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Dołoto A, Bąk E, Batóg G, Piątkowska-Chmiel I, Herbet M. Interactions of antidepressants with concomitant medications-safety of complex therapies in multimorbidities. Pharmacol Rep 2024; 76:714-739. [PMID: 39012418 PMCID: PMC11294384 DOI: 10.1007/s43440-024-00611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024]
Abstract
Depression is the fourth most serious disease in the world. Left untreated, it is a cause of suicide attempts, emergence or exacerbation worsening of serious diseases, bodily and mental disorders, as well as increased risk of cardiovascular diseases, stroke, diabetes, and obesity, as well as endocrine and neurological diseases. Frequent coexistence of depression and other diseases requires the simultaneous use of several drugs from different therapeutic groups, which very often interact and intensify comorbidities, sometimes unrelated mechanisms. Sufficient awareness of potential drug interactions is critical in clinical practice, as it allows both to avoid disruption of proper pharmacotherapy and achieve substantive results. Therefore, this review aims to analyze the interactions of antidepressants with other concomitant medications. Against the backdrop of experimental research and a thorough analysis of the up-to-date literature, the authors discuss in detail the mechanisms and effects of action of individual drug interactions and adaptogens, including the latest antidepressants.
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Affiliation(s)
- Anna Dołoto
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8B Street, 20-090, Lublin, Poland
| | - Ewelina Bąk
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8B Street, 20-090, Lublin, Poland
| | - Gabriela Batóg
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8B Street, 20-090, Lublin, Poland
| | - Iwona Piątkowska-Chmiel
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8B Street, 20-090, Lublin, Poland
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8B Street, 20-090, Lublin, Poland.
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Miziak B, Czuczwar SJ, Pluta R. Comorbid epilepsy and depression—pharmacokinetic and pharmacodynamic drug interactions. Front Pharmacol 2022; 13:988716. [PMID: 36278185 PMCID: PMC9585163 DOI: 10.3389/fphar.2022.988716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Major depressive disorder may be encountered in 17% of patients with epilepsy and in patients with drug-resistant epilepsy its prevalence may reach 30%. This indicates that patients with epilepsy may require antidepressant treatment.Purpose: Both pharmacodynamic and pharmacokinetic interactions between antiepileptic (antiseizure) and antidepressant drugs have been reviewed. Also, data on the adverse effects of co-administration of antiepileptic with antidepressant drugs have been added. This article was submitted to Neuropharmacology, a section of the journal Frontiers in Pharmacology.Methods: The review of relevant literature was confined to English-language publications in PUBMED databases. Table data show effects of antidepressants on the seizure susceptibility in experimental animals, results of pharmacodynamic interactions between antiepileptic and antidepressant drugs mainly derived from electroconvulsions in mice, as well as results concerning pharmacokinetic interactions between these drugs in clinical conditions.Conclusion: Antidepressant drugs may exert differentiated effects upon the convulsive threshold which may differ in their acute and chronic administration. Animal data indicate that chronic administration of antidepressants could reduce (mianserin, trazodone) or potentiate the anticonvulsant activity of some antiepileptics (fluoxetine, reboxetine, venlafaxine). There are also examples of neutral interactions (milnacipran).
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Affiliation(s)
- Barbara Miziak
- Department of Pathophysiology, Medical University, Lublin, Poland
| | - Stanisław J. Czuczwar
- Department of Pathophysiology, Medical University, Lublin, Poland
- *Correspondence: Stanisław J. Czuczwar, ; Ryszard Pluta,
| | - Ryszard Pluta
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Stanisław J. Czuczwar, ; Ryszard Pluta,
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How Antidepressant Drugs Affect the Antielectroshock Action of Antiseizure Drugs in Mice: A Critical Review. Int J Mol Sci 2021; 22:ijms22052521. [PMID: 33802323 PMCID: PMC7959142 DOI: 10.3390/ijms22052521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 01/07/2023] Open
Abstract
Depression coexists with epilepsy, worsening its course. Treatment of the two diseases enables the possibility of interactions between antidepressant and antiepileptic drugs. The aim of this review was to analyze such interactions in one animal seizure model-the maximal electroshock (MES) in mice. Although numerous antidepressants showed an anticonvulsant action, mianserin exhibited a proconvulsant effect against electroconvulsions. In most cases, antidepressants potentiated or remained ineffective in relation to the antielectroshock action of classical antiepileptic drugs. However, mianserin and trazodone reduced the action of valproate, phenytoin, and carbamazepine against the MES test. Antiseizure drug effects were potentiated by all groups of antidepressants independently of their mechanisms of action. Therefore, other factors, including brain-derived neurotrophic factor (BDNF) and glial-derived neurotrophic factor (GDNF) modulation, should be considered as the background for the effect of drug combinations.
