Antidepressant drug interactions in the elderly. Understanding the P-450 system is half the battle in reducing risks

Postgrad Med. 1999 Nov;106(6):231-2, 237-40, 245-9. doi: 10.3810/pgm.1999.11.780.

Abstract

Antidepressant treatment in patients 65 years of age or older carries increased risks of adverse drug events because of age-related physiologic changes, polypharmacy, and individual variability in drug metabolism (due to genetic factors, concurrent disease, diet, and consumption habits). Reduction of total drug burden, adjustment of dose levels, and careful selection of an appropriate agent are important steps toward avoiding adverse drug interactions, In addition, the documented and potential drug interactions of the various classes of antidepressants, and specific agents within each class, should be considered. Each elderly patient should be treated individually and monitored carefully during the initiation and maintenance of antidepressant therapy.

MeSH terms

  • Adrenergic Uptake Inhibitors / adverse effects
  • Aged
  • Aging / physiology
  • Antidepressive Agents / administration & dosage
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / classification
  • Antidepressive Agents / metabolism
  • Antidepressive Agents, Second-Generation / adverse effects
  • Antidepressive Agents, Tricyclic / adverse effects
  • Body Burden
  • Contraindications
  • Cytochrome P-450 Enzyme System / drug effects*
  • Cytochrome P-450 Enzyme System / metabolism
  • Diet
  • Disease
  • Dopamine Uptake Inhibitors / adverse effects
  • Drug Interactions
  • Drug Monitoring
  • Humans
  • Polypharmacy
  • Risk Factors
  • Selective Serotonin Reuptake Inhibitors / adverse effects

Substances

  • Adrenergic Uptake Inhibitors
  • Antidepressive Agents
  • Antidepressive Agents, Second-Generation
  • Antidepressive Agents, Tricyclic
  • Dopamine Uptake Inhibitors
  • Serotonin Uptake Inhibitors
  • Cytochrome P-450 Enzyme System