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Charleston Antidepressant Drug Interactions Surveillance Program (CADISP).

C L DeVane1, J S Markowitz, H L Liston

  • 1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425-0742, USA. devaneL@musc.edu

Psychopharmacology Bulletin
|October 26, 2002
PubMed
Summary
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This study monitored antidepressant drug interactions in 170 patients. Results showed fewer occult interactions than expected, suggesting newer antidepressants are safer when combined with other drugs.

Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Psychiatric Therapeutics

Background:

  • Antidepressant drug interactions pose a risk to patient safety.
  • The cytochrome P-450 (CYP) enzyme system is crucial for metabolizing many drugs, including newer antidepressants.

Purpose of the Study:

  • To prospectively evaluate the occurrence and significance of metabolic drug interactions involving newer antidepressants.
  • To assess the prevalence of occult (undetected) drug interactions with selective serotonin reuptake inhibitors (SSRIs) and other newer antidepressants.

Main Methods:

  • A 4-year prospective surveillance program (Charleston Antidepressant Drug Interactions Surveillance Program, CADISP) enrolled 170 psychiatric patients.
  • Plasma concentrations and clinical effects of drug combinations were monitored in patients receiving SSRIs, nefazodone, or venlafaxine with other CYP-metabolized drugs.

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  • Plasma drug concentrations, with and without antidepressant treatment, served as the primary assessment variable.

    • Main Results:

    • Little evidence of occult pharmacokinetic drug-drug interactions was found with newer antidepressants.
    • Commonly predicted drug interactions were documented, indicating some interactions do occur.
    • The study found that the feared prevalence and routine hazard of these interactions may be overestimated.

    Conclusions:

    • While caution is still warranted when prescribing antidepressants with potential for metabolic interactions, the data suggest these interactions are less prevalent and hazardous than often feared.
    • These findings help allay concerns about the routine clinical danger of drug interactions with newer antidepressants.
    • Further monitoring and research are needed to fully understand the clinical impact of antidepressant drug interactions.