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Borowicz-Reutt KK, Czuczwar SJ, Rusek M. Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy. Expert Rev Clin Pharmacol 2020; 13:1329-1345. [PMID: 33305639 DOI: 10.1080/17512433.2020.1850258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Comorbidities of epilepsy may significantly interfere with its treatment as diseases in the general population are also encountered in epilepsy patients and some of them even more frequently (for instance, depression, anxiety, or heart disease). Obviously, some drugs approved for other than epilepsy indications can modify the anticonvulsant activity of antiepileptics. Areas covered: This review highlights the drug-drug interactions between antiepileptics and aminophylline, some antidepressant, antiarrhythmic (class I-IV), selected antihypertensive drugs and non-barbiturate injectable anesthetics (ketamine, propofol, etomidate, and alphaxalone). The data were reviewed mainly from experimental models of seizures. Whenever possible, clinical data were provided. PUBMED data base was the main search source.Expert opinion: Aminophylline generally reduced the protective activity of antiepileptics, which, to a certain degree, was consistent with scarce clinical data on methylxanthine derivatives and worse seizure control. The only antiarrhythmic with this profile of action was mexiletine when co-administered with VPA. Among antidepressants and non-barbiturate injectable anesthetics, trazodone, mianserin and etomidate or alphaxalone, respectively, negatively affected the anticonvulsant action of some antiepileptic drugs. Clinical data indicate that only amoxapine, bupropion, clomipramine and maprotiline should be used with caution. Possibly, drugs reducing the anticonvulsant potential of antiepileptics should be avoided in epilepsy patients.
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Affiliation(s)
- Kinga K Borowicz-Reutt
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin , Lublin, Poland
| | | | - Marta Rusek
- Department of Pathophysiology, Medical University of Lublin , Lublin, Poland.,Department of Dermatology, Venereology and Pediatric Dermatology, Laboratory for Immunology of Skin Diseases, Medical University of Lublin , Lublin, Poland
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Protti M, Mandrioli R, Marasca C, Cavalli A, Serretti A, Mercolini L. New‐generation, non‐SSRI antidepressants: Drug‐drug interactions and therapeutic drug monitoring. Part 2: NaSSAs, NRIs, SNDRIs, MASSAs, NDRIs, and others. Med Res Rev 2020; 40:1794-1832. [DOI: 10.1002/med.21671] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/18/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Michele Protti
- Department of Pharmacy and Biotechnology (FaBiT), Pharmaco‐Toxicological Analysis Laboratory (PTA Lab)Alma Mater Studiorum ‐ University of Bologna Bologna Italy
| | - Roberto Mandrioli
- Department for Life Quality Studies (QuVi)Alma Mater Studiorum ‐ University of BolognaRimini Italy
| | - Camilla Marasca
- Department of Pharmacy and Biotechnology (FaBiT), Pharmaco‐Toxicological Analysis Laboratory (PTA Lab)Alma Mater Studiorum ‐ University of Bologna Bologna Italy
- Computational and Chemical BiologyFondazione Istituto Italiano di Tecnologia (IIT) Genoa Italy
| | - Andrea Cavalli
- Department of Pharmacy and Biotechnology (FaBiT), Pharmaco‐Toxicological Analysis Laboratory (PTA Lab)Alma Mater Studiorum ‐ University of Bologna Bologna Italy
- Computational and Chemical BiologyFondazione Istituto Italiano di Tecnologia (IIT) Genoa Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum ‐ University of Bologna Bologna Italy
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology (FaBiT), Pharmaco‐Toxicological Analysis Laboratory (PTA Lab)Alma Mater Studiorum ‐ University of Bologna Bologna Italy
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Banach M, Popławska M, Borowicz-Reutt KK. Amiodarone, a multi-channel blocker, enhances anticonvulsive effect of carbamazepine in the mouse maximal electroshock model. Epilepsy Res 2018; 140:105-110. [PMID: 29329017 DOI: 10.1016/j.eplepsyres.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/07/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022]
Abstract
Cardiac arrhythmia may occur in the course of epilepsy. Simultaneous therapy of the two diseases might be complicated by drug interactions since antiarrhythmic and antiepileptic agents share some molecular targets. The aim of this study was to evaluate the influence of amiodarone, an antiarrhythmic drug working as a multi-channel blocker, on the protective activity of four classical antiepileptic drugs in the maximal electroshock test in mice. Amiodarone at doses up to 75 mg/kg did not affect the electroconvulsive threshold in mice. Acute amiodarone at the dose of 75 mg/kg significantly potentiated the anticonvulsive effect of carbamazepine, but not that of valproate, phenytoin or phenobarbital in the maximal electroshock-induced seizures in mice. The antiarrhythmic agent and its combinations with antiepileptic drugs did not impair motor performance or long-term memory in mice, except for the combination of amiodarone and phenobarbital. Brain concentrations of antiepileptic drugs were not changed. Despite favourable impact of amiodarone on the anticonvulsive action of carbamazepine in the maximal electroshock, co-administration of the two drugs should be carefully monitored in clinical conditions. Further studies are necessary to evaluate effects of chronic treatment with amiodarone on seizure activity and the action of antiepileptic drugs.
