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| |  Drug-Drug Interactions, Other Factors Can Affect Antipsychotic Treatment Regimens: Presented at ECNP By Jenny Powers ISTANBUL, Turkey -- September 17, 2009 -- Inhibitors or inducers of the cytochrome (CY) P450 system may affect the metabolism and activity of antipsychotic drugs, according to a study presented September 13 at the 22nd European College of Neuropsychopharmacology (ECNP) Congress. Pierre Chue, MD, Department of Psychiatry, University of Alberta, Edmonton, Alberta, and colleagues performed an evidence-based review of all relevant literature to identify and define possible drug-drug interactions (DDIs) and other factors that may influence patient response to drug treatment. Comorbidities such as smoking, alcohol, other substance-abuse disorders, infections, and metabolic disorders complicate the pharmacological management of psychotic patients. Additional factors such as genetic polymorphisms and environmental interactions (eg, DDIs and drug-food interactions) also influence drug efficacy. The researchers noted that clinicians need to consider these factors and others, along with patients’ unique characteristics, when determining treatment. This study focused on pharmacokinetic interactions that interfere with drug metabolism of a drug; second-generation antipsychotics act as substrates for more than one CYP450 enzyme. Drug metabolism pharmacokinetics may also be affected by p-glycoprotein, protein-displacement mechanisms, and competitive P450 enzyme inhibition/induction. P450 induction may result in subtherapeutic drug levels and decreased effectiveness, whereas P450 inhibition may increase drug levels and result in drug potentiation and the risk of adverse events. The researchers compiled charts that reflect P450-associated DDIs between second-generation antipsychotics and other factors and indicated that such charts are important in routine clinical practice. In addition, they suggested that clinicians must have a fundamental understanding of drug metabolism and potential interactions to prevent polypharmacy-associated adverse events and that DDIs can potentially occur either with continued therapy, when cofactors change, or during transition stages within a therapy. [Presentation title: Theoretical and Clinical Implications of Drug-Drug Interactions in the
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