tailieunhanh - HANDBOOK OF PSYCHIATRIC DRUGS - PART 9

Các chất ức chế CYP3A4 hoặc CYP2D6 có thể tăng tiếp xúc hoàn toàn để galantamine, ví dụ bao gồm paroxetine, fluoxetine, fluvoxamine, amitriptyline, cimetidine, và quinidine. Ý nghĩa lâm sàng của những tương tác này là không chắc chắn, nhưng những thay đổi đồng thời điều trị bằng thuốc | 212 handbook of psychiatric drugs Rivastigmine s metabolism does not depend on liver P450 enzymes and therefore no drug interactions related to the P450 system have been observed. Inhibitors of CYP3A4 or CYP2D6 may increase total exposure to galantamine examples include paroxetine fluoxetine fluvoxamine amitriptyline cimetidine and quinidine. The clinical significance of these interactions is uncertain but changes to concomitant drug therapy during treatment may result in a loss of efficacy or an increased risk of adverse effects. Galantamine appears to have no effect on the metabolism of other hepatic substrates. Memantine does not inhibit or induce hepatic microsomal enzymes because it is excreted in the urine predominantly as unchanged drug it is unlikely to be affected by drugs that affect hepatic enzyme function. Drugs that alkalinize the urine may reduce renal excretion of memantine and increase the risk of adverse effects. Memantine may increase the risk of central nervous system toxicity if administered with amantadine or dextromethorphan. SUMMARY ChIs and memantine are the best proven efficacious symptomatic treatments for AD. They provide consistent but small effects in many patients with mild to moderate dementia and have become the current pharmacological standard of treatment. Other therapeutic approaches are not as well tested or as clearly efficacious. Therefore ChIs are likely to be actively used clinically for at least the next several years. Memantine is the only treatment approved for moderate to severe AD. However therapeutic results of these treatments are usually modest affecting a minority of patients. In trials with ChIs patients assessed were usually outpatients with mild to moderately severe dementia and few concomitant medical illnesses. Duration of effect beyond one year and long-term safety are not known except for the uncontrolled observations of patients who continue on these drugs after the controlled trial. It is essential to .