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Plasma risperidone concentrations during combined treatment with sertraline
Edoardo Spina1, Concetta D'Arrigo, Gaetana Migliardi
1Section of Pharmacology, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy. espina@unime.it
Therapeutic Drug Monitoring
|July 17, 2004
Summary
Sertraline up to 100 mg/day did not significantly alter risperidone levels in patients with schizophrenia. Higher sertraline doses may increase risperidone plasma concentrations, suggesting a dose-dependent interaction.
Area of Science:
- Pharmacology
- Psychiatry
Background:
- Schizophrenia and schizoaffective disorder often present with comorbid depressive symptoms.
- Risperidone is a common antipsychotic, and sertraline is a selective serotonin reuptake inhibitor (SSRI).
Purpose of the Study:
- To investigate the effect of sertraline on steady-state plasma concentrations of risperidone and its active metabolite, 9-hydroxyrisperidone (9-OH-risperidone).
Main Methods:
- 11 patients with schizophrenia or schizoaffective disorder stabilized on risperidone received additional sertraline (50 mg/d initially).
- Dosages were adjusted up to 150 mg/d over 8 weeks.
- Plasma concentrations of risperidone, 9-OH-risperidone, and the active moiety were measured.
Main Results:
- Mean plasma concentrations of risperidone, 9-OH-risperidone, and the active moiety did not change significantly at 50 mg/d sertraline.
- Slight, non-significant increases in active moiety concentrations were observed at 100 mg/d sertraline.
- Significant increases (36-52%) in total plasma risperidone concentrations were noted at 150 mg/d sertraline.
Conclusions:
- Sertraline up to 100 mg/d appears safe and does not cause clinically significant changes in risperidone plasma levels.
- Higher doses of sertraline (≥150 mg/d) may inhibit CYP2D6, leading to elevated risperidone concentrations.
- Combined treatment was well-tolerated, with no extrapyramidal symptoms reported.