Possible Pharmacodynamic and Pharmacokinetic Drug-Drug Interactions That Are Likely to Be Clinically Relevant and/or Frequent in Bipolar Disorder

  • Jose de Leon
  • Edoardo Spina
Mood Disorders (E Baca-Garcia, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Mood Disorders


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).

Recent Findings

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.


Anticonvulsant 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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Kentucky Mental Health Research Center at Eastern State HospitalLexingtonUSA
  2. 2.Psychiatry and Neurosciences Research Group (CTS-549), Institute of NeurosciencesUniversity of GranadaGranadaSpain
  3. 3.Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol HospitalUniversity of the Basque CountryVitoriaSpain
  4. 4.Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly

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