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Flashcards in Psychopharmacology Deck (11)
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1

Lithium interactions

Lithium Interactions:
Li level INCREASES with : --thiazide diuretics (hydrochlorothiazide),
-ACE inhibitors (captopril, enalapril),
-angiotensin II R antagonists (valsartan, losartan),
-NSAIDs (except ASA), COX-2 inhibitors (celecoxib etc)
-metronidazole, tetracycline, spectinomycin
LI level DECREASE with:
-Aminophylline, theophylline
-Urinary alkalization (acetazolamide, sodium bicarbonate)
-Sodium chloride (salt)
-Osmotic diuretics (mannitol)

2

MAO inhibiter interactions

MAO Inhibitor Interactions
• Hypertensive Crisis
○ With sympathomimetics
§ OTCs: pseudoephedrine, phenylephrine, oxymetazoline
§ Inhibition of MAO-A primarily
□ Less risk with selegiline patch <6mg/24h (as mostly MAO-B)-- but at higher doses non-specific for MAO-A and MAO-B
-->Serotonin syndrome

3

MAOi inhibitor interactions

• Serotonin Syndrome
• Develops over hours-- usually no unique lab findings
○ Narcotics: meperidine (demerol) especially, with codeine and morphine- generally safer although use with caution
○ Serotonergic agents
§ SSRIs and MAOi's are ABSOLUTELY Contraindicated
§ Wait 5 weeks after fluoxetine before MAOi and, 4-5 t1/2 after other SSRI or other serotonergic agents
§ Wait 2 weeks after MAOis before starting SSRI or other serotonergic agent to allow MAO to regenerate
§ Antidepressants: SSRI, SNRI, other MAOi's, nefazodone, mirtazapine, buspirone
§ Lithium
§ St John's Wort
§ carbamazapine
§ L-tryptophan
§ Dextromethorphan
§ Sumatriptin

4

Hunter Criteria for Serotonin Syndrome

○ Hunter Criteria for Serotonin Syndrome
ANY OF THE FOLLOWING SETS (A-E)
(A) Spontaneous clonus
(B) Inducible clonus plus agitation or diaphoresis
(C) Ocular clonus plus agitation or diaphoresis
(D) Tremor plus hyperreflexia
(E) Hypertonicity plus fever plus ocular clonus or inducible clonus

5

CYP 1A2

Substrates: clozapine, olanzapine, haldol, fluvoxamine, duloxetine, imipramine
Inhibitors (increase levels): fluvoxamine, fluoroquinolones, cimetidine
Inducers (decrease levels): carbamazepine, tobacco, rifampin

6

CYP 2C19

Substrate: citalopram, amitryptyline, imipramine PPIs (lansoprazole etc), anti epileptics (diazepam, phenytoin, phenobarbitals),
Inhibitors (increase levels): fluoxetine, fluvoxamine, PPIs, contraceptives
Inducers (decrease levels): St John's wort, rifampin, ritonovir (ARV)

7

CYP 2D6

Substrate: fluoxetine, paroxetine, duloxetine, TCAs (amitryptyline, clomipramine, despiramine, imipramine), haldol, risperidone, aripiprazole, atomoxetine, codeine, dextromethorphan, ondansetron
Inhibitor (increase levels): bupropion, fluoxetine, paroxetine, quinidine, duloxetine, aripiprazole, haldol
Inducer (decrease levels): none

8

CYP 3A4, 5, 7

Substrate: levomilanacipran, vilazodone, quetiapine, lurasidone, haldol, methadone, benzos (alprazolam, diazepam, midazolam, triazolam), macrolide antibiotics (clarithromycin etc- not azithromycin), immune modulators (cyclosporine, tacrolimus, sirolimus), HIV antiretrovirals (-avir)
Inhibitors (increase levels): fluvoxamine, suboxone, HIV antiretrovirals (-avir), macrolide abx, grapefruit juice, antifungals (-azole)
Inducers (decrease levels): carbamazepine, St Johns Wort, phenobarbitals, phenytoin, rifampin

9

antipsychotics and QTc prolongation

QTc most prolonged (in decreasing order): Thorazine, ziprasidone, risperidone, olanzapine, quetiapine, haloperidol
o Not known to prolong QTc: lurasidone, aripiprazole, paliperidone, asenapine

10

antidepressants and QTc prolongation

SSRI without QTc prolongation: fluoxetine, fluvoxamine, sertraline, paroxetine
Increased QTc with buproprion, citalopram and amitryptline

11

antidepressants and sexual side effects

CANMAT Depression 2016 agents with less sexual side effects incl: agomelatine, buproprion, mirtazapine, vilazodone, vortioxetine