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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
Summary
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.
- 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.