Drug and Diet Interactions: Avoiding Therapeutic Paralysis

An explosion of information about drug and diet interactions has greatly complicated and confusedthe use of antidepressant drugs, yet if clearly understood, such information will actually enhance thesafety and efficacy of these medications. The background against which antidepressants are discussedincludes an overview of the cytochrome P450 (CYP) system (which now contains over 500 P450genes), the concepts of enzyme specificity and selectivity, the roles of genetics and nonpharmacologicenvironmental factors, and examples of beneficial and detrimental drug and diet interactions. Thecomparative profiles of the various antidepressants are then presented with consideration given totheir roles as substrates, inhibitors, and inducers of P450 enzymes such as CYP1A2, 2B6, 2C, 2D6,and 3A4. Examples of clinically important antidepressant drug/drug and drug/diet interactions areprovided.