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Affiliation(s)
- Monika Banach
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL-20-954, Lublin, Poland
| | - Monika Popławska
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL-20-954, Lublin, Poland
| | - Kinga K Borowicz-Reutt
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL-20-954, Lublin, Poland.
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Anticonvulsant activity of the antidepressant drug, tianeptine, against pentylenetetrazole-induced seizures mitigates cognitive impairment in rats. Behav Pharmacol 2016; 27:623-32. [DOI: 10.1097/fbp.0000000000000257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Banach M, Popławska M, Błaszczyk B, Borowicz KK, Czuczwar SJ. Pharmacokinetic/pharmacodynamic considerations for epilepsy - depression comorbidities. Expert Opin Drug Metab Toxicol 2016; 12:1067-80. [PMID: 27267259 DOI: 10.1080/17425255.2016.1198319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Epilepsy may be frequently associated with psychiatric disorders and its co-existence with depression usually results in the reduced quality of life of patients with epilepsy. Also, the efficacy of antiepileptic treatment in depressed patients with epilepsy may be significantly reduced. AREAS COVERED Results of experimental studies indicate that antidepressants co-administered with antiepileptic drugs may either increase their anticonvulsant activity, remain neutral or decrease the protective action of antiepileptic drugs in models of seizures. Apart from purely pharmacodynamic interactions, pharmacokinetic mechanisms have been proven to contribute to the final outcome. We report on clinical data regarding the pharmacokinetic interactions of enzyme-inducing antiepileptic drugs with various antidepressants, whose plasma concentration may be significantly reduced. On the other hand, antidepressants (especially selective serotonin reuptake inhibitors) may influence the metabolism of antiepileptics, in many cases resulting in the elevation of plasma concentration of antiepileptic drugs. EXPERT OPINION The preclinical data may provide valuable clues on how to combine these two groups of drugs - antidepressant drugs neutral or potentiating the anticonvulsant action of antiepileptics are recommended in this regard. Avoidance of antidepressants clearly decreasing the convulsive threshold or decreasing the anticonvulsant efficacy of antiepileptic drugs (f.e. bupropion or mianserin) in patients with epilepsy is recommended.
