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2.
Drug Metab Dispos ; 29(10): 1263-8, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11560868

RESUMO

The antipsychotic agent risperidone, is metabolized by different cytochrome P-450 (CYP) enzymes, including CYP2D6, to the active 9-hydroxyrisperidone, which is the major metabolite in plasma. Two enantiomers, (+)- and (-)-9-hydroxyrisperidone might be formed, and the aim of this study was to evaluate the importance of CYP2D6 and CYP3A4/CYP3A5 in the formation of these two enantiomers in human liver microsomes and in recombinantly expressed enzymes. The enantiomers of 9-hydroxyrisperidone were analyzed with high pressure liquid chromatography using a chiral alpha-1 acid glycoprotein column. A much higher formation rate was observed for (+)-9-hydroxyrisperidone than for (-)-9-hydroxyrisperidone in microsomes prepared from six individual livers. The formation of (+)-9-hydroxyrisperidone was strongly inhibited by quinidine, a potent CYP2D6 inhibitor, whereas ketoconazole, a CYP3A4 inhibitor, strongly inhibited the formation of (-)-9-hydroxyrisperidone. Recombinant human CYP2D6 produced only (+)-9-hydroxyrisperidone, whereas a lower formation rate of both enantiomers was detected with expressed CYP3A4 and CYP3A5. In vivo data from 18 patients during treatment with risperidone indicate that the plasma concentration of the (+)-enantiomer is higher than that of the (-)-enantiomer in extensive metabolizers of CYP2D6. These findings clearly suggest that CYP2D6 plays a predominant role in (+)-9-hydroxylation of risperidone, the major metabolic pathway in clinical conditions, whereas CYP3A catalyzes the formation of the (-)-9-hydroxymetabolite. Further studies are required to evaluate the pharmacological/toxic activity of both enantiomers.


Assuntos
Citocromo P-450 CYP2D6/metabolismo , Sistema Enzimático do Citocromo P-450/metabolismo , Antagonistas de Dopamina/sangue , Microssomos Hepáticos/metabolismo , Oxigenases de Função Mista/metabolismo , Risperidona/sangue , Cromatografia Líquida de Alta Pressão , Citocromo P-450 CYP3A , DNA Complementar/genética , Antagonistas de Dopamina/metabolismo , Humanos , Hidroxilação , Técnicas In Vitro , Conformação Molecular , Proteínas Recombinantes/metabolismo , Risperidona/metabolismo
3.
Ther Drug Monit ; 23(3): 223-7, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11360029

RESUMO

SUMMARY: The effects of paroxetine on steady-state plasma concentrations of risperidone and its active metabolite 9-hydroxyrisperidone (9-OH-risperidone) were studied in 10 patients with schizophrenia or schizoaffective disorder. Patients stabilized using risperidone therapy (4-8 mg/d) also received paroxetine (20 mg/d) for 4 weeks. During paroxetine administration, mean plasma concentrations of risperidone increased significantly (P < 0.01), whereas levels of 9-OH-risperidone decreased slightly but not significantly. After 4 weeks of paroxetine treatment, the sum of the concentrations of risperidone and 9-OH-risperidone (active moiety) increased significantly by 45% (P < 0.05) over baseline. The mean plasma risperidone/9-OH-risperidone ratio was also significantly modified (P < 0.001) during paroxetine treatment. The drug combination was generally well tolerated with the exception of one patient who developed Parkinsonian symptoms in the second week of adjunctive therapy. In this patient total plasma levels of risperidone and its active metabolite increased by 62% during paroxetine co-administration. The authors' findings indicate that paroxetine, a potent inhibitor of CYP2D6, may impair the elimination of risperidone, primarily by inhibiting CYP2D6-mediated 9-hydroxylation and to a lesser extent by simultaneously affecting the further metabolism of 9-OH-risperidone or other pathways of risperidone biotransformation. Careful clinical observation and possibly monitoring of plasma risperidone levels may be useful whenever paroxetine is co-administered with risperidone.


