A review of significant pharmacokinetic drug interactions with antidepressants and their management

Treatment of depression often requires long-term management with medication. Practitioners should be aware of potentially significant drug interactions with the use of antidepressants in order to effectively prevent or manage adverse events while optimizing patient response to treatment. Most antidepressants are metabolized by the liver, primarily via the CYP450 system. Pharmacokinetic profiles of the most recently approved antidepressants are reviewed in addition to evidence supporting potentially significant interactions. In addition, pharmacokinetic interactions between multiple antidepressants and other drug classes, including opiates, antineoplastics, antiepileptics, and antipsychotics, are discussed. This article provides recommendations for the monitoring and management of drug interactions. In addition, limitations of the evidence are reviewed.