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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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Sison-Young RL, Lauschke VM, Johann E, Alexandre E, Antherieu S, Aerts H, Gerets HHJ, Labbe G, Hoët D, Dorau M, Schofield CA, Lovatt CA, Holder JC, Stahl SH, Richert L, Kitteringham NR, Jones RP, Elmasry M, Weaver RJ, Hewitt PG, Ingelman-Sundberg M, Goldring CE, Park BK. A multicenter assessment of single-cell models aligned to standard measures of cell health for prediction of acute hepatotoxicity. Arch Toxicol 2016; 91:1385-1400. [PMID: 27344343 PMCID: PMC5316403 DOI: 10.1007/s00204-016-1745-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
Assessing the potential of a new drug to cause drug-induced liver injury (DILI) is a challenge for the pharmaceutical industry. We therefore determined whether cell models currently used in safety assessment (HepG2, HepaRG, Upcyte and primary human hepatocytes in conjunction with basic but commonly used endpoints) are actually able to distinguish between novel chemical entities (NCEs) with respect to their potential to cause DILI. A panel of thirteen compounds (nine DILI implicated and four non-DILI implicated in man) were selected for our study, which was conducted, for the first time, across multiple laboratories. None of the cell models could distinguish faithfully between DILI and non-DILI compounds. Only when nominal in vitro concentrations were adjusted for in vivo exposure levels were primary human hepatocytes (PHH) found to be the most accurate cell model, closely followed by HepG2. From a practical perspective, this study revealed significant inter-laboratory variation in the response of PHH, HepG2 and Upcyte cells, but not HepaRG cells. This variation was also observed to be compound dependent. Interestingly, differences between donors (hepatocytes), clones (HepG2) and the effect of cryopreservation (HepaRG and hepatocytes) were less important than differences between the cell models per se. In summary, these results demonstrate that basic cell health endpoints will not predict hepatotoxic risk in simple hepatic cells in the absence of pharmacokinetic data and that a multicenter assessment of more sophisticated signals of molecular initiating events is required to determine whether these cells can be incorporated in early safety assessment.
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Affiliation(s)
- Rowena L Sison-Young
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Esther Johann
- Early Non-Clinical Safety, Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | | | | | - Hélène Aerts
- Biologie Servier, 905 Rue de Saran, 45520, Gidy, France
| | - Helga H J Gerets
- UCB BioPharma SPRL, Non-Clinical Development, Chemin du Foriest, 1420, Braine-l'Alleud, Belgium
| | - Gilles Labbe
- Sanofi-Aventis Recherche and Développement, Drug Safety Evaluation, Alfortville, France
| | - Delphine Hoët
- Sanofi-Aventis Recherche and Développement, Drug Safety Evaluation, Alfortville, France
| | - Martina Dorau
- Sanofi-Aventis Deutschland GmbH, R&D DSAR, Preclinical Safety FF, Industriepark Hoechst, Building H823, Room 104, 65926, Frankfurt am Main, Germany
| | | | - Cerys A Lovatt
- GSK, David Jack Centre for R&D, Park Road, Ware, Hertfordshire, SG12 0DP, UK
| | - Julie C Holder
- GSK, David Jack Centre for R&D, Park Road, Ware, Hertfordshire, SG12 0DP, UK
| | - Simone H Stahl
- AstraZeneca, Innovative Medicines and Early Development, Drug Safety and Metabolism, ADME Transporters, Unit 310 - Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4 0FZ, UK
| | - Lysiane Richert
- KaLy-Cell, 20A rue du Général Leclerc, 67115, Plobsheim, France.,Université de Franche-Comté, EA 4267, 25030, Besançon, France
| | - Neil R Kitteringham
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - Robert P Jones
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.,North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Mohamed Elmasry
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.,North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool, L9 7AL, UK
| | | | - Philip G Hewitt
- Early Non-Clinical Safety, Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Magnus Ingelman-Sundberg
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Chris E Goldring
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.
