Pharmacokinetic Interactions Between Antiseizure and Psychiatric Medications

Antiseizure medications and drugs for psychiatric diseases are frequently used in combination. In this context, pharmacokinetic interactions between these drugs may occur. The vast majority of these interactions are primarily observed at a metabolic level and result from changes in the activity of the cytochrome P450 (CYP). Carbamazepine, phenytoin, and barbiturates induce the oxidative biotransformation and can consequently reduce the plasma concentrations of tricyclic antidepressants, many typical and atypical antipsychotics and some benzodiazepines. Newer antiseizure medications show a lower potential for clinically relevant interactions with drugs for psychiatric disease. The pharmacokinetics of many antiseizure medications is not influenced by antipsychotics and anxiolytics, while some newer antidepressants, namely fluoxetine, fluvoxamine and viloxazine, may inhibit CYP enzymes leading to increased serum concentrations of some antiseizure medications, including phenytoin and carbamazepine. Clinically relevant pharmacokinetic interactions may be anticipated by knowledge of CYP enzymes involved in the biotransformation of individual medications and of the influence of the specific comedication on the activity of these CYP enzymes. As a general rule, these interactions can be managed by careful evaluation of clinical response and, when indicated, individualized dosage adjustments guided by measurement of drugs serum concentrations, especially if pharmacokinetic interactions may cause any change in seizure control or signs of toxicity. Further studies are required to improve predictions of pharmacokinetic interactions between antiseizure medications and drugs for psychiatric diseases providing practical helps for clinicians in the clinical setting.

Automated summary

Antiseizure medications and drugs for psychiatric diseases often interact at a metabolic level, primarily through changes in the activity of cytochrome P450 enzymes. Some antiseizure medications can reduce the plasma concentrations of certain antidepressants, antipsychotics, and benzodiazepines, while newer antiseizure medications have a lower potential for these interactions. However, some newer antidepressants may inhibit CYP enzymes and increase the serum concentrations of certain antiseizure medications. Knowledge of specific CYP enzymes involved in the metabolism of individual medications and the influence of comedication on the activity of these enzymes can help anticipate clinically relevant interactions. Careful evaluation of clinical response and personalized dosage adjustments based on drug serum concentrations are recommended to manage these interactions.