Assuntos
Antipsicóticos/sangue , Isoxazóis/sangue , Paroxetina/administração & dosagem , Pirimidinas/sangue , Risperidona/sangue , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Adulto , Citocromo P-450 CYP2D6/fisiologia , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palmitato de Paliperidona , Risperidona/administração & dosagem
4.
Eur J Clin Pharmacol ; 56(12): 881-8, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11317475

RESUMO

OBJECTIVE: The present study was carried out to identify the cytochrome P450 enzyme(s) involved in the 6-hydroxylation and O-demethylation of melatonin. METHODS: The formation kinetics of 6-hydroxymelatonin and N-acetylserotonin were determined using human liver microsomes and cDNA yeast-expressed human enzymes (CYP1A2, 2C9 and 2C19) over the substrate concentration range 1-1000 microM. Selective inhibitors and substrates of various cytochrome P450 enzymes were also employed. RESULTS: Fluvoxamine was a potent inhibitor of 6-hydroxymelatonin formation, giving 50 +/- 5% and 69 +/- 9% inhibition at concentrations of 1 microM and 10 microM, respectively, after incubation with 50 microM melatonin. Furafylline, sulphaphenazole and omeprazole used at low and high concentrations substantially inhibited both metabolic pathways. cDNA yeast-expressed CYP1A2, CYP2C9 and CYP2C19 catalysed the formation of the two metabolites, confirming the data obtained with specific inhibitors and substrates. CONCLUSIONS: Our results strongly suggest that 6-hydroxylation, the main metabolic pathway of melatonin, is mediated mainly, but not exclusively, by CYP1A2, the high-affinity enzyme involved in melatonin metabolism, confirming the observation that a single oral dose of fluvoxamine increases nocturnal serum melatonin levels in healthy subjects. Furthermore, the results indicate that there is a potential for interaction with drugs metabolised by CYP1A2 both at physiological levels and after oral administration of melatonin, while CYP2C19 and CYP2C9 are assumed to be less important.


Assuntos
Sistema Enzimático do Citocromo P-450/fisiologia , Fluvoxamina/farmacologia , Isoenzimas/fisiologia , Melatonina/análogos & derivados , Melatonina/metabolismo , Microssomos Hepáticos/enzimologia , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Células Cultivadas , Cromatografia Líquida de Alta Pressão , Sistema Enzimático do Citocromo P-450/efeitos dos fármacos , Humanos , Hidroxilação/efeitos dos fármacos , Isoenzimas/efeitos dos fármacos , Microssomos Hepáticos/metabolismo , Especificidade por Substrato
5.
Psychopharmacology (Berl) ; 153(2): 238-43, 2001 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-11205425

RESUMO

RATIONALE: Evaluation of relationships between serum antipsychotic drug concentrations and clinical response may provide valuable information for rational dosage adjustments. For risperidone, this relationship has been little investigated to date. OBJECTIVE: To assess the relationship between plasma concentrations of risperidone and its active 9-hydroxy-metabolite (9-OH-risperidone) and clinical response in schizophrenic patients who experienced an acute exacerbation of the disorder. METHODS: Forty-two patients (30 males, 12 females, age 24-60 years) were given risperidone at dosages ranging from 4 to 9 mg/day for 6 weeks. The design of the study was open and risperidone dosage could be adjusted individually according to clinical response. Steady-state plasma concentrations of risperidone and its 9-hydroxymetabolite were measured after 4 and 6 weeks using a specific HPLC assay. Psychopathological state was assessed at baseline and at weeks 2, 4, and 6 by means of the positive and negative syndrome scale (PANSS), and patients were considered responders if they showed a greater than 20% reduction in total PANSS score at final evaluation compared with baseline. RESULTS: Mean plasma concentrations of risperidone, 9-OH-risperidone, and active moiety (sum of risperidone and 9-OH-risperidone concentrations) did not differ between responders (n = 28) and non-responders (n = 14). No correlation between plasma levels and percent decrease in total PANSS score was found for risperidone (rs = -0.187, NS), 9-OH-risperidone (rs = 0.246, NS), and active moiety (rs = 0.249, NS). Active moiety concentrations in plasma were higher (P < 0.001) in patients developing clinically significant parkinsonian symptoms (n = 7) than in those with minimal (n = 7) or no drug-induced parkinsonism (n = 28). CONCLUSIONS: In chronic schizophrenic patients experiencing an acute exacerbation of the disorder, plasma levels of risperidone and its active metabolite correlate with the occurrence of parkinsonian side effects, whereas no significant correlation appears to exist with the degree of clinical improvement.


