Paulzen, Michael and Haen, Ekkehard and Hiemke, Christoph and Fay, Bianca and Unholzer, Sandra and Gruender, Gerhard and Schoretsanitis, Georgios (2018) Antidepressant polypharmacy and the potential of pharmacokinetic interactions: Doxepin but not mirtazapine causes clinically relevant changes in venlafaxine metabolism. JOURNAL OF AFFECTIVE DISORDERS, 227. pp. 506-511. ISSN 0165-0327, 1573-2517
Full text not available from this repository. (Request a copy)Abstract
Background: To uncover pharmacokinetic interactions between venlafaxine and doxepin or mirtazapine in a naturalistic sample. Methods: A therapeutic drug monitoring database containing plasma concentrations of venlafaxine (VEN) and its active metabolite O-desmethylvenlafaxine (ODVEN) was analyzed. We included 1067 of 1594 patients in the analysis. Three study groups were considered; a group of patients under venlafaxine without confounding medications, V-0 (n = 905), a group of patients co-medicated with doxepin, V-DOX (n = 25) and a second group, co-medicated with mirtazapine, V-MIR, n = 137. Plasma concentrations of VEN, ODVEN and the clinically relevant active moiety, sum of venlafaxine and O-desmethylvenlafaxine (ODVEN) (AM), as well as dose-adjusted plasma concentrations (C/D) were compared. Results: Median concentrations in the doxepin group showed 57.7% and 194.4% higher values for AM and VEN respectively; these differences were statistically significant (p<0.001 for AM and p = 0.002 for VEN). Similar differences were detected for C/D concentrations of active moiety and VEN (p<0.001 and p = 0.001) with higher values also in the doxepin group. The ratios ODVEN/VEN were lower in the doxepin group (p<0.001). A co-medication with mirtazapine did not cause any changes in venlafaxine metabolism. Conclusions: Higher concentrations for VEN and AM imply an inhibiting effect of doxepin on the metabolism of venlafaxine, although the huge variability of concentrations has to be taken into account. It is recommended to monitor plasma concentrations in combination treatment to avoid problems in safety and efficacy. Limitations: Despite the large size of our study sample, the naturalistic nature of this data may arise some concerns of information bias potentially resulting from non-standardized data recording.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MAJOR DEPRESSIVE DISORDER; DRUG-DRUG INTERACTIONS; TRICYCLIC ANTIDEPRESSANTS; 2ND-GENERATION ANTIPSYCHOTICS; SERUM CONCENTRATIONS; PRIMARY INSOMNIA; IN-VITRO; RISPERIDONE; CYP2D6; EFFICACY; Therapeutic drug monitoring; Venlafaxine; Antidepressant polypharmacy; Cytochrome P450; Interaction; CYP2D6; Pharmacokinetics |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Psychiatrie und Psychotherapie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 19 Mar 2020 08:06 |
| Last Modified: | 19 Mar 2020 08:06 |
| URI: | https://pred.uni-regensburg.de/id/eprint/15119 |
Actions (login required)
 |
View Item |
