scholarly journals A review of significant pharmacokinetic drug interactions with antidepressants and their management

2016 ◽  
Vol 6 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Charity Hoffelt ◽  
Tonya Gross
Keyword(s):  
Adverse Events ◽  
Drug Interactions ◽  
Response To Treatment ◽  
Patient Response ◽  
Pharmacokinetic Profiles ◽  
Drug Classes ◽  
Treatment Of Depression ◽  
Term Management ◽  
Pharmacokinetic Drug

Abstract Treatment of depression often requires long-term management with medication. Practitioners should be aware of potentially significant drug interactions with the use of antidepressants in order to effectively prevent or manage adverse events while optimizing patient response to treatment. Most antidepressants are metabolized by the liver, primarily via the CYP450 system. Pharmacokinetic profiles of the most recently approved antidepressants are reviewed in addition to evidence supporting potentially significant interactions. In addition, pharmacokinetic interactions between multiple antidepressants and other drug classes, including opiates, antineoplastics, antiepileptics, and antipsychotics, are discussed. This article provides recommendations for the monitoring and management of drug interactions. In addition, limitations of the evidence are reviewed.

Other Biological Approaches to OCD

2012 ◽  
Author(s):  
Nicole C. R. McLaughlin ◽  
Benjamin D. Greenberg
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Response To Treatment ◽  
History Of ◽  
Key Issues ◽  
Term Management ◽  
Deep Brain

Interest in psychiatric neurosurgery has waxed and waned since the 1930s. This chapter reviews the history of these methods, with a focus on OCD. This review of lesion procedures and deep brain stimulation includes neuropsychological and neuroimaging research in the context of putative neurocircuitry underlying symptoms and response to treatment. The chapter highlights how an abundance of caution is needed, as well as key issues in long-term management of patients so treated.

scholarly journals The Safety and Effect of Local Botulinumtoxin A Injections for Long-Term Management of Chronic Pain in Post-Herpetic Neuralgia: Literature Review and Cases Report Treated with Incobotulinumtoxin A

2021 ◽  
Vol 11 (8) ◽  
pp. 758
Author(s):  
Songjin Ri ◽  
Anatol Kivi ◽  
Jörg Wissel
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Adverse Events ◽  
Case Reports ◽  
Pain Reduction ◽  
Post Herpetic Neuralgia ◽  
Botulinumtoxin A ◽  
Incobotulinumtoxin A ◽  
Term Management

There are few reports on the safety and effectiveness of long-term botulinumtoxin A (BoNT A) therapy in severe chronic pain of post-herpetic neuralgia (PHN). The literature was searched with the term “neuropathic pain” and “botulinum” on PubMed (up to 29 February 2020). Pain was assessed with the Visual Analogue Scale (VAS) before and after BoNT A therapy. A total of 10 clinical trials and six case reports including 251 patients with PHN were presented. They showed that BoNT A therapy had significant pain reduction (up to 30–50%) and improvement in quality of life. The effect duration seems to be correlated with BoNT A doses injected per injection site. Intervals between BoNT A injections were 10–14 weeks. No adverse events were reported in cases and clinical studies, even in the two pregnant women, whose babies were healthy. The repeated (≥6 times) intra/subcutaneous injections of incobotulinumtoxin A (Xeomin®, Merz Pharmaceuticals, Germany) over the two years of our three cases showed marked pain reduction and no adverse events. Adjunctive local BoNT A injection is a promising option for severe PHN, as a safe and effective therapy in long-term management for chronic neuropathic pain. Its effect size and -duration seem to be depended on the dose of BoNT A injected per each point.

scholarly journals Safety of Repeated Administration of Parenteral Ketamine for Depression

2020 ◽  
Vol 13 (7) ◽  
pp. 151
Author(s):  
David Feifel ◽  
David Dadiomov ◽  
Kelly C. Lee
Keyword(s):  
Adverse Events ◽  
Bladder Dysfunction ◽  
Response Rate ◽  
Repeated Administration ◽  
Term Treatment ◽  
Psychotic Symptoms ◽  
Electronic Survey ◽  
Treatment Of Depression ◽  
Long Term Treatment

The objective of this study was to investigate the safety of repeated parenteral ketamine for depression. An electronic survey inquiring about the frequency of adverse events was distributed to providers of parenteral ketamine for depression. In addition, the investigators conducted a search of published studies describing six or more repeated parenteral ketamine treatments administered to individuals for depression, and extracted reported adverse events. The survey was sent to 69 providers, of which 36 responded (52% response rate); after eliminating those that were incomplete, 27 were included in the analysis. The providers in the analysis collectively reported treating 6630 patients with parenteral ketamine for depression, one-third of whom received more than 10 treatments. Only 0.7% of patients experienced an adverse effect that required discontinuation of ketamine. Psychological distress during the treatment was the most frequent cause. Other adverse events were extremely rare (such as bladder dysfunction (0.1%), cognitive decline (0.03%) and psychotic symptoms (0.03%)). Among the 20 published reports of repeated parenteral ketamine treatments, rates of significant adverse events resulting in discontinuation were low (1.2%). The rate of adverse effects reported in the survey and the published literature is low, and suggests that long-term treatment of depression with ketamine is reasonably safe.

