

Macrolide antibiotics:

clarithromycin

erythromycin

telithromycin

Anti-arrhythmics:

quinidine=>3-OH

Immune Modulators:

cyclosporine

tacrolimus-(FK506)

HIV Antivirals:

indinavir

nelfinavir

ritonavir

saquinavir

Prokinetic:

cisapride

Antihistamines:

astemizole*

chlorpheniramine*

terfenidine

Calcium Channel

Blockers:

amlodipine

diltiazem

felodipine

lercanidipine

nifedipine

nisoldipine

nitrendipine

verapamil*

HMG CoA Reductase Inhibitors:

atorvastatin

cerivastatin

lovastatin

simvastatin

Steroid6beta-OH:

estradiol*

hydrocortisone

progesterone*

testosterone

Miscellaneous:

alfentanyl

aprepitant

cafergot

caffeine=>TMU

cilostazol

cocaine

codeine-N-demethylation

dapsone

dextromethorphan

docetaxel

domperidone

eplerenone

fentanyl

finasteride

gleevec

irinotecan

LAAM

lidocaine

methadone

nateglinide

odanestron

propranolol

quinine

salmeterol

sildenafil

sirolimus

tamoxifen

taxol

vincristine

vinblastin

INDUCED BY

HIV Antivirals:

efavirenz

nevirapine

——-

barbiturates

Anticonvulsants

carbamazepine

phenetoin

phenobarbitol

oxcarbamazepine

——-

glucocorticoids

dexamethasone

modafanil

pioglitazone

rifampin

rifabutin

St John’s Wort

troglitazone

INHIBITED BY

Grapefruit juice 4+

Star Fruit 4+

Antidepressants

norfluoxetine

fluvoxamine
HIV-Antivirals

delaviridine

indinavir

nelfinavir

ritonavir

——-

Macrolid Antibiotics
clarithromycin
erythromycin
——-

Antifungals

fluconazole
itraconazole
ketoconazole

voriconazole

——-

amiodarone

aprepitant

chloramphenicol

cimetidine

diethyl-

dithiocarbamate

diltiazem

gestodene

imatinib

mifepristone

norfloxacin

mibefradil

verapamil

 

Click Here for a thorough Guide to the CPY-450 System

Cick Here for a Guide to the Names and Properties of Drugs

 

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