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Transcript
Antidepressant Drug Interactions All antidepressants are metabolized by the P450 isoenzyme system in the liver. Certain antidepressants inhibit specific subtypes of P450 enzymes and this may increase blood levels in patients who are taking other medications metabolized by the same isoenzyme systems. Care is advised in patients who are taking medications with a narrow therapeutic window such as tricyclic antidepressants, digoxin, warfarin, anticonvulsants, or theophylline. It is advised to observe clinically for side effects from such medications and to recheck serum blood levels of such medications as the dose of the antidepressant is titrated upwards. For example, patients who are taking both a tricyclic antidepressant and an SSRI should have their serum levels of the TCA checked in order to avoid toxicity resulting from increased levels of TCAs. Some of the absolute contraindications for combining drugs involve the combination of Nefazodone with other drugs that are metabolized by the P450 3A4 enzyme system. Monoamine oxidase inhibitors (MAOIs such as phenelzine or tranylcypromine) should NOT be co-administered with other antidepressants, lithium, meperidine, stimulants, pseudoephedrine, phenylephrine, reserpine, sumatriptan, l-dopa, tyramine, or morphine. Consult with the team psychiatrist before using MAOIs as these medications have a narrow therapeutic window and can result in serotonin syndrome or hypertensive crises if used incorrectly. Please refer to the medication package insert, a pharmacology text, or consult with your team psychiatrist or a pharmacist if you have questions about specific drug-drug interactions involving antidepressants.