Assuntos
Antipsicóticos/sangue , Antipsicóticos/uso terapêutico , Isoxazóis/sangue , Pirimidinas/sangue , Risperidona/sangue , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Antipsicóticos/efeitos adversos , Doenças dos Gânglios da Base/induzido quimicamente , Doenças dos Gânglios da Base/psicologia , Cromatografia Líquida de Alta Pressão , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palmitato de Paliperidona , Escalas de Graduação Psiquiátrica , Risperidona/efeitos adversos , Psicologia do Esquizofrênico
6.
J Chromatogr B Biomed Sci Appl ; 746(2): 173-81, 2000 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-11076069

RESUMO

A simple and sensitive high-performance liquid chromatographic (HPLC) method with UV absorbance detection is described for the quantitation of risperidone and its major metabolite 9-hydroxyrisperidone in human plasma, using clozapine as internal standard. After sample alkalinization with 1 ml of NaOH (2 M) the test compounds were extracted from plasma using diisopropyl ether-isoamylalcohol (99:1, v/v). The organic phase was back-extracted with 150 microl potassium phosphate (0.1 M, pH 2.2) and 60 microl of the acid solution was injected into a C18 BDS Hypersil analytical column (3 microm, 100x4.6 mm I.D.). The mobile phase consisted of phosphate buffer (0.05 M, pH 3.7 with 25% H3PO4)-acetonitrile (70:30, v/v), and was delivered at a flow-rate of 1.0 ml/min. The peaks were detected using a UV detector set at 278 nm and the total time for a chromatographic separation was about 4 min. The method was validated for the concentration range 5-100 ng/ml. Mean recoveries were 98.0% for risperidone and 83.5% for 9-hydroxyrisperidone. Intra- and inter-day relative standard deviations were less than 11% for both compounds, while accuracy, expressed as percent error, ranged from 1.6 to 25%. The limit of quantitation was 2 ng/ml for both analytes. The method shows good specificity with respect to commonly prescribed psychotropic drugs, and it has successfully been applied for pharmacokinetic studies and therapeutic drug monitoring.


Assuntos
Antipsicóticos/sangue , Cromatografia Líquida de Alta Pressão/métodos , Isoxazóis/sangue , Pirimidinas/sangue , Risperidona/sangue , Humanos , Palmitato de Paliperidona , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espectrofotometria Ultravioleta
7.
Ther Drug Monit ; 22(4): 481-5, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10942191

RESUMO

To evaluate the pharmacokinetic interaction between risperidone and the mood-stabilizing agents carbamazepine and valproic acid, steady state plasma concentrations of risperidone and 9-hydroxyrisperidone (9-OH-risperidone) were compared in patients treated with risperidone alone (controls, n = 23) and in patients comedicated with carbamazepine (n = 11) or sodium valproate (n = 10). The three groups were matched for sex, age, body weight, and antipsychotic dosage. Plasma concentrations of risperidone and 9-OH-risperidone did not differ between valproate-comedicated patients and controls. By contrast, the concentrations of both compounds were lower in patients taking carbamazepine, although the difference reached statistical significance only for the metabolite (p < 0.001). The sum of the concentrations of risperidone and 9-OH-risperidone in patients receiving carbamazepine (median 44 nmol/L) was also significantly lower than in patients receiving valproate (168 nmol/L) and in controls (150 nmol/L). In five patients assessed with and without carbamazepine comedication, dose-normalized plasma risperidone and 9-OH-risperidone concentrations were significantly lower when the patients received combination therapy than when they received risperidone alone. In three patients assessed with and without valproate, no major changes in the levels of risperidone and its metabolite were observed. These findings demonstrate that carbamazepine markedly decreases the plasma concentrations of risperidone and its active 9-OH-metabolite, probably by inducing CYP3A4-mediated metabolism. This interaction is likely to be clinically significant. Conversely, valproic acid does not cause any major change in plasma antipsychotic levels.


Assuntos
Antipsicóticos/sangue , Carbamazepina/farmacologia , Isoxazóis/sangue , Pirimidinas/sangue , Risperidona/sangue , Ácido Valproico/farmacologia , Adulto , Citocromo P-450 CYP3A , Sistema Enzimático do Citocromo P-450/fisiologia , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenases de Função Mista/fisiologia , Palmitato de Paliperidona
8.
Psychopharmacology (Berl) ; 148(1): 83-9, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10663421

