![]() ![]() ![]() Escitalopram, citalopram and duloxetine are less potent CYP2D6 inhibitors, and have been shown to cause 2- to 3-fold increases in biologically available dose of metoprolol. Severe bradycardia and atroventricular block has been reported in patients who have taken metoprolol in combination with these three drugs. The same degree of increase is expected for the two other potent CYP2D6 inhibitors in the class, fluoxetine and bupropion. ![]() The potent CYP2D6 inhibitor paroxetine has been shown to increase the biologically available dose of metoprolol about 4- to 6-fold. Relevant literature was identified by a PubMed search using the word "metoprolol" combined with generic names of antidepressant drugs. The aim of this article is to provide an overview of the interactions between metoprolol and antidepressants with an emphasis on CYP2D6 inhibition. This enzyme is inhibited to a varying extent by antidepressants. Metoprolol, the most commonly used beta-receptor antagonist in Norway, is eliminated mainly via the enzyme cytochrome P450 (CYP) 2D6. ![]()
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