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Drug Interactions with Psychotropic Medications

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   Psychotropic medications, including antidepressants, antipsychotics, anxiolytics, mood stabilizers, sedative hypnotics, and stimulants, have complex pharmacological actions and many have shown the potential to interact with other classes of medications. They are often used together to treat mental illnesses in unique combinations that have not been rigorously studied to establish safety or efficacy. They are also commonly prescribed to treat a wide variety of conditions well beyond the traditional borders of psychiatric illness. Drug interactions, therefore, should always be a major consideration before psychotropics are combined with other agents.

   The risk of serious drug interactions with psychotropic medications increases with the number of concurrent medications prescribed, and is amplified in specific populations (e.g., elders). Because older patients are more likely to suffer from multiple medical and/or psychiatric conditions, they take more medications on a daily basis and the potential for interactions is enhanced dramatically. For example, patients over the age of 65 take an average of 13 prescription medications on an annual basis and consume about 7 different medications daily.

   This issue provides a brief review of psychotropic drug interactions that can occur with commonly prescribed agents. Pharmacokinetic and pharmacodynamic mechanisms as well as patient specific factors that contribute to drug interactions are discussed. The goal of the issue is to foster an understanding of the risks posed by encountered drug combinations, and enable the reader to predict the safety of a given drug regimen by applying basic principles and known trends concerning drug interactions.


Publication Date: 07/01/2009
Expiration Date: 07/01/2012
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Patrick R. Finley, Pharm.D., BCPP, Professor of Clinical Pharmacy, University of California, San Francisco, School of Pharmacy, San Francisco, CA.

Disclosure Statement

Dr. Finley reports no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Guest Editorial Advisor

Julie A. Dopheide, Pharm.D., BCPP

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe clinically significant CYP450-based drug interactions that can occur with antidepressants, antipsychotics, anticonvulsants and other commonly prescribed psychotropic medications.
    2. Describe patient specific factors that contribute to drug interactions.
    3. Identify 4 drug combinations that increase the risk of serotonin syndrome. Name 3 symptoms of the syndrome.
    4. Identify a pharmacodynamic interaction that may occur with each of the following: lithium, triptans, clozapine, tricyclic antidepressants, and monoamine oxidase inhibitors.

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The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 428-0000-09-016-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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