Clinically relevant interactions between newer antidepressants and second-generation antipsychotics

Edoardo Spina, Jose De Leon

Research output: Contribution to journalReview articlepeer-review

98 Scopus citations

Abstract

Introduction: Combinations of newer antidepressants and second-generation antipsychotics (SGAs) are frequently used by clinicians. Pharmacokinetic drug interaction (PK DI) and poorly understood pharmacodynamic (PD) drug interaction (PD DI) can occur between them. Areas covered: This paper comprehensively reviews PD DI and PK DI studies. Expert opinion: More PK DI studies are needed to better establish dose correction factors after adding fluoxetine and paroxetine to aripiprazole, iloperidone and risperidone. Further PK DI studies and case reports are also needed to better establish the need for dose correction factors after adding i) fluoxetine to clozapine, lurasidone, quetiapine and olanzapine; ii) paroxetine to olanzapine; iii) fluvoxamine to asenapine, aripiprazole, iloperidone, lurasidone, olanzapine, quetiapine and risperidone; iv) high sertraline doses to aripiprazole, clozapine, iloperidone and risperidone: v) bupropion and duloxetine to aripiprazole, clozapine, iloperidone and risperidone; and vi) asenapine to paroxetine and venlafaxine. Possible beneficial PD DI effects occur after adding SGAs to newer antidepressants for treatment-resistant major depressive and obsessive-compulsive disorders. The lack of studies combining newer antidepressants and SGAs in psychotic depression is worrisome. PD DIs between newer antidepressants and SGAs may be more likely for mirtazapine and bupropion. Adding selective serotonin reuptake inhibitors and SGAs may increase QTc interval and may very rarely contribute to torsades de pointes.

Original languageEnglish
Pages (from-to)721-746
Number of pages26
JournalExpert Opinion on Drug Metabolism and Toxicology
Volume10
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • Drug interactions
  • New antidepressants
  • Pharmacodynamics
  • Pharmacokinetics
  • Second-generation antipsychotics

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

Fingerprint

Dive into the research topics of 'Clinically relevant interactions between newer antidepressants and second-generation antipsychotics'. Together they form a unique fingerprint.

Cite this