27 - References

References

Pharmacokinetics CHAPTER 11 References

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17. Lennernäs H. Ethanol-­drug absorption interaction: potential for a significant effect on the plasma pharmacokinetics of ethanol vulnerable formulations. Mol Pharm 2009; 6:1429–1440. Table 11.11  Psychotropic drugs: choice in patients who continue to drink. Safest choice Best avoided Antipsychotics Sulpiride and amisulpride Paliperidone, if depot required (non-­sedative and renally excreted) Very sedative antipsychotics such as chlorpromazine and clozapine Antidepressants SSRIs – citalopram, sertraline Potent inhibitors of CYP3A4 (fluoxetine, paroxetine) may decrease alcohol metabolism in chronic drinkers TCAs, because impairment of metabolism by alcohol (while intoxicated) can lead to increased plasma levels and consequent signs and symptoms of overdose (profound hypotension, seizures, arrhythmias and coma) Cardiac effects can be exacerbated by electrolyte disturbances Combinations of TCAs and alcohol profoundly impair psychomotor skills Mirtazapine – often very sedative MAOIs, as can cause profound hypotension. Also potential interaction with tyramine-­containing drinks which can lead to hypertensive crisis Mood stabilisers Valproate (where regulations allow) Carbamazepine Higher plasma levels achieved during periods of alcohol intoxication may be poorly tolerated Lithium, because it has a narrow therapeutic index and alcohol-­related dehydration and electrolyte disturbance can precipitate lithium toxicity Note: be aware of the possibility of hepatic failure or reduced hepatic function in chronic alcohol misusers. See ‘Hepatic impairment’ in Chapter  8. Also note the risk of hepatic toxicity with some recommended drugs (e.g. valproate). MAOIs, monoamine oxidase inhibitors; TCAs, tricyclic antidepressants.