| | - B Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
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Nakada N, Kawamura A, Kamimura H, Sato K, Kazuki Y, Kakuni M, Ohbuchi M, Kato K, Tateno C, Oshimura M, Usui T. MurineCyp3aknockout chimeric mice with humanized liver: prediction of the metabolic profile of nefazodone in humans. Biopharm Drug Dispos 2016; 37:3-14. [DOI: 10.1002/bdd.1990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Naoyuki Nakada
- Drug Metabolism Research Laboratories, Drug Discovery Research; Astellas Pharma Inc.; Osaka Japan
| | - Akio Kawamura
- Drug Metabolism Research Laboratories, Drug Discovery Research; Astellas Pharma Inc.; Osaka Japan
| | - Hidetaka Kamimura
- ADME & Tox Research Institute; Sekisui Medical Co., Ltd; Tokyo Japan
| | - Koya Sato
- Drug Metabolism Research Laboratories, Drug Discovery Research; Astellas Pharma Inc.; Osaka Japan
| | - Yasuhiro Kazuki
- Department of Biomedical Science, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Science; Tottori University; Yonago Tottori Japan
| | | | - Masato Ohbuchi
- Drug Metabolism Research Laboratories, Drug Discovery Research; Astellas Pharma Inc.; Osaka Japan
| | - Kota Kato
- Drug Metabolism Research Laboratories, Drug Discovery Research; Astellas Pharma Inc.; Osaka Japan
| | - Chise Tateno
- PhoenixBio, Co., Ltd; Higashi Hiroshima Hiroshima Japan
- Liver Research Project Center; Hiroshima University; Japan
| | - Mitsuo Oshimura
- Department of Biomedical Science, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Science; Tottori University; Yonago Tottori Japan
| | - Takashi Usui
- Drug Metabolism Research Laboratories, Drug Discovery Research; Astellas Pharma Inc.; Osaka Japan
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Dingemanse J, Cavallaro M, Eydeler U. Single-dose pharmacokinetics of the renin inhibitor ACT-077825 in elderly and young subjects of both sexes. Pharmacology 2014; 94:135-42. [PMID: 25247698 DOI: 10.1159/000362822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The study objective was to investigate and compare the pharmacokinetics of a single oral dose of ACT-077825, a novel direct renin inhibitor, in young and elderly, male and female healthy subjects and to evaluate the safety and tolerability of ACT-077825 in these population groups. METHODS A total of 32 healthy subjects were included in this single-center, open-label study. The subjects were divided into 4 groups, including 8 young male, 8 young female, 8 elderly male and 8 elderly female subjects. Each participant received a single 200-mg dose of ACT-077825. Blood samples were taken over 5 days (120 h) to determine the plasma levels of ACT-077825. Safety and tolerability were monitored using standard assessments before drug administration, on the administration day and at the end of the blood sampling period. RESULTS Upon pooling male and female subjects, exposure was higher in elderly compared to young subjects, showing an increase of 65% for AUC0-∞, 40% for Cmax and 38% for t1/2. While young male and female subjects showed similar plasma profiles and exposure, a significant increase in exposure occurred with age in both sexes compared to younger subjects. The difference was largest between young and elderly females. Furthermore, the exposure to ACT-077825 was around 30% higher in elderly female compared to elderly male subjects. ACT-077825 was well tolerated by all groups, including the elderly females who showed the highest exposure. CONCLUSIONS ACT-077825 exposure is moderately increased in elderly subjects. The clinical relevance of this observation should be explored in the context of further studies.
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Affiliation(s)
- Jasper Dingemanse
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
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Abstract
The elderly frequently have changes in pharmacokinetics, sensitivity to medications, homeostatic reserve (ability to tolerate physiological challenges), exposure to multiple medications, and adherence. All of these age-associated factors can potentially influence total exposure to medication, adverse effects, and subsequent treatment outcome. Most clinical trials are performed with healthy, younger adults. Extrapolating the results of these trials to the elderly may be inappropriate, particularly for the antidepressant treatment of depression. The authors review these age-associated differences and discuss their implications for antidepressant use in older adults.
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Affiliation(s)
- Francis E Lotrich
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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6
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Obach RS. Pharmacologically active drug metabolites: impact on drug discovery and pharmacotherapy. Pharmacol Rev 2013; 65:578-640. [PMID: 23406671 DOI: 10.1124/pr.111.005439] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Metabolism represents the most prevalent mechanism for drug clearance. Many drugs are converted to metabolites that can retain the intrinsic affinity of the parent drug for the pharmacological target. Drug metabolism redox reactions such as heteroatom dealkylations, hydroxylations, heteroatom oxygenations, reductions, and dehydrogenations can yield active metabolites, and in rare cases even conjugation reactions can yield an active metabolite. To understand the contribution of an active metabolite to efficacy relative to the contribution of the parent drug, the target affinity, functional activity, plasma protein binding, membrane permeability, and pharmacokinetics of the active metabolite and parent drug must be known. Underlying pharmacokinetic principles and clearance concepts are used to describe the dispositional behavior of metabolites in vivo. A method to rapidly identify active metabolites in drug research is described. Finally, over 100 examples of drugs with active metabolites are discussed with regard to the importance of the metabolite(s) in efficacy and safety.
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Affiliation(s)
- R Scott Obach
- Pfizer Inc., Eastern Point Rd., Groton, CT 06340, USA.
