Lack of Citalopram Effect on the Pharmacokinetics of Cyclosporine

Liston, Heidi L.; Markowitz, John S.; Hunt, Noel; DeVane, C. Lindsay; Boulton, David W.; Ashcraft, Elizabeth E.

doi:10.1176/appi.psy.42.4.370-a

Cited by 14 publications

(6 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A small study failed to show any effect of citalopram upon ciclosporin levels in OLT patients. 104 While some studies have demonstrated an elevation in ciclosporin levels when co-administered with sertraline, 105 others have not, 106 and clarification is needed. In keeping with the known neurocognitive side effects of the medication, a retrospective analysis of cohort of patients receiving liver transplants for different pathologies used multivariate analysis to identify that high-dose corticosteroid use is an independent risk factor for the mental health component of HRQOL in the post-OLT population.…”

Section: Use Of Antidepressants In Liver Transplant Patientsmentioning

confidence: 99%

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Mullish

Kabir

Thursz

et al. 2014

Aliment Pharmacol Ther

116

View full text Add to dashboard Cite

SummaryBackgroundThe scale of depression in patients with chronic liver disease (CLD) and those who have received orthotopic liver transplantation (OLT) is poorly characterised. Clinicians are uncertain of how best to manage depression within these patients.AimsTo review the literature evaluating both the prevalence and impact of depression in patients with CLD and post‐OLT, and to assess the safety and efficacy of antidepressant use within this context.MethodsA PubMed search using the phrases ‘chronic liver disease’, ‘cirrhosis’, ‘liver transplantation’, ‘depression’, ‘antidepressant’ and the names of specific causes of liver disease and individual antidepressants.ResultsOver 30% of cirrhotic patients have depressive features, and they experience worse clinical outcomes than nondepressed cirrhotic patients. CLD patients with chronic hepatitis C are particularly prone to depression, partly related to the use of interferon therapy. OLT patients with depression have higher mortality rates than nondepressed patients; appropriate antidepressant use reverses this effect. Selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) are effective and generally safe in both CLD and OLT patients.ConclusionsDepression is much more prevalent in CLD or OLT patients than is generally recognised, and it adversely affects clinical outcomes. The reasons for this relationship are complex and multifactorial. Antidepressants are effective in both CLD and post‐OLT, although lower doses or a reduced dosing frequency may be required to minimise side effects, e.g. exacerbation of hepatic encephalopathy. Further research is needed to establish optimal management of depression in these patients, including the potential role of nonpharmacological treatments.

show abstract

Section: Use Of Antidepressants In Liver Transplant Patientsmentioning

confidence: 99%

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Mullish

Kabir

Thursz

et al. 2014

Aliment Pharmacol Ther

116

View full text Add to dashboard Cite

show abstract

“…Therapeutic interventions may include individual and group psychotherapy as well as pharmacotherapy with selective serotonin reuptake inhibitors such as citalopram. 133,134 Bone Disease Bone disease in KTR differs from 'steroid-induced' osteoporosis seen after transplantation of non-renal solid organs. In KTR, bone disease is worsened by the frequent pre-existing bone damage acquired during dialysis and prior CKD.…”

Section: Goutmentioning

confidence: 99%

Primary Care of the Renal Transplant Patient

et al. 2010

View full text Add to dashboard Cite

There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60-65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP's perspective. Medical management issues related to immunosuppressive medications are also briefly discussed.

show abstract

“…63,64 Sertraline, mirtazapine, and paroxetine are weak inhibitors of CYP3A4; citalopram, a substrate for CYP3A4, and venlafaxine, a substrate and inhibitor of CYP2D6, may be potential alternatives. 65 With numerous antidepressants available, nefazodone should be avoided in patients receiving CSA and TAC. Because of the lack of data, fluoxetine and fluvoxamine should be used with caution when combined with CSA or TAC.…”

Section: Antifungal Agentsmentioning

confidence: 99%

Drug Therapy in the Heart Transplant Recipient

2005

View full text Add to dashboard Cite

With improving survival, the heart transplant recipient faces an increasing number of medical problems caused by both aging and the cumulative complications of immunosuppressive drugs. 1 The availability of new drugs to treat infection, obesity, hypertension, hyperlipidemia, renal insufficiency, diabetes, osteoporosis, gout, and malignancies has resulted in the heart transplant recipient and their physicians facing an almost overwhelming number of important drug-drug interactions. In parts 1 through 3 of this series, we reviewed commonly used immunosuppressive drugs and their pharmacology, as well as the common medical problems faced by the heart transplant recipient. In this article, we provide an overview of the mechanisms of common and important potential drug-drug interactions and guidelines for avoiding these interactions. Principles of Drug-Drug InteractionsThe risk for drug-drug interactions is increased by advanced age, polypharmacy, medications with a narrow therapeutic index, or medications requiring intensive monitoring. All of these factors except advanced age are present in the heart transplant recipient. A 10-fold interpatient variability may exist in the magnitude of a drug interaction resulting from patient-related and drug-related factors. 2 Patient-related factors predisposing to drug interactions include concomitant diseases, genetics, diet, and environmental exposures. For example, commonly used immunosuppressants, antifungal agents, and lipid-lowering medications are metabolized through the cytochrome P450 (CYP450) enzyme system and effluxed from cells by the multiple drug resistance transporter protein p-glycoprotein (P-gp). Both systems are found in the liver and gastrointestinal tract and exhibit genetic polymorphism. 2 The CYP450 enzymes belong to a superfamily of oxygenases; the primary purpose of these oxygenases is to add a functional group to a drug to increase its polarity and to promote its excretion from the body. If enzymes possess Ͼ40% homology, they are grouped together into families designated by an Arabic numeral (eg, the CYP1 family). Families are further divided into subfamilies, which are designated by a letter after the number (eg, CYP2C and CYP2D subfamilies); members of each subfamily have Ͼ55% homology with each another. Individual members are given an additional number (eg, CYP3A4) to identify a specific enzyme pathway. 2 CYP3A4 is particularly important because 60% of oxidized drugs, including the calcineurin inhibitors (CIs) cyclosporine (CSA) and tacrolimus (TAC), sirolimus (SIR), and everolimus (EVER), undergo biotransformation through this particular enzyme system. 3 P-gp is a membrane-bound glycoprotein belonging to the superfamily of ATP-binding cassette transporters. Like the CYP450 enzyme system, P-gp acts in a protective capacity by "effluxing" drug from the cell membrane or cytoplasm. P-gp density is highest within the small intestine, proximal tubules of the kidney, and biliary canalicular membranes. Some medications such as CIs and SIR use both the CYP450...

show abstract

Lack of Citalopram Effect on the Pharmacokinetics of Cyclosporine

Cited by 14 publications

References 9 publications

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Primary Care of the Renal Transplant Patient

Drug Therapy in the Heart Transplant Recipient

Contact Info

Product

Resources

About