RESUMO

RATIONALE: Monitoring plasma clozapine concentrations may play a useful role in the management of patients with schizophrenia, but information on the relationship between the plasma levels of the drug and response is still controversial. OBJECTIVE: The purpose of this study was to assess the relationship between plasma concentrations of clozapine and its weakly active metabolite norclozapine and clinical response in patients with schizophrenia resistant to conventional neuroleptics. METHODS: Forty-five patients, 35 males and ten females, aged 19-65 years, were given clozapine at a dosage up to 500 mg/day for 12 weeks. Steady-state plasma concentrations of clozapine and norclozapine were measured at week 12 by a specific HPLC assay. Psychopathological state was assessed at baseline and at week 12 by using the Brief Psychiatric Rating Scale, and patients were considered responders if they showed a greater than 20% reduction in total BPRS score compared with baseline and a final BPRS score of 35 or less. RESULTS: Mean plasma clozapine concentrations were higher in responders (n=18) than in non-responders (n=27) (472+/-220 versus 328+/-128 ng/ml, P<0.01), whereas plasma norclozapine levels did not differ between the two groups (201+/-104 versus 156+/-64 ng/ml, NS). A significant positive correlation between plasma levels and percent decrease in total BPRS score was found for clozapine (r(s)=0.371, P<0.02), but not for norclozapine (r(s)=0.162, NS). A cutoff value at a clozapine concentration of about 350 ng/ml differentiated responders from non-responders with a sensitivity of 72% and a specificity of 70%. At a cutoff of 400 ng/ml, sensitivity was 67% and specificity 78%. The incidence of side effects was twice as high at clozapine concentrations above 350 ng/ml compared with lower concentrations (38% versus 17%). CONCLUSIONS: These results suggest that plasma clozapine levels are correlated with clinical effects, although there is considerable variability in the response achieved at any given drug concentration. Because many patients respond well at plasma clozapine concentrations in a low range, aiming initially at plasma clozapine concentrations of 350 ng/ml or greater would require in some patients use of unrealistically high dosages and imply an excessive risk of side effects. Increasing dosage to achieve plasma levels above 350-400 ng/ml may be especially indicated in patients without side effects who failed to exhibit amelioration of psychopathology at standard dosages or at lower drug concentrations.


Assuntos
Antipsicóticos/sangue , Clozapina/análogos & derivados , Clozapina/sangue , Esquizofrenia/tratamento farmacológico , Adulto , Idoso , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Ensaios Clínicos como Assunto , Clozapina/efeitos adversos , Clozapina/uso terapêutico , Sedação Consciente , Constipação Intestinal/induzido quimicamente , Tontura/induzido quimicamente , Relação Dose-Resposta a Droga , Resistência a Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Sialorreia/induzido quimicamente , Taquicardia/induzido quimicamente , Resultado do Tratamento , Aumento de Peso/efeitos dos fármacos
9.
Pharmacopsychiatry ; 33(6): 213-7, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11147928

RESUMO

The effect of paroxetine or sertraline on steady-state plasma concentrations of clozapine and its major metabolites was studied in 17 patients with schizophrenia or schizoaffective disorder stabilized on clozapine therapy (200-400 mg/day). In order to treat negative symptomatology or concomitant depression, 9 patients received additional paroxetine (20-40mg/day) and 8 patients sertraline (50-100 mg/day). After 3 weeks of paroxetine administration, mean plasma concentrations of clozapine and norclozapine increased significantly by 31% (p<0.01) and by 20% (p<0.05), respectively, while levels of clozapine N-oxide remained almost unchanged. The mean plasma norclozapine/clozapine and clozapine N-oxide/clozapine ratios were not modified during paroxetine treatment. No significant changes in plasma concentrations of clozapine and its major metabolites were observed after 3 weeks of combined therapy with sertraline. Clozapine coadministration with either paroxetine or sertraline was well tolerated. Our findings suggest that the metabolism of clozapine is not affected by sertraline treatment at typical therapeutic doses, while paroxetine, a potent inhibitor of CYP2D6, appears to inhibit the metabolism of clozapine, possibly by affecting pathways other than N-demethylation and N-oxidation. While sertraline may be added safely to patients on maintenance treatment with clozapine, careful clinical observation and monitoring of plasma clozapine levels may be useful whenever paroxetine is coadministered with clozapine.


Assuntos
Clozapina/farmacocinética , Paroxetina/administração & dosagem , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Antagonistas da Serotonina/farmacocinética , Sertralina/administração & dosagem , Adulto , Clozapina/sangue , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas da Serotonina/sangue
10.
Ther Drug Monit ; 21(5): 577-9, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10519458