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Abstract
The response to a psychotropic medication reflects characteristics of both the medication and the substrate, ie, the individual receiving the medication. Sex is an individual characteristic that influences all elements of the pharmacokinetic process - absorption, distribution, metabolism, and elimination. The effects of sex on these components of the pharmacokinetic process often counterbalance one another to yield minimal or varying sexual differences in blood levels achieved. However, sex also appears to influence pharmacodynamics, the tissue response to a given level of medication. Consideration by the practitioner of sex as a possible contributing factor to treatment nonresponse will enhance the efficacy and precision of clinical interventions.
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Affiliation(s)
- David R Rubinow
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Md, USA
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Wahajuddin, Singh SP, Jain GK. Gender differences in pharmacokinetics of lumefantrine and its metabolite desbutyl-lumefantrine in rats. Biopharm Drug Dispos 2012; 33:229-34. [PMID: 22447530 DOI: 10.1002/bdd.1786] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/17/2012] [Accepted: 03/20/2012] [Indexed: 11/10/2022]
Abstract
Lumefantrine has been reported to be mainly bio-transformed by cytochrome P450 isozyme 3A4 to desbutyl-lumefantrine (DLF) in human liver microsomes. Since CYP3A is expressed in a sex specific manner in rats, it could be expected that the pharmacokinetics of lumefantrine would be changed in male rats compared with those in female rats. The pharmacokinetics of lumefantrine and its active metabolite DLF were evaluated after intravenous (0.5 mg/kg) and oral (20 mg/kg) administration of lumefantrine to male and female Sprague-Dawley rats. The quantitative bioanalysis was carried out by the liquid chromatography tandem mass spectrometry method. After intravenous and oral administration of lumefantrine the area under the curve (AUC) of lumefantrine was significantly higher in female rats than that in male rats, whereas the AUC of DLF was significantly lower in female rats in comparison with male rats. This lower AUC of DLF in female rats could have been due to reduced metabolism of lumefantrine in female rats. The bioavailability (%F) of lumefantrine was 1.66 times higher in male rats than that in female rats.
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Affiliation(s)
- Wahajuddin
- Pharmacokinetics and Metabolism Division, Central Drug Research Institute, CSIR, Lucknow, Uttar Pradesh, India.
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Kokras N, Dalla C, Papadopoulou-Daifoti Z. Sex differences in pharmacokinetics of antidepressants. Expert Opin Drug Metab Toxicol 2010; 7:213-26. [DOI: 10.1517/17425255.2011.544250] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Bigos KL, Pollock BG, Stankevich BA, Bies RR. Sex differences in the pharmacokinetics and pharmacodynamics of antidepressants: an updated review. ACTA ACUST UNITED AC 2010; 6:522-43. [PMID: 20114004 DOI: 10.1016/j.genm.2009.12.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND An increasing number of studies have reported differences in the pharmacokinetics and/or pharmacodynamics of antidepressants between women and men. OBJECTIVES This article updates previously published literature describing sex differences in the pharmacokinetics and pharmacodynamics of antidepressants, and examines specific issues that face women with psychiatric illness. METHODS An English-language literature search was performed with the PubMed database (March 2003-December 2008) using combinations of the search terms sex, gender, and antidepressants. In addition, each antidepressant was identified in the 63rd edition of the Physicians' Desk Reference. RESULTS The current data suggest that the pharmacokinetics of antidepressants can be substantially different between women and men. Likewise, the response to antidepressants can be quite variable, including sex differences in adverse effects and time to response. CONCLUSIONS Despite the many sex differences reported, there is still little published work systematically evaluating potential sex differences in antidepressant pharmacokinetics and pharmacodynamics. More research is needed to guide the treatment of depression and other mental illnesses.
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Affiliation(s)
- Kristin L Bigos
- Clinical Brain Disorders Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA.
