Pharmacokinetics and pharmacodinamics of psychotropic drugs: effect of sex

Abstract

Data on the specific effects of sex on pharmacokinetics, as well as tolerability, safety, and efficacy of psychotropic medications are still meager, mainly because only recently sex-related issues have attracted a certain degree of interest within the pharmacological domain. Therefore, with the present study, we aimed to provide a comprehensive review of the literature on this topic, through careful MEDLINE and PubMed searches of the years 1990-2012. Generally, data on pharmacokinetics are more consistent and numerous than those on pharmacodynamics. Sex-related differences have been reported for several parameters that influence pharmacokinetics, such as gastric acidity, intestinal motility, body weight and composition, blood volume, liver enzymes (mainly the cytochrome P450), or renal excretion, which may alter plasma drug levels. Sex-related peculiarities may also account for a different sensitivity of men and women to side effects and toxicity of psychotropic drugs. Further, some differences in drug response, mainly to antipsychotics and antidepressants, have been described. Further studies are, however, necessary to explore more thoroughly the impact of sex on the pharmacokinetics and pharmacodynamics of psychotropic drugs, in order to reach the most appropriate and tailored prescription for each patient.

Gender differences in 353 inpatients with acute psychosis: The experience of one Psychiatric Emergency Service of Turin

“…Second, results regarding the different pattern of improvement were not cleared for medication type and dosage and for gender related latency. Indeed, different pharmacokinetic characteristics in men and women may influence plasma levels of psychotropic drugs and, perhaps, their effectiveness as recently confirmed (Meibohm et al, 2002;Marazziti et al, 2013). Finally, it would be interesting to confirm our findings on gender differences at the time of the admission and after a brief hospitalization in other diagnoses.…”

Evaluation of the Relationship Between Pharmacokinetics and the Safety of Aripiprazole and Its Cardiovascular Effects in Healthy Volunteers

“…There are different factors causing these differences, such as hormonal changes and differences in body weight (29,30). Women present a higher Vd/W than men, due to their highest fat percentage (30).…”

Steady-state serum concentrations of venlafaxine in patients with late-life depression. Impact of age, sex and BMI

“…This difference can somewhat be explained by reduced gastric emptying, lower body weight, reduced volume of distribution and lower hepatic blood flow in females (Gandhi et al 2004). Moreover, higher serum concentrations of venlafaxine in females might also be explained by slower hydroxylation and glucuronidation possibly due to drug metabolizing effects of estrogens and progesterone (Marazziti et al 2013). In the present study, females demonstrated an approximately 24 % increase in dose-adjusted serum concentrations of the venlafaxine active moiety, compared with males (Table 2).…”