Safety Considerations in Pharmacotherapy of Bipolar Disorder

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S12) ◽  
pp. 16-26 ◽  
Author(s):  
Prakash S. Masand ◽  
Farhan S. Fazal ◽  
Ashwin A. Patkar
Keyword(s):  
Bipolar Disorder ◽  
Adverse Events ◽  
Drug Interactions ◽  
Treatment Regimen ◽  
Mood Stabilizers ◽  
Drug Classes ◽  
Precise Knowledge ◽  
Safety Considerations ◽  
The Individual ◽  
Monitoring Protocols

AbstractBipolar disorder is a chronic, frequently relapsing illness with a prevalence of 1.2% to 3.4% in the general population. It is associated with high disability, higher comorbidity due to medical illnesses, and significant social and economical consequences for patients, their families, and society. The episodic nature of this disease warrants rational use of medications and proper monitoring for adverse events. Various drug classes, such as mood stabilizers, antipsychotics, benzodiazepines, and antidepressants, are used for the acute and maintenance treatment of bipolar disorder. Each group of drugs is associated with wide array of adverse events and drug interactions, which are the main hurdles in treatment outcome and compliance. Common side effects seen with several agents, particularly antipsychotics, are somnolence, weight gain, extrapyramidal symptoms, dyslipidemia, type-2 diabetes, and hyperprolactinemia. Major drug interactions are seen with drugs such as carbamazepine, due to hepatic enzyme induction. Adverse effects such as somnolence are tolerability concerns and can be managed easily; others, such as diabetes mellitus, are safety concerns. It is prudent to have precise knowledge of the individual drug's side-effect profile, pharmacokinetics, and pharmacodynamics, to plan a treatment regimen. More research is needed to understand potential rish of various drugs and to devise and incorporate monitoring protocols in the treatment regimen.

scholarly journals Anesthetic Considerations for Patients on Antidepressant Therapy – Part II

2018 ◽  
Vol 65 (1) ◽  
pp. 60-65 ◽  
Author(s):  
Mana Saraghi ◽  
Leonard Golden ◽  
Elliot V. Hersh
Keyword(s):  
Drug Interactions ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Activity ◽  
The United States ◽  
General Anesthetics ◽  
Drug Classes ◽  
Treatment Of Depression ◽  
Menstrual Symptoms ◽  
Anesthetic Considerations ◽  
Expansive Group

Millions of patients take antidepressant medications in the United States for the treatment of depression or anxiety disorders. Some antidepressants are prescribed off-label to treat problems such as chronic pain, low energy, and menstrual symptoms. Antidepressants are a broad and expansive group of medications, but the more common drug classes include tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors. A miscellaneous or “atypical” category covers other agents. Some herbal supplements that claim to have antidepressant activity will also be discussed. Part I of this series reviewed antidepressant pharmacology, adverse effects, and drug interactions with adrenergic agonists. In part II, drug–drug interactions with sedation and general anesthetics, bleeding effects, and serotonin syndrome will be discussed.

scholarly journals Anesthetic Considerations for Patients on Antidepressant Therapy—Part I

2017 ◽  
Vol 64 (4) ◽  
pp. 253-261 ◽  
Author(s):  
Mana Saraghi ◽  
Leonard R. Golden ◽  
Elliot V. Hersh
Keyword(s):  
Drug Interactions ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Activity ◽  
The United States ◽  
General Anesthetics ◽  
Drug Classes ◽  
Treatment Of Depression ◽  
Menstrual Symptoms ◽  
Anesthetic Considerations ◽  
Expansive Group

Millions of patients take antidepressant medications in the United States for the treatment of depression or anxiety disorders. Some antidepressants are prescribed off-label to treat problems such as chronic pain, low energy, and menstrual symptoms. Antidepressants are a broad and expansive group of medications, but the more common drug classes include tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors. A miscellaneous or “atypical” category covers other agents. Some herbal supplements that claim to have antidepressant activity will also be discussed. In Part I of this review, antidepressant pharmacology, adverse effects, and drug interactions with adrenergic agonists will be discussed. In part II, drug interactions with sedation and general anesthetics will be reviewed. Bleeding effects and serotonin syndrome implications in anesthetic practice will also be highlighted.