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11
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Polasek TM, Miners JO. Time-dependent inhibition of human drug metabolizing cytochromes P450 by tricyclic antidepressants. Br J Clin Pharmacol 2008; 65:87-97. [PMID: 17662092 PMCID: PMC2291266 DOI: 10.1111/j.1365-2125.2007.02964.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 04/17/2007] [Indexed: 11/29/2022] Open
Abstract
AIMS To investigate time-dependent inhibition (TDI) of human drug metabolizing CYP enzymes by tricyclic antidepressants (TCAs). METHODS CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A/CYP3A4 activities were investigated following co- and preincubation with TCAs using human liver microsomes (HLM) and human recombinant CYP proteins (expressed in Escherichia coli) as the enzyme sources. A two-step incubation method was employed to examine the in vitro mechanism-based inactivation (MBI) criteria. Potential metabolite-intermediate complex (MIC) formation was studied by spectral analysis. RESULTS TCAs generally exhibited significant TDI of recombinant CYP1A2, CYP2C19 and CYP2D6 (>10% positive inhibition differences between co- and preincubation conditions). TDI of recombinant CYP2C9 was minor (<10%), and was minor or absent in experiments utilizing recombinant CYP3A4 or HLM as the enzyme sources. Where observed, TDI of recombinant CYP occurred via alkylamine MIC formation, but evidence to support similar behaviour in HLM was limited. Indeed, only secondary amine TCAs reduced the apparent P450 content of HLM (3-6%) consistent with complexation. As a representative TCA, nortriptyline fulfilled the in vitro MBI criteria using recombinant CYP2C19 and CYP3A4 (K(I) and k(inact) values of 4 microm and 0.19 min(-1), and 70 microm and 0.06 min(-1)), but not with the human liver microsomal enzymes. CONCLUSIONS TCAs appear to have minimal potential for MBI of human liver microsomal CYP enzymes involved in drug metabolism. HLM and recombinant CYP (expressed in E. coli) are not equivalent enzyme sources for evaluating the TDI associated with some drugs.
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Affiliation(s)
- Thomas M Polasek
- Laboratory, Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Adelaide, Australia.
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Abstract
Older patients frequently have a high burden of medical illness, are subject to extensive medication regimens, and often experience adverse drug events. In general, pharmacokinetic changes associated with aging result in higher and more variable drug concentrations in older patients. Nonetheless, available information on pharmacokinetics of antidepressants is inadequate particularly with regard to medical subgroups and potential drug interactions. Although age-associated pharmacodynamic changes appear to make older patients more sensitive to side effects of antidepressants, differences in pharmacodynamics are not interpretable in the absence of drug concentration data. Population pharmacokinetics provides a means for assessing antidepressant drug exposure with relative ease and precision in clinical trials.
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Affiliation(s)
- Bruce G Pollock
- Academic Division of Geriatrics and Neuropsychiatry, University of Pittsburgh, Thomas Detre Hall E-1234, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Abstract
Ageing is associated with a decline in drug elimination; hence, using the same doses as in younger adults may result in higher plasma drug concentrations and toxicity. Two approaches are available for dose correction to account for decreased drug elimination. One procedure is based on the extrarenal elimination fraction (Q(0)) and the age-dependent changes in creatinine clearance; the other uses the decline in total drug clearance (CL). Mean values of Q(0) and CL in young and old people are reported for many drugs in the literature and are summarised in this article. Although the pharmacokinetic techniques for dose adjustment in the elderly are useful, they provide only an average dose correction and neglect age-dependent changes in drug bio-availability, plasma protein binding, the fate of active metabolites, and altered sensitivity to drugs. To account for pharmacodynamic changes in old age, clinical and/or biochemical targets should be defined as therapeutic goals. Drugs whose effects cannot be monitored in these terms should be avoided in elderly individuals.
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Affiliation(s)
- Klaus Turnheim
- Medical University Vienna, Institute of Pharmacology, Center for Biomolecular Medicine and Pharmacology, Währinger Str. 13a, A-1090 Vienna, Austria.
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Cotreau MM, von Moltke LL, Greenblatt DJ. The influence of age and sex on the clearance of cytochrome P450 3A substrates. Clin Pharmacokinet 2005; 44:33-60. [PMID: 15634031 DOI: 10.2165/00003088-200544010-00002] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cytochrome P450s (CYPs) are an important family of enzymes in the metabolism of many therapeutic agents and endogenous metabolic reactions. The CYP3A subfamily is especially prominent in these metabolic activities. This review article focuses on how the factors of age and sex may influence the in vivo activity of human CYP3A. The functional activity of CYP3A varies based on issues such as interaction with one or more substrates and between individuals and/or localisation. For CYP3A substrates, intrinsic clearance is the component of total clearance that is contributed by the enzymes. Depending on the route of administration and the contribution of hepatic blood flow to overall clearance, sensitivities to changes in CYP3A activities may differ. Additionally, age may influence the hepatic blood flow and, in turn, affect CYP3A activity. A review of the literature regarding age influences on the clearance of CYP3A substrates does suggest that age can affect the clearance of certain CYP3A substrates.CYP3A is responsible for a large number of endogenous metabolic reactions involving steroid hormones, and enzyme activity has been reported to be induced and/or inhibited in the presence of some sex steroids. Based on published studies for most CYP3A substrates, sex does not appear to influence clearance; however, with certain substrates significant sex-related differences are found. In such cases, women primarily have higher clearance than men.
