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Current Antipsychotics pp 241–265Cite as

Interactions and Monitoring of Antipsychotic Drugs

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Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 212))

Abstract

As a consequence of individualized antipsychotic pharmacotherapy, many patients need more than a single drug, since they do not respond sufficiently to monotherapy. Other patients suffer from comorbid diseases and therefore require additional drugs from other pharmacological classes. Drug combinations, however, can give rise to pharmacokinetic and/or pharmacodynamic drug–drug interactions. Evaluation of pharmacokinetic interactions with antipsychotic drugs must consider substrate, inhibitor, and inducer properties for the cytochrome P450 (CYP) isoenzymes of all combined drugs. For consideration of pharmacodynamic interactions, special attention must be given to effects on dopamine D2, histamine H1, and acetylcholine M1 receptors and on cardiac potassium channels. Additive pharmacological actions of combined drugs on these target structures can induce adverse reactions such as extrapyramidal symptoms, drowsiness, metabolic disturbances leading to weight gain and cardiac problems, cognitive impairment, delirium, or ventricular arrhythmia. Measuring plasma concentrations, i.e., therapeutic drug monitoring (TDM), is valuable to adjust antipsychotic medication when drug combinations contain inhibitors or inducers that alter plasma concentrations of the antipsychotic drugs. Amalgamating the broad knowledge on drug–drug interactions and using appropriately the option to monitor plasma concentrations in blood will help to apply complex combination therapies with antipsychotic drugs with maximal efficiency and safety.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany

    Christoph Hiemke

  2. Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Würzburg, Füchsleinstr. 15, 97080, Würzburg, Germany

    Bruno Pfuhlmann

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  1. Christoph Hiemke
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Correspondence to Christoph Hiemke .

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Editors and Affiliations

  1. Institut für Pharmakologie, Universität, Neuroscience Research, Abbott GmbH & Co. KG, Knollstraße, Ludwigshafen, 67061, Germany

    Gerhard Gross

  2. Dept. Psychiatry, University of California San Diego, Gilman Drive 9500, La Jolla, 92093-0804, California, USA

    Mark A. Geyer

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Hiemke, C., Pfuhlmann, B. (2012). Interactions and Monitoring of Antipsychotic Drugs. In: Gross, G., Geyer, M. (eds) Current Antipsychotics. Handbook of Experimental Pharmacology, vol 212. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25761-2_10

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