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Affiliation(s)
- Monika Banach
- a Experimental Neuropathophysiology Unit, Department of Pathophysiology , Medical University , Lublin , Poland
| | - Monika Popławska
- a Experimental Neuropathophysiology Unit, Department of Pathophysiology , Medical University , Lublin , Poland
| | - Barbara Błaszczyk
- b Faculty of Health Sciences , High School of Economics, Law and Medical Sciences , Kielce , Poland
| | - Kinga K Borowicz
- a Experimental Neuropathophysiology Unit, Department of Pathophysiology , Medical University , Lublin , Poland
| | - Stanisław J Czuczwar
- c Department of Pathophysiology , Medical University , Lublin , Poland.,d Department of Physiopathology , Institute of Rural Health , Lublin , Poland
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Garrido-Acosta O, Meza-Toledo SE, Anguiano-Robledo L, Soriano-Ursúa MA, Correa-Basurto J, Davood A, Chamorro-Cevallos G. Anticonvulsant and Toxicological Evaluation of Parafluorinated/Chlorinated Derivatives of 3-Hydroxy-3-ethyl-3-phenylpropionamide. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3978010. [PMID: 27006945 PMCID: PMC4783531 DOI: 10.1155/2016/3978010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 02/07/2023]
Abstract
Although the anticonvulsant activity of 3-hydroxy-3-ethyl-3-phenylproionamide (HEPP) is well-known, its use is limited by the pharmacotoxicological profile. We herein tested its fluorinated and chlorinated derivatives (F-HEPP and Cl-HEPP) with two seizure models, maximal electroshock seizures (MES), and intraperitoneal pentylenetetrazole (PTZ) administration. Neurotoxicity was examined via the rotarod test. With in silico methods, binding was probed on possible protein targets-GABAA receptors and the sodium channel Nav1.2. The median effective doses (ED50) of HEPP, F-HEPP, and Cl-HEPP in the MES seizure model were 129.6, 87.1, and 62.0 mg/kg, respectively, and 66.4, 43.5, and in the PTZ seizure model 43.5 mg/kg. The HEPP-induced neurotoxic effect, which occurred at twice the ED50 against MES (p < 0.05), did not occur with F-HEPP or Cl-HEPP. Docking studies revealed that all tested ligands bound to GABAA receptors on a site near to the benzodiazepine binding site. However, on the sodium channel open pore Nav1.2, R-HEPP had interactions similar to those reported for phenytoin, while its enantiomer and the ligands F-HEPP and Cl-HEPP reached a site that could disrupt the passage of sodium. Our results show that, as anticonvulsant agents, parahalogen substituted compounds have an advantageous pharmacotoxicological profile compared to their precursor.
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Affiliation(s)
- Osvaldo Garrido-Acosta
- 1Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, 15500 México City, DF, Mexico
- *Osvaldo Garrido-Acosta: and
| | - Sergio E. Meza-Toledo
- 2Laboratorio de Quimioterapia Experimental, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11350 México City, DF, Mexico
| | - Liliana Anguiano-Robledo
- 3Laboratorio de Farmacología Molecular, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 México City, DF, Mexico
| | - Marvin A. Soriano-Ursúa
- 4Departamento de Fisiología, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 México City, DF, Mexico
| | - José Correa-Basurto
- 5Laboratorio de Modelado Molecular y Diseño de Fármacos, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 México City, DF, Mexico
| | - Asghar Davood
- 6Department of Medicinal Chemistry, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran 19419, Iran
| | - Germán Chamorro-Cevallos
- 7Laboratorio de Toxicología Preclínica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11350 México City, DF, Mexico
- *Germán Chamorro-Cevallos:
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Wlaź P, Poleszak E, Serefko A, Wlaź A, Rundfeldt C. Anxiogenic- and antidepressant-like behavior in corneally kindled rats. Pharmacol Rep 2015; 67:349-52. [PMID: 25712662 DOI: 10.1016/j.pharep.2014.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anxiety and depression affect epileptic patients much more often than individuals from the general population. We were interested in whether corneal kindling in rats, which is a model of complex partial seizures with secondary generalization, would influence animal behavior in models of anxiety and depression. METHODS Kindling was achieved by transcorneal electric stimulation and fully kindled rats were used in this study. Kindled and sham-stimulated rats were subjected to the elevated plus maze and forced swim test which are believed to be predictive models for anxiety and depression in humans, respectively. RESULTS Kindling significantly decreased the percentage of time spent by the rats in open arms relative to time spent in open plus closed arms and it reduced immobility time in the swim test as compared with sham-stimulated rats. CONCLUSIONS Our results suggest that corneal kindling produces antidepressant- and anxiety-like effects in rats and it may be a useful model to study epilepsy-associated anxiety.
