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September 1995

Interactions of Serotonin Reuptake Inhibitors With Tricyclic Antidepressants-Reply

Author Affiliations

Cleveland Veterans Affairs Medical Center Psychiatry Service 116A(B) 10000 Brecksville Rd Brecksville, OH 44141
Boston, Mass

Arch Gen Psychiatry. 1995;52(9):784-785. doi:10.1001/archpsyc.1995.03950210078015

In reply  Harvey and Preskorn are to be commended for their efforts to predict the degree of in vivo interaction of SSSRIs with other agents at human hepatic microsomal enzymes of the CYP oxidase family, which is critical for the metabolic clearance of drugs and other xenobiotic molecules. Their models are based on in vitro characterizations of liver-plasma parBased on recent reviews by De Vane and Preskorn.8 SSRI indicates selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant; FVX, fluvoxamine; FLX, fluoxetine; SRT, sertraline; PRX, paroxetine, NORFLX, norfluoxetine; VNX, venlafaxine; and NFZ, nefazodone.•Secondary-amine TCAs include desipramine and tertiary-amine TCAs include amitryptyline. Neuroleptics include phenothiazines, clozapine, haloperidol, and risperidone.•Inducers of increased oxidase activity include carbamazepine.§ Possible CYP enzyme inhibitors. tition coefficients and normalized Kis of SSRIs and yield plausible results. Nevertheless, several caveats and points of agreement concerning the state of knowledge on this topic need to be reemphasized.

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