PHARMACOTHERAPY IN PATIENTS WITH COMORBIDITY: THE POSSIBILITY OF DRUG INTERACTIONS AT THE LEVEL OF METABOLISM
- Authors: Fomln E.1,2, Balchorov I.1,2, Shlkh E.1,2, Slzova Z.1,2
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Affiliations:
- City Polyclinic Two
- I.M. Sechenov First State Medical University
- Issue: Vol 25, No 1 (2014)
- Pages: 13-17
- Section: Articles
- URL: https://journals.eco-vector.com/0236-3054/article/view/115873
- ID: 115873
Cite item
Abstract
Affective disorders are implicated in the pathogenesis of somatic diseases, such as hypertension, angina pectoris, myocardial infarction, asthma, etc., or aggravate their course. Thus, combination pharmacotherapy with drugs from different groups is used in patients with comorbidity. The CYP3A4 isoenzyme is known to metabolize about 70% of all known drugs. There are many CYP3A4 inhibitors among antidepressants. If a drug substrate is co-administered with a CYP3A4 inhibitor, the metabolism of the substrate slows down and it can be accumulated in the body; this increases the risk of adverse reactions. When comorbidities are treated, drugs should be prescribed with regard to metabolic pathways, which will make it possible to predict a priori undesirable interactions and to enhance the safety of performed combination therapy.
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About the authors
E. Fomln
City Polyclinic Two; I.M. Sechenov First State Medical University
Email: chih@mail.ru
Moscow
I. Balchorov
City Polyclinic Two; I.M. Sechenov First State Medical University
Email: chih@mail.ru
Moscow
E. Shlkh
City Polyclinic Two; I.M. Sechenov First State Medical University
Email: chih@mail.ru
Professor, MD Moscow
Zh. Slzova
City Polyclinic Two; I.M. Sechenov First State Medical University
Email: chih@mail.ru
Professor, MD Moscow
References
- Смулевич А.Б. Депрессии в общей медицине. Руководство для врачей / М.: Медицинское информационное агентство, 2001.
- Сыркин А.Л, Медведев В.Э, Троснова А.П. и др. Терапия депрессивных расстройств в кардиологической практике // Психич. расстройства в общ. мед. - 2007; 2: 28-31.
- Зотов П.Б., Уманский М.С. Депрессия в общемедицинской практике (клиника, диагностика, лекарственная терапия). Метод. пособие для врачей / М., 2006; 35 с
- Гиндикин В.Я. Справочник. Соматогенные и соматоформные психические расстройства / М.: Триада-Х, 2000; 255 с.
- Tollefson G., Bosomworth J., Heiligenstein J. et al. A double-blind placebocontrolled clinical trials of fluoxetine in geriatric patients with major depression. The fluoxetine collaborative study group // Int. Psychogeriatr. - 1995; 7 (1): 89-104.
- Кукес В.Г., Фисенко В.П., Стародубцев А.К. и др. Метаболизм лекарственных препаратов / М.: Палея-М, 2004.
- Белоусов Ю.Б., Моисеев В.С., Лепахин В.К. Клиническая фармакология и фармакотерапия / М.: Универсум паблишинг, 1997; 326-30.
- Josien H., Bara T., Rajagopalan M. et al. Novel orally active morpholine N-arylsulfonamides gamma-secretase inhibitors with low CYP 3A4 liability // Bioorg. Med. Chem. Lett. - 2009; 19 (21): 6032-7.
- Zhou S. Drugs behave as substrates, inhibitors and inducers of human cytochrome P450 3A4 // Curr. Drug. Metab. - 2008; 9 (4): 310-22.
- Hammann F., Gutmann H., Baumann U. et al. Classification of cytochrome p(450) activities using machine learning methods // Mol. Pharm. - 2009; 6 (6): 1920-6.
- Woolfrey S., Gammack N., Dewar M. et al. Fluoxetine-warfarin interaction // BMJ. - 1993; 307: 241.
- Dent L., Orrock M. Warfarinfluoxetine and diazepam-fluoxetine interaction // Pharmacotherapy. - 1997; 17: 170-2.
- Sternbach H. Fluoxetine-associated potentiation of calcium-channel blockers // J. Clin. Psychopharmacol. - 1991; 11: 390-1.
- Yap K., Low S. Interaction offluvoxamine with warfarin in an elderly woman // Singapore Med. J. - 1999; 40: 480-2.
- Benfield P., Ward A. Fluvoxamine: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness // Drugs. - 1986; 32: 313-34.
- Preskorn S., Greenblatt D., Flockhart D. et al. Comparison of duloxetine, escitalopram, and sertraline effects on cytochrome P450 2D6 function in healthy volunteers // J. Clin. Psychopharmacol. - 2007; 27: 28-34.
- Priskorn M., Sidhu J., Larsen F. et al. Investigation of multiple dose citalopram on the pharmacokinetics and pharmacodynamics of racemic warfarin // Br. J. Clin. Pharmacol. - 1997; 44: 199-202.
- Gutierrez M., Abramowirz W. Lack of effect of a single dose of ketoconazole on the pharmacokinetics of citalopram // Pharmacotherapy. - 2001; 21: 163-8.