Neuroleptics interaction

Normann C, Brandt C, Berger M, Walden J. Delirium and persistent dyskinesia induced by a lithium-neuroleptic interaction. Pharmacopsychiatry 1998 31(5) 201—4. 

Schou M. Adverse lithium-neuroleptic interactions are there permanent effects Hum Psychopharmacol 1990 5 263. 

Neuroleptic Interactions with the Noradrenergic q-Receptor - Autonomic sympatholytic effects such as orthostatic hypotension and sedation are among the most prominent untoward actions of neuroleptic drugs. These side effects have been attributed to blockade of central and peripheral adrenergic a-receptors39 0 1 but direct quantitative evaluation of a-receptor blockade in the CNS by these agents has not been heretofore feasible. In... 

In addition to halopeiidol, the putative neuroleptics, limcazole (311), lemoxipiide (312), and gevotioline (313) bind to (7-ieceptois as does the dopamine uptake blocker, GBR 12909 (314) and two ligands active at the NMDA receptor, ifenprodil (315) and CNS 1102 (316). NPC 16377, (317) is a selective (7-teceptor ligand. MAO inhibitors and antidepressants also bind to (7-teceptors. Some evidence indicates that (7-teceptors in the brain are in fact a form of cytochrome which may account for the diversity of ligands interacting with (7-sites. 

The administration of low doses of PCP to rodents induces hyperactivity and stereotypy (Chen et al. 1959 ). The observation that neuroleptics such as chlorpromazine, haloperidol, and pimozide, and adrenolytics such as alpha-methyl paratyrosine antagonize these behavioral effects of PCP suggests that they are mediated by facilitation of central dopaminergic neurotransmission (Murray and Horita 1979). The actions of PCP on central dopaminergic neurotransmission may be similar to amphetamine. A dose of PCP (2.5 mg/kg) in rats, which has no effects when given alone, enhances the behavioral effects of 1 and 3 mg/kg of d-amphetamine (Balster and Chait 1978). PCP, like dopamine, has also been shown to suppress plasma prolactin (Bayorh et al. 1983). However, the firm establishment of an excl usive relationship between dopamine neuro-transmission and PCP effects is difficult because of the prominent interactions of this drug with other neurotransmitter systems. 

Peroutka, S.J., U Prichard, D.C., Greenberg, D.A. and Snyder, S.H. (1977) Neuroleptic drug interactions with norepinephrine alpha receptor binding sites in rat brain. Neuropharmacology, 16, 549-556. 

Areca may interact adversely with antipsychotic medications (Deahl 1989). Two cases have been reported of schizophrenic patients who were taking neuroleptics and developed severe extrapyramidal symptoms after areca chewing. Given the functional antagonism between dopamine and acetylcholine in the striatum, it is likely that arecoline amplified the dyskinetic effect of neuroleptic medications. 

Moreover, the neuroleptic, chlor-promazine, formerly used as a neuroleptic, is able to interact with several different receptor types. Thus, its action is neither organ-specific nor receptor-specific. 

Quazepam (Doral) [C IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose 7.5-15 mg PO hs PRN i in elderly hqjatic failure Caution [X, /-] NA glaucoma Contra PRG, sleep apnea Disp Tabs SE Sedation, hangovCT, somnolence, resp depression Interactions T Effects W/ azole antifungals, cimetidine, digoxin, disulfiram, INH, levodopa, macrolides, neuroleptics, phenytoin, quinolones, SSRIs, verapamil, grapefruit juice, EtOH effects W/carbamazepine, rifampin, rifabutin, tobacco EMS Use caution w/ other benzodiazepines, antihistamines, opioids and verapamil, can T CNS depression concurrent EtOH and grapefruit juice use T CNS depression OD May cause profound CNS depression, confusion, bradycardia, hypotension, and altered reflexes flumazenil can be used as antidote activated charcoal may be effective... 

Neuroleptic and antidepressant drugs interact with a number of different receptors in the brain, which may partly explain their PK-PD relationships. Figure 9 shows the bell shaped concentration-response relationship for the antidepressant drug nortriptyline. 

As it inhibits microsomal cytochrome P450 cimetidine has a high potential for drug interactions not shared by the other H2 receptor antagonists. The oxidative metabolism of agents such as anticoagulants, most antiepileptics, some beta-blockers, warfarin, theophylline and many hypnotics, neuroleptics and antidepressants may be reduced, leading to increased effects. 

Understanding of potential interference with cognitive and motor performance, potential for drug interactions, and risk factors for neuroleptic malignant syndrome (overheating, dehydration)... 

Bamrah IS, Kumar V, Krska 1, et al Interactions between procyclidine and neuroleptic drugs some pharmacological and clinical aspects. Br 1 Psychiatry 1986 149 726-733. 

---