目的:我们旨在通过回顾性图表评估与适应原和抗抑郁药相互作用相关的不良事件的患病率和临床特征。方法:共评估了1816份不良事件报告。如果药物流行病学分析显示适应原和抗抑郁药相互作用与不良事件发生之间存在很高的因果关系,则将病例包括在分析中。从报告中提取了以下数据:年龄,性别,抗抑郁药,含有适应原的植物产品,其他合并用药,以及相互作用的临床后果及其可能的机制。结果:9%的与抗抑郁药和其他制剂的伴随使用相关的不良事件涉及适应原。我们确定了30份报告,其中副作用与抗抑郁药和适应原的使用存在因果关系。这里,我们提供了具有相应抗抑郁药的适应原列表以及由它们的相互作用引起的副作用:Withaniasomnifera:reboxetine(睾丸疼痛和射精功能障碍),舍曲林(严重腹泻),艾司西酞普兰(肌痛,上腹痛,恶心,呕吐,不宁腿综合征,和严重的咳嗽),和帕罗西汀(全身肌痛,眼痛,和高眼压);刺五加球菌:度洛西汀(上消化道出血),帕罗西汀(鼻出血),舍曲林(阴道出血),和阿戈美拉汀(烦躁,激动,头痛,和头晕);五味子:安非他酮(关节痛和血小板减少症),阿米替林(谵妄),和氟西汀(排尿困难);三棘:西酞普兰(全身瘙痒),艾司西酞普兰(溢乳),和曲唑酮(牛皮癣复发);黄连:米安色林(心律失常),米氮平(下肢水肿和肌痛),和氟西汀(男子乳房发育症);cimicifugaracemosa:mianserin(不安腿综合征),帕罗西汀(男性乳房发育症和乳房痛),和文拉法辛(低钠血症);巴多巴:阿戈美拉汀(背痛和多汗症)和莫洛贝胺(心肌梗塞);绞股蓝:度洛西汀(背痛);冬虫夏草:舍曲林(上消化道出血);细菌草:米安塞林(无极腿);结论:临床医生应监测精神障碍患者伴随使用适应原和抗抑郁药物的不良事件。这些药物之间的副作用和药代动力学相互作用(CYP和P-糖蛋白的抑制)的聚集可能导致临床上显著的不良事件。
Aim: We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart
review. Methodology: A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms. Results: Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: Withania somnifera: reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); Eleutherococcus senticosus: duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); Schisandra chinensis: bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); Tribulus terrestris: citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); Coptis chinensis: mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); Cimicifuga racemosa: mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); Bacopa monnieri: agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); Gynostemma pentaphyllum: duloxetine (back pain); Cordyceps sinensis: sertraline (upper gastrointestinal bleeding); Lepidium meyenii: mianserin (restless legs syndrome); and Scutellaria baicalensis: bupropion (seizures). Conclusion: Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.