RESUMO

The effect of the new antidepressant reboxetine on the activity of the cytochrome P450 (CYP) 2D6 isoenzyme was investigated in 10 healthy volunteers using dextromethorphan as a model CYP2D6 substrate. Each volunteer received a single 30 mg oral dose of dextromethorphan on three different occasions separated by an interval of at least 4 weeks: a) in a control session; b) after 1 week of treatment with reboxetine, 8 mg/day; and c) after 1 week of treatment with paroxetine (an inhibitor of CYP2D6 activity) 20 mg/day. Urine was collected over the next 8 hours for the determination of the dextromethorphan/dextrorphan metabolic ratio. All subjects were classified as extensive metabolizers (EM) with a dextromethorphan/dextrorphan ratio < 0.3. There were no notable changes in the urinary dextromethorphan/dextrorphan ratio in the reboxetine phase as compared to the control session. By contrast, there was a statistically significant increase in the metabolic ratio in the paroxetine phase (p < 0.001), with 4 subjects switching to poor metabolizer (PM) phenotype. These results suggest that reboxetine is unlikely to cause clinically significant interactions with substrates of CYP2D6.


Assuntos
Antidepressivos/farmacologia , Citocromo P-450 CYP2D6/metabolismo , Inibidores Enzimáticos/farmacologia , Morfolinas/farmacologia , Paroxetina/farmacologia , Adulto , Estudos Cross-Over , Dextrometorfano/farmacologia , Dextrometorfano/urina , Dextrorfano/urina , Interações Medicamentosas , Feminino , Humanos , Isoenzimas , Masculino , Fenótipo , Reboxetina , Fatores de Tempo
11.
Ther Drug Monit ; 21(3): 341-5, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10365650

RESUMO

Two separate studies were carried out to assess the effect of valproic acid on the steady-state plasma concentrations of clozapine and its major metabolites norclozapine and clozapine N-oxide in psychotic patients. In the first study, concentrations of clozapine and metabolites were compared between patients treated with clozapine in combination with sodium valproate (n = 15) and control patients treated with clozapine alone (n = 22) and matched for sex, age, body weight, and antipsychotic dosage. Patients comedicated with valproate tended to have higher clozapine levels and lower norclozapine levels, but the differences did not reach statistical significance. In a subsequent study, plasma concentrations of clozapine and its metabolites were determined in 6 patients with schizophrenia stabilized on clozapine therapy (200-400 mg/d) before and after treatment with sodium valproate (900-1200 mg/d) for 4 weeks. Mean plasma concentrations of clozapine and its metabolites did not change significantly throughout the study, but there was a trend for clozapine levels to be higher and for norclozapine levels to be lower after valproate. Overall, these findings suggest that valproic acid may have an inhibiting effect on the CYP1A2- or CYP3A4-mediated conversion of clozapine to norclozapine. However, the interaction is unlikely to be clinically significant.


Assuntos
Anticonvulsivantes/uso terapêutico , Antipsicóticos/farmacocinética , Clozapina/farmacocinética , Transtornos do Humor/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Ácido Valproico/uso terapêutico , Adulto , Antipsicóticos/sangue , Clozapina/análogos & derivados , Clozapina/sangue , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/sangue , Esquizofrenia/sangue
12.
Psychopharmacology (Berl) ; 147(3): 300-5, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10639689

RESUMO

The role of the polymorphic cytochrome P450 2D6 (CYP2D6) in the metabolism of risperidone to its major active metabolite, 9-hydroxyrisperidone (9-OH-risperidone), has been documented after single oral doses of the drug. In this study, the influence of the CYP2D6 polymorphism on the steady-state plasma concentrations of risperidone and 9-OH-risperidone was investigated. Thirty-seven schizophrenic patients on monotherapy with risperidone, 4-8 mg/day, were genotyped by RFLP and PCR for the major functional variants of the CYP2D6 gene. Steady state plasma levels of risperidone and 9-OH-risperidone were analysed by HPLC. Based on the genotype analysis, three patients were classified as ultrarapid metabolizers (UM) with an extra functional CYP2D6 gene, 16 were homozygous extensive metabolizers (EM), 15 heterozygous EM and three poor metabolizers (PM). The median steady-state plasma concentration-to-dose (C/D) ratios of risperidone were 0.6, 1.1, 9.7 and 17.4 nmol/l per mg in UM, homozygous EM, heterozygous EM and PM, respectively, with statistically significant differences between PM and the other genotypes (P < 0.02). The C/D of 9-OH-risperidone also varied widely but was not related to the genotype. The risperidone/9-OH-risperidone ratio was strongly associated with the CYP2D6 genotype, with the highest ratios in PM (median 0.79). Heterozygous EM also had significantly higher ratios than homozygous EM (median value 0.23 versus 0.04; P < 0.01) or UM (median 0.03; P < 0.02). No significant differences were found in the C/D of the sum of the plasma concentrations of risperidone and 9-OH-risperidone between the genotype groups. In conclusion, the steady-state plasma concentrations of risperidone and the risperidone/9-OH-risperidone ratio are highly dependent on the CYP2D6 genotype. However, as risperidone and 9-OH-risperidone are considered to have similar pharmacological activity, the lack of relationship between the genotype and the sum of risperidone and 9-OH-risperidone indicates that the CYP2D6 polymorphism may be of limited importance for the clinical outcome of the treatment.


