Possible Pharmacodynamic and Pharmacokinetic Drug-Drug Interactions That Are Likely to Be Clinically Relevant and/or Frequent in Bipolar Disorder
Purpose of Review
Patients with bipolar disorder are frequently treated with polypharmacy. This article should provide clinicians with an understanding of how polypharmacy can contribute to pharmacokinetic and pharmacodynamic drug-drug interactions (DDIs).
The pharmacokinetics and pharmacodynamics of lithium and other mood stabilizers (valproate, lamotrigine, carbamazepine, oxcarbazepine, and eslicarbazepine), antipsychotics, and selective serotonin reuptake inhibitors (SSRIs) were reviewed and summarized in the first four tables describing their pharmacokinetic and pharmacodynamic mechanisms.
Four tables summarized the DDIs which are likely to be clinically relevant in adults with bipolar disorder: two for mania treatments (with and without carbamazepine), one for maintenance treatments, and one for depression treatments. The purpose is to be practical, helping clinicians pay attention to and manage polypharmacy, avoiding adverse drug reactions (ADRs) in patients with bipolar disorder, including both the frequent ADRs and those rare but potentially lethal ADRs. Future articles should improve these tables.
KeywordsAnticonvulsant Antidepressant Antipsychotic Bipolar disorder Drug interactions Lithium
The authors acknowledge Lorraine Maw, M.A., at the University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA, who helped in editing this article.
Compliance with Ethical Standards
Conflict of Interest
The authors declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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