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Affiliation(s)
- Monette M Cotreau
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
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Giron MST, Fastbom J, Winblad B. Clinical trials of potential antidepressants: to what extent are the elderly represented: a review. Int J Geriatr Psychiatry 2005; 20:201-17. [PMID: 15717338 DOI: 10.1002/gps.1273] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is widespread use of antidepressants in the elderly population. The principle of treatment of depression, however, is derived mostly from studies employing young adults and healthy elderly. This article reviews the literature on the extent to which the elderly are represented in clinical trials of potential antidepressants. METHOD Medline search of relevant articles of clinical trials of potential antidepressants. RESULTS The maximum age of inclusion for most clinical trials was 65 years. The highest age reported for depressed subjects was 90 years. There was no clear consensus on who were considered to be elderly; clinical trials conducted on the elderly included subjects who were 50, 55, or 60 years and over. Pharmacological studies on healthy subjects were most often done on young adults, age range 18 to 65 years. The period of study was relatively shorter for clinical trials done on elderly subjects. There was however, no difference in the exclusion or inclusion criteria between studies done in young and elderly subjects. CONCLUSIONS Elderly subjects aged 75 years and over were clearly underrepresented in the clinical trials of potential antidepressants. For drugs that are used by the elderly, in its pivotal studies for registration, the inclusion of at least 25% of subjects aged 75 years and over is recommended.
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Affiliation(s)
- Maria Stella T Giron
- Aging Research Center (ARC), Division of Geriatric Epidemiology, Neurotec Department, Karolinska Institutet, Stockholm, Sweden
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Uzüm G, Díler AS, Bahçekapili N, Tasyüreklí M, Zíylan YZ. Nicotine improves learning and memory in rats: morphological evidence for acetylcholine involvement. Int J Neurosci 2004; 114:1163-79. [PMID: 15370181 DOI: 10.1080/00207450490475652] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It has been suggested that nicotine improves rapid information processing (learning and memory) tasks. However, it is not clear which aspects of cognition actually underlie these improvements because relatively less attention has been given to nicotinic cholinergic systems compared to muscarinic systems. The authors therefore studied the effects of nicotine on the learning and memory performance by a step-through passive avoidance task. Nicotine (0.4 mg/kg) was administered s.c. single dose (acute group), once a day for 3 days (subchronic group) or 21 days (chronic group). Nicotine treated and control rats were trained in one trial learning step-through passive avoidance task, where retention latencies were carried out 1 h, 24 h, and 3 days after learning trial. Treatment with nicotine before training session prolonged the latencies significantly (p < .01). Control group, acute, subacute and chronic nicotine treatment groups showed latencies 4.75 +/- 0.6, 69.4 +/- 14, 116.2 +/- 30, and 118.5 +/- 23 s, respectively. In addition, to prove the actual contribution of nicotinic cholinergic system in improvement of learning and memory processing, histological methods that permit the visualization and quantification of ACh levels were used. Electron microscopic evaluation revealed increased numbers of Ach-containing vesicles especially in hippocampus in chronic nicotine-treated rats; although frontal and temporal cortex in addition to hippocampus showed increment in Ach vesicles in a lesser extent in all nicotine treatment groups. These results indicate that long-term nicotine treatment can be important for improving cognitive function in regard to increased cholinergic activity.
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Affiliation(s)
- Gülay Uzüm
- Istanbul University, Istanbul Medical Faculty, Department of Physiology, Istanbul, Turkey
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Koch KM, Palmer JL, Noordin N, Tomlinson JJ, Baidoo C. Sex and age differences in the pharmacokinetics of alosetron. Br J Clin Pharmacol 2002; 53:238-42. [PMID: 11874386 PMCID: PMC1874312 DOI: 10.1046/j.0306-5251.2001.01565.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS To determine the effects of sex and age on the pharmacokinetics of alosetron. METHODS Single oral and intravenous 2 mg doses of alosetron were administered on separate occasions to 48 healthy, young and elderly, males and females. Serum was sampled for 12 h post-dose to measure alosetron concentrations. RESULTS Serum concentrations of alosetron were higher in females than in males, resulting from a sex difference in clearance by metabolism. Mean clearance values were 504 vs 677 ml min(-1) in young females vs males (mean ratio 0.75), and 461 vs 670 ml min(-1) in elderly females vs males (mean ratio 0.69). The sex difference in alosetron pharmacokinetics achieved statistical significance in the elderly, but not in the young. Irrespective of sex, alosetron clearance was increased by smoking. Serum concentrations tended to be higher in the elderly, although the effect of age was generally not significant. Volume of distribution was smaller in females (approximately 63 l) compared with males (approximately 84 l), regardless of age or the sex difference in body weight. CONCLUSIONS A significant difference in clearance by metabolism of alosetron between the sexes, and possibly between the young and elderly was observed.