Assuntos
Antipsicóticos/sangue , Citocromo P-450 CYP2D6/genética , Isoxazóis/sangue , Pirimidinas/sangue , Risperidona/sangue , Adulto , Alelos , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Palmitato de Paliperidona , Polimorfismo Genético/genética , Polimorfismo de Fragmento de Restrição , Esquizofrenia/sangue
13.
Ther Drug Monit ; 20(6): 628-30, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9853978

RESUMO

The steady state plasma concentrations of clozapine and its two major metabolites, norclozapine and clozapine N-oxide, were compared in patients with schizophrenia treated with clozapine in combination with phenobarbital (n=7), and in control patients treated with clozapine alone (n=15). Patients were matched for sex, age, body weight, and antipsychotic dosage. Patients comedicated with phenobarbital had significantly lower plasma clozapine levels than those of the controls (232+/-104 versus 356+/-138 ng/ml; mean, SD, p < 0.05). Plasma norclozapine levels did not differ between the two groups (195+/-91 versus 172+/-61 ng/ml, NS), whereas clozapine N-oxide levels were significantly higher in the phenobarbital group (115+/-49 versus 53+/-31 ng/ml, p < 0.01). Norclozapine/clozapine and clozapine N-oxide/ clozapine ratios were also significantly higher (p < 0.001) in patients comedicated with phenobarbital. These findings suggest that phenobarbital stimulates the metabolism of clozapine, probably by inducing its N-oxidation and demethylation pathways.


Assuntos
Clozapina/análogos & derivados , Clozapina/farmacocinética , Fenobarbital/farmacologia , Esquizofrenia/metabolismo , Adulto , Sistema Enzimático do Citocromo P-450/efeitos dos fármacos , Sistema Enzimático do Citocromo P-450/metabolismo , Interações Medicamentosas , Indução Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
J Chromatogr B Biomed Sci Appl ; 714(2): 299-308, 1998 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-9766870

RESUMO

An isocratic high-performance liquid chromatography (HPLC) method with ultraviolet detection for the simultaneous determination of clozapine and its two major metabolites in human plasma is described. Analytes are concentrated from alkaline plasma by liquid-liquid extraction with n-hexane-isoamyl alcohol (75:25, v/v). The organic phase is back-extracted with 150 microl of 0.1 M dibasic phosphate (pH 2.2 with 25% H3PO4). Triprolidine is used as internal standard. For the chromatographic separation the mobile phase consisted of acetonitrile-0.06 M phosphate buffer, pH 2.7 with 25% phosphoric acid (48:52, v/v). Analytes are eluted at a flow-rate of 1.0 ml/min, separated on a 250 x 4.60 mm I.D. analytical column packed with 5 microm C6 silica particles, and measured by UV absorbance detection at 254 nm. The separation requires 7 min. Calibration curves for the three analytes are linear within the clinical concentration range. Mean recoveries were 92.7% for clozapine, 82.0% for desmethylclozapine and 70.4% for clozapine N-oxide. C.V. values for intra- and inter-day variabilities were < or = 13.8% at concentrations between 50 and 1000 ng/ml. Accuracy, expressed as percentage error, ranged from -19.8 to 2.8%. The method was specific and sensitive with quantitation limits of 2 ng/ml for both clozapine and desmethylclozapine and 5 ng/ml for clozapine N-oxide. Among various psychotropic drugs and their metabolites, only 2-hydroxydesipramine caused significant interference. The method is applicable to pharmacokinetic studies and therapeutic drug monitoring.