Review of Duloxetine and Venlafaxine in Depression

2009 ◽  
Vol 142 (3) ◽  
pp. 144-152.e6 ◽  
Author(s):  
Sylvia Zerjav ◽  
Gordon Tse ◽  
Michael J.W. Scott
Keyword(s):  
Adverse Effects ◽  
Drug Interactions ◽  
Case Reports ◽  
Similar Efficacy ◽  
Comparable Efficacy ◽  
Pharmacokinetic Profiles ◽  
Pharmacokinetic Drug Interaction ◽  
Treatment Of Depression ◽  
Safety Case ◽  
Patient Groups

Objectives: To compare the efficacy and pharmacologic, pharmacokinetic, drug interaction and adverse effect profiles of duloxetine and venlafaxine. Methods: A systematic review of the literature pertaining to duloxetine and venlafaxine was conducted using a computer-aided search of MEDLINE and EMBASE for the period January 1988 to May 2008 with the following search terms: venlafaxine and duloxetine and depression, clinical studies, pharmacology, drug interactions, pharmacokinetics, adverse effects, safety, case reports and review articles. Results: Duloxetine and venlafaxine have comparable efficacy and share similar pharmacologic profiles but differ somewhat in their pharmacokinetic profiles, drug interactions and adverse effects. Both agents block the reuptake of serotonin and norepinephrine and both are substrates for the cytochrome P450 2D6 isoenzyme; however, duloxetine inhibits these enzymes to a moderate extent, whereas venlafaxine is only a weak inhibitor. Furthermore, duloxetine is more extensively bound to protein than venlafaxine. Venlafaxine is more likely to elevate blood pressure in a dose-related manner. Both duloxetine and venlafaxine have the potential to cause hepatic injury. Conclusions: Although venlafaxine and duloxetine have similar efficacy in the treatment of depression, differences in their adverse effects and pharmacokinetic profiles suggest that one agent may be preferred over the other in certain patient groups.

scholarly journals Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis

2021 ◽  
pp. 014556132199852
Author(s):  
Pawina Jiramongkolchai ◽  
Siddharth Patel ◽  
John S. Schneider
Keyword(s):  
Chronic Rhinosinusitis ◽  
Response To Treatment ◽  
Topical Steroids ◽  
Patient Response ◽  
Off Label ◽  
Nasal Irrigation ◽  
Nasal Steroids ◽  
Nasal Steroid ◽  
Sinonasal Mucosa

Objective: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. Methods: A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. Results: Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. Conclusions: Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.

Patient ownership of primary biliary cholangitis long-term management

2020 ◽  
pp. flgastro-2019-101324
Author(s):  
Jessica Leighton ◽  
Collette Thain ◽  
Robert Mitchell-Thain ◽  
Jessica K Dyson ◽  
David E Jones
Keyword(s):  
Alkaline Phosphatase ◽  
Symptom Burden ◽  
Clinic Visit ◽  
Response To Treatment ◽  
Biochemical Response ◽  
Primary Biliary Cholangitis ◽  
Response Measure ◽  
Key Aspects ◽  
Term Management

ObjectivePatient ownership of disease is vital in rare diseases like primary biliary cholangitis (PBC). This survey of UK members of the PBC foundation aimed to assess patients’ perception of their disease management, focusing on key biomarkers and problematic symptoms.DesignRegistered PBC foundation members were surveyed on their experiences on their most recent clinic visit, covering the type of hospital and clinician and whether biochemical response and symptom burden were discussed, including who initiated these conversations. Respondents were also asked about their willingness to initiate these conversations.ResultsAcross 633 respondents, 42% remembered discussing alkaline phosphatase, the key biochemical response measure, and the majority of discussions were initiated by the healthcare provider. 56% of respondents remembered discussing itch, a key PBC symptom. There was no distinction between the grade of healthcare professional, but both patients and clinicians were significantly more likely to discuss symptoms over disease progression. Reassuringly, 84% of respondents felt willing to initiate conversations about their illness, regardless of the grade of managing clinician.ConclusionsThis work lays a positive foundation for patient education and empowerment projects, likely to improve clinical outcomes. Key aspects of management (biochemical response to treatment and symptom burden) should be emphasised as topics of discussion to both patients and clinicians managing PBC. We suggest a simple cue card to prompt patient-led discussion.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Treatment breaks in long-term management of osteoporosis

2019 ◽  
Vol 180 (1) ◽  
pp. R29-R35 ◽  
Author(s):  
Bente L Langdahl
Keyword(s):  
Management Plan ◽  
Term Treatment ◽  
Response To Treatment ◽  
Current Evidence ◽  
Endocrine Disease ◽  
Common Chronic Disease ◽  
Long Term Treatment ◽  
Future Fracture ◽  
Term Management

Osteoporosis is a common chronic disease and therefore a long-term management plan based on disease severity, comorbidities, other pharmacological treatments, gender, age and patient preferences is necessary. Consideration of treatment breaks may be included in the long-term management plan if the patient has been treated with a bisphosphonate, the disease is less severe, the response to treatment has been satisfactory and the risk of future fracture is estimated to be low. This perspective reviews the current evidence for long-term treatment with bisphosphonates and off treatment effects. Approaches to decision making and monitoring of treatment breaks are discussed.

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