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Affiliation(s)
- K M Koch
- Clinical Pharmacology, GlaxoSmithKline, North Carolina, USA
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Abstract
Women have a higher prevalence of GAD than do men. This ratio holds true in most clinical and general-population samples. Some variations exist, with evidence to suggest the strong impact of environment and life events. Women are sensitive to lifetime adversity and exacerbation of symptoms in conjunction with their menstrual cycle. Comorbidity is a crucial diagnostic factor when treating anyone with GAD, especially women. Most notably, high comorbidity with other anxiety disorders, MDD and alcohol-abuse disorder occurs for women. Overall, although the prevalence of women with GAD is greater than that of men with GAD, the course of illness and prognosis are not qualitatively different. Across varied methodology, data suggest gender-related differences in the metabolism and potentially in the effects and side effects of the various benzodiazepines and antidepressant psychopharmacologic treatments of GAD. Additional research is needed to better understand these differences.
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Affiliation(s)
- H B Howell
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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19
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Brotto LA, Barr AM, Gorzalka BB. Sex differences in forced-swim and open-field test behaviours after chronic administration of melatonin. Eur J Pharmacol 2000; 402:87-93. [PMID: 10940361 DOI: 10.1016/s0014-2999(00)00491-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The effects of melatonin administered chronically on forced-swim test and open-field test behaviours were examined in male and female rats. The forced-swim test has been shown to be sensitive to all major classes of antidepressants and evidence indicates that melatonin possesses putative antidepressive properties. Male and female Long-Evans rats received either a regimen of chronic administration of melatonin or the control condition for 14 days via the drinking water. On day 15, each animal was individually introduced into a swim chamber, and was scored for 15 min on the duration of swimming, struggling, and immobility. After 24 h, each animal was again tested in the forced-swim test for 10 min. On day 18, all animals were tested in the open-field test apparatus for 5 min. Results revealed that females consistently showed higher activity levels than males in the forced-swim and open-field tests. Melatonin significantly increased struggling in males on day 15, but failed to do so in females. Also, whereas melatonin-treated females showed higher levels of behavioural immobility during their first exposure to the forced-swim test, this effect was prevented upon a second exposure. In both males and females, melatonin decreased swimming in the forced-swim test while increasing open-field ambulatory behaviour. Therefore, it is unlikely that melatonin's mechanism of action is a general inhibitory effect on motor activity. Taken together, the results suggest that the effects of melatonin treatment on forced-swim test behaviours are sex- and test-dependent.
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Affiliation(s)
- L A Brotto
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada V6T 1Z4
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20
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Forlenza OV. Transtornos depressivos na doença de Alzheimer: diagnóstico e tratamento. BRAZILIAN JOURNAL OF PSYCHIATRY 2000. [DOI: 10.1590/s1516-44462000000200010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transtornos do humor afetam uma porcentagem considerável de indivíduos com doença de Alzheimer, em algum ponto da evolução da síndrome demencial. Pode ser uma condição difícil de se detectar, dependendo da gravidade do acometimento cognitivo. Na presença de manifestações depressivas leves ou atípicas, a observação da evolução, associada ou não ao emprego de técnicas não-farmacológicas, é a abordagem inicial mais recomendável; na vigência de depressão moderada a grave, o emprego de psicofármacos pode fazer-se necessário. Embora haja evidências dos benefícios advindos do tratamento da depressão em pacientes com demência, avaliações formais da sua eficácia nesses pacientes são limitadas. A escolha do antidepressivo depende muito mais do seu perfil de tolerabilidade, das condições clínicas associadas e das características individuais do paciente. Os inibidores seletivos da recaptação de serotonina são usualmente as drogas de primeira opção, pelo perfil mais adequado de segurança, tolerabilidade e facilidade posológica. Em situações especiais, devem ser considerados os potenciais terapêuticos das novas drogas ou mesmo dos medicamentos tradicionais. O artigo revê a literatura dos últimos dez anos, enfocando particularidades do diagnóstico da depressão em pacientes com doença de Alzheimer, bem como diretrizes para uma prescrição segura.
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21
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Abstract
For every antidepressant so far investigated in the breast milk of mothers prescribed these medications, findings indicate that some amount of drug will be excreted into the breast milk. Nursing infants will be exposed to some, usually a very low, amount of drug and drug metabolites. Levels of drug exposure to infants for the many antidepressants available are examined, discussing milk to plasma drug concentration ratios and the infant dose as a percentage of the maternal dose. Drug concentrations in infant plasma and adverse effects of drug exposures to infants are reviewed. Factors influencing the decision on whether to breast or bottle feed an infant nursed by a mother taking antidepressants are discussed, concluding that the decision needs to be made on an individual basis. The lactating mother, in consultation with her doctor, should be in a position to make an informed decision on whether or not to breast feed. Under certain circumstances the decision to bottle feed may be wise, but more commonly the advantages of breast-feeding will outweigh the very low risk of an adverse event from drug exposure to the infant.