Assuntos
Antipsicóticos/sangue , Cromatografia Líquida de Alta Pressão/métodos , Clozapina/análogos & derivados , Clozapina/sangue , Humanos , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espectrofotometria Ultravioleta
15.
Int Clin Psychopharmacol ; 13(3): 141-5, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9690983

RESUMO

The effect of fluoxetine on the plasma concentrations of clozapine and its major metabolites was studied in 10 schizophrenic patients with residual negative symptoms. Patients stabilized on clozapine therapy (200-450 mg/day) received additional fluoxetine (20 mg/day) for eight consecutive weeks. During fluoxetine administration, mean plasma concentrations of clozapine, norclozapine and clozapine N-oxide increased significantly by 58%, 36% and 38%, respectively. There was no difference in negative symptomatology, as measured by the Scale for Assessment of Negative Symptoms, and the drug combination was generally well tolerated. The concomitant elevation in plasma levels of clozapine and its major metabolites suggests that fluoxetine inhibits the metabolism of clozapine by affecting pathways other than N-demethylation and N-oxidation. Close monitoring of clinical response and, possibly, plasma clozapine levels is recommended whenever fluoxetine is given to patients stabilized on clozapine therapy.


Assuntos
Antidepressivos de Segunda Geração/administração & dosagem , Antipsicóticos/farmacocinética , Clozapina/farmacocinética , Depressão/enzimologia , Fluoxetina/administração & dosagem , Esquizofrenia/enzimologia , Adulto , Antidepressivos de Segunda Geração/efeitos adversos , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Biotransformação , Doença Crônica , Clozapina/administração & dosagem , Clozapina/efeitos adversos , Citocromo P-450 CYP1A1/antagonistas & inibidores , Inibidores do Citocromo P-450 CYP2D6 , Depressão/tratamento farmacológico , Relação Dose-Resposta a Droga , Interações Medicamentosas , Monitoramento de Medicamentos , Quimioterapia Combinada , Feminino , Fluoxetina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/tratamento farmacológico
16.
Eur J Pharmacol ; 331(2-3): 267-74, 1997 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-9274989

RESUMO

In 24 h water deprived rats we have evaluated the effects of melatonin on the inhibition of thirst and on fever induced by Escherichia coli lipopolysaccharide. Intraperitoneal (i.p) injection of lipopolysaccharide (0.32, 0.64 and 0.96 mg/kg) alone induced, a dose-dependent and significant inhibition of water intake as well as fever. In addition, lipopolysaccharide at the same concentrations increased urinary prostaglandins and serum cytokines levels. On the contrary, lipopolysaccharide treatment had no effects on cerebral brain nitric oxide synthase activity. All lipopolysaccharide effects were reverted by a prior, concomitant and subsequent i.p. treatment with melatonin (2, 4 and 6 mg/kg), whereas they were still present when melatonin was injected in combination with the melatonin receptor antagonist luzindole (15, 30 and 60 mg/kg, i.p.). We suggest that melatonin could exert its dipsogenic effects through a reduction of the free radical nitric oxide (NO.) whereas it may reduce body temperature by preventing an excessive formation of prostaglandins and cytokines.


Assuntos
Toxinas Bacterianas/antagonistas & inibidores , Enterotoxinas/antagonistas & inibidores , Proteínas de Escherichia coli , Febre/prevenção & controle , Melatonina/farmacologia , Sede/efeitos dos fármacos , Animais , Toxinas Bacterianas/farmacologia , Temperatura Corporal/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Encéfalo/enzimologia , Dinoprostona/metabolismo , Dinoprostona/urina , Relação Dose-Resposta a Droga , Enterotoxinas/farmacologia , Inibidores Enzimáticos/farmacologia , Febre/induzido quimicamente , Interleucina-1/sangue , Interleucina-6/sangue , Masculino , Óxido Nítrico Sintase/antagonistas & inibidores , Óxido Nítrico Sintase/metabolismo , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/metabolismo
17.
Pharmacol Res ; 35(4): 335-9, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9264051

RESUMO

The extent and clinical significance of the pharmacokinetic interaction between fluoxetine and haloperidol was studied in 13 schizophrenic patients with prominent negative symptoms. Patients stabilized on chronic low-dose haloperidol (3-8 mg day-1) received additional fluoxetine (20 mg day-1) for 12 consecutive weeks. Mean plasma concentrations of haloperidol increased significantly from 6.5 +/- 2.4 nmol l-1 at baseline to 8.8 +/- 3.6 nmol l-1 (P < 0.01) at week 12 of fluoxetine treatment, but this effect was not associated with an increase in mean extrapyramidal side effects score on the Simpson and Angus Scale. The improvement in negative symptomatology, as measured by the Scale for Assessment of Negative Symptoms, did not correlate significantly with the increase in plasma haloperidol levels. Though our findings confirm that fluoxetine impairs haloperidol clearance, this interaction is unlikely to have adverse clinical consequences, at least in patients chronically stabilized on a low dosage of haloperidol. As fluoxetine is a potent inhibitor of cytochrome P450 (CYP) 2D6, these results also provide indirect evidence for an involvement of CYP2D6 in the metabolism of haloperidol.


