Biochemistry and Pharmacology of Tryptamines and by McKenna, Towers

By McKenna, Towers

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Longer-term maintenance therapy may need to be discontinued over a 6 month period. • Fluoxetine has a long plasma half-life; doses ≤20mg OD may be stopped abruptly without dose tapering, although gradual withdrawal may be necessary at higher doses. • Care is required when switching between antidepressants. • When switching between SSRIs, TCAs, and related antidepressants, the ideal method would be to incrementally reduce the dose of the first antidepressant and discontinue it before starting the second.

DRUG INTERACTIONS Drug interactions Be alert to the fact that all drugs taken by patients, including over-thecounter medicines, herbal products, and nutritional supplements, have the potential to cause clinically relevant drug interactions. The patient’s diet can also affect drug disposition The pharmacological actions of a drug can be enhanced or diminished by other drugs, food, herbal products, and nutritional supplements. Clinically relevant and potentially significant drug–drug interactions are included in the monographs.

Pharmacodynamic interactions can be additive or antagonistic in nature. Additive When two or more drugs with similar pharmacodynamic effects are coprescribed, the additive results may result in exaggerated response or toxicity. g. 10). g. warfarin and vitamin K, NSAIDs and ACE inhibitors, metoclopramide and cyclizine. 10 The serotonin syndrome The serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system (CNS). It can occur as the result of co-administration of drugs that have the net effect of increasing serotonergic neurotransmission.

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