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.

中文翻译：

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抗癫痫药物和精神药物之间的药代动力学相互作用


抗癫痫药物和治疗精神疾病的药物经常联合使用。在这种情况下，这些药物之间可能会发生药代动力学相互作用。绝大多数这些相互作用主要是在代谢水平上观察到的，是由细胞色素 P450 (CYP) 活性变化引起的。卡马西平、苯妥英和巴比妥类药物可诱导氧化生物转化，从而降低三环类抗抑郁药、许多典型和非典型抗精神病药以及一些苯二氮卓类药物的血浆浓度。较新的抗癫痫药物与精神疾病药物发生临床相关相互作用的可能性较低。许多抗癫痫药物的药代动力学不受抗精神病药和抗焦虑药的影响，而一些较新的抗抑郁药，即氟西汀、氟伏沙明和维洛嗪，可能会抑制 CYP 酶，导致一些抗癫痫药物（包括苯妥英和卡马西平）的血清浓度升高。通过了解参与个体药物生物转化的 CYP 酶以及特定药物对这些 CYP 酶活性的影响，可以预测临床相关的药代动力学相互作用。作为一般规则，这些相互作用可以通过仔细评估临床反应来管理，并且在有指示时，通过测量药物血清浓度指导个体化剂量调整，特别是如果药代动力学相互作用可能导致癫痫发作控制或毒性体征发生任何变化。需要进一步的研究来改进抗癫痫药物和精神疾病药物之间药代动力学相互作用的预测，为临床医生在临床环境中提供实际帮助。