Assuntos
Antidepressivos de Segunda Geração/farmacocinética , Antidepressivos de Segunda Geração/uso terapêutico , Antipsicóticos/farmacocinética , Antipsicóticos/uso terapêutico , Fluoxetina/farmacocinética , Fluoxetina/uso terapêutico , Haloperidol/farmacocinética , Haloperidol/uso terapêutico , Esquizofrenia/tratamento farmacológico , Esquizofrenia/metabolismo , Adulto , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicologia do Esquizofrênico
18.
Int J Immunopharmacol ; 19(1): 31-8, 1997 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9226477

RESUMO

Intracerebroventricular (i.c.v.) interleukin-10 (25, 50, and 100 ng/rat) effects on water intake, exploratory behaviour, and rectal temperature were evaluated in rats treated intraperitoneally (i.p.) with lipopolysaccharide (0.32, 0.64, and 0.96 mg/kg). Endotoxin administration induced fever and inhibition of thirst in water-deprived rats, and a decrease in lococomotory activity in normohydrated and water-deprived animals. Our data show that interleukin-10 during lipopolysaccharide administration controlled fever, increases exploratory behaviour, but did not reverse lipopolysaccharide inhibition of thirst. These effects suggest that fever, depression in locomotory activity but not inhibition of thirst, induced by endotoxin are influenced by interleukin-10 levels.


Assuntos
Temperatura Corporal/efeitos dos fármacos , Endotoxinas/farmacologia , Comportamento Exploratório/efeitos dos fármacos , Interleucina-10/farmacologia , Lipopolissacarídeos/farmacologia , Sede/efeitos dos fármacos , Animais , Endotoxinas/toxicidade , Febre/induzido quimicamente , Febre/fisiopatologia , Injeções Intraventriculares , Interleucina-10/administração & dosagem , Interleucina-10/metabolismo , Lipopolissacarídeos/toxicidade , Locomoção/efeitos dos fármacos , Masculino , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/farmacologia , Células Th1/efeitos dos fármacos , Células Th2/metabolismo
19.
Life Sci ; 60(7): 457-64, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9042373

RESUMO

Interleukin-1 beta (IL-1 beta) causes inhibition of drinking behaviour. Moreover it induces formation of prostaglandins (PGs) and nitric oxide (NO). Both PGs and NO are able to inhibit drinking stimulated by water deprivation or by intracerebroventricular (i.c.v.) administration of angiotensin II. In this study, we studied in the preoptic area (POA) the possible role of PGs and NO in the antidipsogenic action induced by IL-1 beta. IL-1 beta was injected in the lateral cerebral ventricle (i.c.v.) (2.5, 10, 20, and 40 ng/rat) or into POA (0.625, 1.25, 2.5, and 10 ng/rat). L-arginine (12.5, 25, 50, and 100 ng/rat), the precursor of NO, or NG-nitro-L-arginine methyl ester (L-NAME) (25, 50, and 100 ng/rat), an inhibitor of nitric oxide synthase (NOS), were injected only into POA. Drinking behaviour was induced by water deprivation (24 h). IL-1 beta injected either i.c.v. or into POA caused dose dependent inhibition of drinking. In the POA a treatment with acetylsalicylic acid (ASA) (33, 66, and 135 micrograms/rat), but not with L-NAME, antagonized the inhibition of drinking behaviour induced by the highest doses of IL-1 beta in the POA. In the POA, a treatment with ASA or L-NAME antagonized the inhibition of drinking behaviour caused by injection of the highest doses of L-arginine. Our data suggest that the central inhibition of drinking behaviour of IL-1 beta is mediated through the formation of PGs, but not NO, in the POA.


Assuntos
Comportamento de Ingestão de Líquido/efeitos dos fármacos , Interleucina-1/farmacologia , Óxido Nítrico/biossíntese , Prostaglandinas/fisiologia , Animais , Aspirina/administração & dosagem , Aspirina/farmacologia , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/farmacologia , Injeções Intraventriculares , Interleucina-1/administração & dosagem , Interleucina-1/antagonistas & inibidores , Masculino , NG-Nitroarginina Metil Éster/administração & dosagem , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico Sintase/antagonistas & inibidores , Ratos , Ratos Sprague-Dawley
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