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Affiliation(s)
- S Dodd
- Department of Psychiatry, University of Melbourne, Austin & Repatriation Medical Centre, Heidelberg, Australia
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22
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Frackiewicz EJ, Sramek JJ, Cutler NR. Gender differences in depression and antidepressant pharmacokinetics and adverse events. Ann Pharmacother 2000; 34:80-8. [PMID: 10669189 DOI: 10.1345/aph.18465] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review data generated by studies examining gender differences in the prevalence of depression, as well as in antidepressant pharmacokinetics, pharmacodynamics, and adverse events. DATA SOURCES Published articles and abstracts were identified through MEDLINE (January 1966-April 1999) using the following search terms: antidepressant, response, gender, pharmacokinetic, pharmacodynamic, female, side effect, and adverse events. All articles that assessed gender differences in antidepressant response, pharmacokinetics, and adverse events, as well as articles that evaluated postulated mechanisms for these differences, were reviewed. Additional articles were identified from bibliographies of retrieved articles. STUDY SELECTION AND DATA EXTRACTION All relevant abstracts, studies, and review articles were evaluated. DATA SYNTHESIS Gender differences in the prevalence of depression have been reported and may result from the interaction of several factors. Women have been shown to have a higher incidence of depression, which may be due to artifact, social, or biologic reasons. Studies suggest that the pharmacokinetic disposition of popular antidepressants varies between men and women, and women taking antidepressants may exhibit a different adverse event profile. Only one study specifically evaluated gender differences in antidepressant treatment response. CONCLUSIONS Further research elucidating gender differences in response to antidepressant treatment and on depression prevalence is needed. Some studies report that the pharmacokinetics of antidepressants may vary between men and women. Therefore, clinicians should be aware that potential differences in antidepressant pharmacokinetics may exist, and a dosage adjustment may be necessary for women to ensure a favorable drug response, compliance, and decreased incidence of adverse events.
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23
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Rotzinger S, Bourin M, Akimoto Y, Coutts RT, Baker GB. Metabolism of some "second"- and "fourth"-generation antidepressants: iprindole, viloxazine, bupropion, mianserin, maprotiline, trazodone, nefazodone, and venlafaxine. Cell Mol Neurobiol 1999; 19:427-42. [PMID: 10379419 DOI: 10.1023/a:1006953923305] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
1. This review summarizes the major known aspects of the metabolism of second-generation (iprindole, viloxazine, bupropion, mianserin, maprotiline, and trazodone) and fourth-generation (nefazodone and venlafaxine) antidepressants. 2. Discussions about specific enzymes involved and about possible pharmacokinetic drug-drug interactions, particularly as they relate to cytochrome P450 enzymes, are provided.
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Affiliation(s)
- S Rotzinger
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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24
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Dodd S, Buist A, Burrows GD, Maguire KP, Norman TR. Determination of nefazodone and its pharmacologically active metabolites in human blood plasma and breast milk by high-performance liquid chromatography. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 1999; 730:249-55. [PMID: 10448960 DOI: 10.1016/s0378-4347(99)00225-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A method is described for the determination of nefazodone and its active metabolites hydroxynefazodone, the dione BMS-180492 and m-chlorophenylpiperazine in blood plasma and expressed human milk based on reversed-phase high-performance liquid chromatography. Measurements were performed on drug-free plasma and expressed human milk spiked with nefazodone and metabolites to prepare and validate standard curves and specimens collected from nursing mothers. Parent drug and metabolites were separated from the biological matrices by solid-phase extraction using CERTIFY columns. Chromatographic separation was achieved with a C18 column and compounds were detected by their absorbance at 205 nm. Trazodone was used as an internal standard. The assay was validated for each analyte in the concentration range 200 to 1200 ng/ml.
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Affiliation(s)
- S Dodd
- Department of Psychiatry, University of Melbourne, Austin and Repatriation Medical Centre, Victoria, Australia
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25
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26
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Hay DP, Zayas EM, Franson KL. Update on the use of antidepressants in the elderly. NEW DIRECTIONS FOR MENTAL HEALTH SERVICES 1998:97-107. [PMID: 9520528 DOI: 10.1002/yd.2330247609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This chapter presents a review of the current status of depression treatment for the elderly. The authors describe currently available antidepressants and discuss special considerations when they are used to treat elderly patients.
