Review Article

Clinically relevant drug interactions in anxiety disorders

  1. Maria Rosaria Muscatello1,
  2. Edoardo Spina2,*,
  3. Borwin Bandelow3,
  4. David S. Baldwin4

Article first published online: 7 FEB 2012

DOI: 10.1002/hup.2217

Issue

Human Psychopharmacology: Clinical and Experimental

Human Psychopharmacology: Clinical and Experimental

Volume 27, Issue 3, pages 239–253, May 2012

Additional Information

How to Cite

Muscatello, M. R., Spina, E., Bandelow, B. and Baldwin, D. S. (2012), Clinically relevant drug interactions in anxiety disorders. Hum. Psychopharmacol. Clin. Exp., 27: 239–253. doi: 10.1002/hup.2217

Author Information

  1. 1

    Section of Psychiatry, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Messina, Italy

  2. 2

    Section of Pharmacology, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy

  3. 3

    Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany

  4. 4

    Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK

*E. Spina, Section of Pharmacology, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Policlinico Universitario, via Consolare Valeria 98125, Messina, Italy. Tel: +39 090 2213647; Fax: +39 090 2213300. E-mail: espina@unime.it

Publication History

  1. Issue published online: 15 MAY 2012
  2. Article first published online: 7 FEB 2012
  3. Manuscript Accepted: 6 JAN 2012
  4. Manuscript Received: 12 JUL 2011

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Keywords:

  • anxiety disorders;
  • drug interactions;
  • selective serotonin reuptake inhibitors;
  • serotonin–noradrenaline reuptake inhibitors;
  • benzodiazepines;
  • pregabalin

Objective

Certain drugs used in the treatment of patients with anxiety disorders can interact with other psychotropic drugs and with pharmacological treatments for physical illnesses. There is a need for an updated comparative review of clinically relevant drug interactions in this area.

Design

Relevant literature on drug interactions with medications used in the treatment of anxiety disorders was identified through a search in MEDLINE and EMBASE.

Results

Drug interactions involving medications used to treat anxiety disorders may be pharmacokinetic, such as enzyme inhibition or induction in the cytochrome P450 system and transporter-mediated drug interactions, or pharmacodynamic, such as additive effects in causing drowsiness or additive effects at neurotransmitter receptors. Certain selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine, and paroxetine) are particularly liable to be potentially involved in untoward pharmacokinetic interactions.

Conclusions

The potential for drug interactions with medications used in anxiety disorders should be the cause of clinical concern, particularly in elderly individuals. However, the liability for harmful drug interactions may be anticipated, and the risk reduced. Although not all interactions are clinically relevant, careful monitoring of clinical response and possible interactions is essential. Copyright © 2012 John Wiley & Sons, Ltd.

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