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Affiliation(s)
- Piotr Wlaź
- Department of Animal Physiology, Institute of Biology, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, Lublin, Poland.
| | - Ewa Poleszak
- Chair and Department of Applied Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Anna Serefko
- Chair and Department of Applied Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Wlaź
- Department of Pathophysiology, Medical University of Lublin, Lublin, Poland
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Garrido-Acosta O, Meza-Toledo SE, Anguiano-Robledo L, Valencia-Hernández I, Chamorro-Cevallos G. Adaptation of Lorke's method to determine and compare ED50 values: the cases of two anticonvulsants drugs. J Pharmacol Toxicol Methods 2014; 70:66-9. [PMID: 24857835 DOI: 10.1016/j.vascn.2014.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/30/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We determined the median effective dose (ED50) values for the anticonvulsants phenobarbital and sodium valproate using a modification of Lorke's method. This modification allowed appropriate statistical analysis and the use of a smaller number of mice per compound tested. METHODS The anticonvulsant activities of phenobarbital and sodium valproate were evaluated in male CD1 mice by maximal electroshock (MES) and intraperitoneal administration of pentylenetetrazole (PTZ). The anticonvulsant ED50 values were obtained through modifications of Lorke's method that involved changes in the selection of the three first doses in the initial test and the fourth dose in the second test. Furthermore, a test was added to evaluate the ED50 calculated by the modified Lorke's method, allowing statistical analysis of the data and determination of the confidence limits for ED50. RESULTS The ED50 for phenobarbital against MES- and PTZ-induced seizures was 16.3mg/kg and 12.7mg/kg, respectively. The sodium valproate values were 261.2mg/kg and 159.7mg/kg, respectively. DISCUSSION These results are similar to those found using the traditional methods of finding ED50, suggesting that the modifications made to Lorke's method generate equal results using fewer mice while increasing confidence in the statistical analysis. This adaptation of Lorke's method can be used to determine median letal dose (LD50) or ED50 for compounds with other pharmacological activities.
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Affiliation(s)
- Osvaldo Garrido-Acosta
- Departamento de Farmacia. Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Col. Plutarco Elías Calles, C.P. 11340, México, D.F., Mexico.
| | - Sergio Enrique Meza-Toledo
- Departamento de Bioquímica. Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Col. Plutarco Elías Calles, C.P. 11340, México, D.F., Mexico
| | - Liliana Anguiano-Robledo
- Sección de Estudios de Posgrado e Investigación Laboratorio de Farmacología Molecular, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomás, C.P. 11340, México, D.F., Mexico
| | - Ignacio Valencia-Hernández
- Sección de Estudios de Posgrado e Investigación Laboratorio de Farmacología Molecular, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomás, C.P. 11340, México, D.F., Mexico
| | - Germán Chamorro-Cevallos
- Departamento de Farmacia. Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Col. Plutarco Elías Calles, C.P. 11340, México, D.F., Mexico
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Moon J, Jung KH, Shin JW, Lim JA, Byun JI, Lee ST, Chu K, Lee SK. Safety of tianeptine use in patients with epilepsy. Epilepsy Behav 2014; 34:116-9. [PMID: 24739449 DOI: 10.1016/j.yebeh.2014.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/15/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
Depression is a frequent comorbidity in patients with epilepsy (PWE). However, it is often undertreated because of concerns of seizure exacerbation by antidepressant treatment. The effect of tianeptine on seizure frequency is not known as yet. Thus, we aimed to evaluate the influence of tianeptine on the seizure frequency in PWE. We retrospectively reviewed the medical records of PWE who received tianeptine between January 2006 and June 2013 at the Epilepsy Center of Seoul National University Hospital. Patients were excluded if the dose or type of antiepileptic drugs (AEDs) they took was altered at the start of tianeptine treatment or if the treatment period of tianeptine was <3 months. A total of 74 PWE were enrolled in our study (male: 32, mean age: 41.9±14.5). Sixty-nine patients had localization-related epilepsy, and 5 had idiopathic generalized epilepsy (IGE). Mean seizure frequency during the 3-month period just after tianeptine exposure was compared with the baseline seizure frequency, which showed no change in 69 (93.2%) patients, decrease in 2 (2.7%) patients, and increase in 3 patients (4.1%). The type of epileptic syndrome, the baseline seizure frequency, and the number of coadministered AEDs did not influence the change in seizure frequency after tianeptine prescription. Change in seizure frequency did not differ between the patients given tianeptine as an additive antidepressant and those given tianeptine as a replacement antidepressant. Our data suggest that tianeptine can be prescribed safely to PWE with depression without increasing the seizure frequency regardless of the baseline severity of epilepsy. Tianeptine may be actively considered as a first-choice antidepressant or as an alternative antidepressant in PWE with depression.
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Affiliation(s)
- Jangsup Moon
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Jung-Won Shin
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Jung-Ah Lim
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Jung-Ick Byun
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
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