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Affiliation(s)
- D P Hay
- St. Louis University School of Medicine, USA
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27
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28
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Srinivas NR, Shyu WC, Gleason C, Schuster A, Greene DS, Barbhaiya RH. Effects of age, gender, and diurnal variation on the steady-state pharmacokinetics of BMS-181101, an antidepressant, in healthy subjects. Clin Pharmacol Ther 1997; 62:408-16. [PMID: 9357392 DOI: 10.1016/s0009-9236(97)90119-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the effects of age, gender, and diurnal variation on the safety, tolerability, and steady-state pharmacokinetics of BMS-181101, an antidepressant, in humans. METHODS This was a multiple-dose parallel-design study in 51 healthy subjects (12 young and 12 elderly men and 12 young and 15 elderly women). Each subject received a 15 mg oral dose of BMS-181101 every 12 hours on days 1 through 6 and one dose on day 7. After the evening dose on day 6 and morning dose on day 7, serial blood samples were collected at specified times after administration. Plasma was analyzed for BMS-181101 with use of an HPLC method. RESULTS Male subjects tolerated BMS-181101 better than female subjects. The mean values for area under the plasma concentration-time curve over the dosing interval tau (AUC tau; 58.8 to 102.4 ng.hr/ml) and elimination half-life t1/2; 5.7 to 10.4 hours) for the elderly subjects were significantly greater than those for the young subjects (39.0 to 64.3 ng.hr/ml and 3.2 to 4.5 hours). The mean values for peak plasma concentration (Cmax; 14.7 to 25.2 ng/ml) and AUC tau (52.4 to 102.4 ng.hr/ml) for the women were significantly greater than those for the men (9.08 to 15.3 ng/ml and 39.0 to 73.6 ng.hr/ml). The mean values for Cmax (14.7 to 25.2 ng/ml) and AUC tau (54.8 to 102.4 ng.hr/ml) on the morning of day 7 were significantly greater than those after the evening dose on day 6 (9.08 to 17.3 ng/ml; 39.0 to 83.4 ng.hr/ml). CONCLUSIONS An initial lower dose or appropriate titration of daily doses of BMS-181101 may be necessary for the treatment of elderly and female subjects, and the pharmacokinetics of BMS-181101 exhibited significant diurnal effects.
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Affiliation(s)
- N R Srinivas
- Department of Metabolism and Pharmacokinetics, Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, NJ 08543-4000, USA
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29
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Davis R, Whittington R, Bryson HM. Nefazodone. A review of its pharmacology and clinical efficacy in the management of major depression. Drugs 1997; 53:608-36. [PMID: 9098663 DOI: 10.2165/00003495-199753040-00006] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nefazodone hydrochloride is a phenylpiperazine antidepressant with a mechanism of action that is distinct from those of other currently available drugs. It potently and selectively blocks postsynaptic serotonin (5-hydroxytryptamine; 5-HT) 5-HT2A receptors and moderately inhibits serotonin and noradrenaline (norepinephrine) reuptake. In short term clinical trials of 6 or 8 weeks' duration, nefazodone produced clinical improvements that were significantly greater than those with placebo and similar to those achieved with imipramine, and the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine and sertraline. The optimum therapeutic dosage of nefazodone appears to be between 300 and 600 mg/day. Limited long term data suggest that nefazodone is effective in preventing relapse of depression in patients treated for up to 1 year. Analyses of pooled clinical trial results indicate that nefazodone and imipramine produces similar and significant improvements on anxiety- and agitation-related rating scales compared with placebo in patients with major depression. Short term tolerability data indicate that nefazodone has a lower incidence of adverse anticholinergic, antihistaminergic and adrenergic effects than imipramine. Compared with SSRIs, nefazodone causes fewer activating symptoms, adverse gastrointestinal effects (nausea, diarrhoea, anorexia) and adverse effects on sexual function, but is associated with more dizziness, dry mouth, constipation, visual disturbances and confusion. Available data also suggest that nefazodone is not associated with abnormal weight gain, seizures, priapism or significant sleep disruption, and appears to be relatively safe in overdosage. Nefazodone inhibits the cytochrome P450 3A4 isoenzyme and thus has the potential to interact with a number of drugs. Further long term and comparative studies will provide a more accurate assessment of the relative place of nefazodone in the management of major depression. Nonetheless, available data suggest that nefazodone is a worthwhile treatment alternative to tricyclic antidepressants and SSRIs in patients with major depression.
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Affiliation(s)
- R Davis
- Adis International Limited, Auckland, New Zealand
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30
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Abstract
This review covers mechanisms of action, efficacy, side effects, and toxicity of various classes of antidepressants: tricyclic antidepressants, monoamine oxidase inhibitors, second-generation antidepressants including the selective inhibitors of serotonin reuptake, and novel drugs such as mirtazapine, nefazodone, and venlafaxine.
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Affiliation(s)
- A Frazer
- Department of Pharmacology, University of Texas Health Science Center at San Antonio 78284-7764, USA
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