Objective We aimed to unravel potential pharmacokinetic interactions between aripiprazole and duloxetine. Methods Plasma concentrations of aripiprazole in two groups of 78 patients each, receiving aripiprazole as a monotherapy or combined with duloxetine, were compared. A potential impact of duloxetine on the metabolism of aripiprazole was expected in higher plasma concentrations of aripiprazole and higher dose‐adjusted plasma concentrations. Results Patients co‐medicated with duloxetine showed significantly higher plasma concentrations of aripiprazole by 54.2% (p = 0.019). Dose‐adjusted plasma concentrations were 45.6% higher (p = 0.001); 12.8% of these patients exhibited aripiprazole plasma concentrations above the upper limit of the therapeutic reference range, in the control group this was only the case for 10.3% of the patients. A positive relationship was found between the daily dose of duloxetine and dose‐adjusted plasma concentrations of aripiprazole (p = 0.034). As dehydroaripiprazole concentrations were not available, conclusions for the active moiety (aripiprazole plus dehydroaripiprazole) could not be drawn. Conclusions Combining duloxetine and aripiprazole leads to significantly higher drug concentrations of aripiprazole, most likely via an inhibition of cytochrome P450 CYP2D6 and to a lesser extent of CYP3A4 by duloxetine. Clinicians have to consider increasing aripiprazole concentrations when adding duloxetine to a treatment regimen with aripiprazole.
Objective: Although clinically widespread, scientific evidence for augmentation strategies in the treatment of severe mental illnesses is still limited. Combining different drugs increases the potential for drug-drug interactions enhancing the risk of adverse drug reactions. We aimed to unravel potential pharmacokinetic interactions between ari-piprazole and duloxetine. Methods: Plasma concentrations of aripiprazole from a large therapeutic drug monitoring da-tabase were analyzed. Two groups of 78 patients each, receiving aripiprazole as a monotherapy, or combined with duloxetine, were compared addressing a potential impact of duloxetine on the metabolism of aripiprazole being reflected in higher plasma concentrations of aripiprazole and higher dose-adjusted plasma concentra-tions (C/D). Results: Patients co-medicated with duloxetine showed significantly higher plasma concen-trations of aripiprazole (p=0.02) than in the control group by 54.2% while the dose-adjusted plasma concentrations were 45.6% higher in the co-medication group (p=0.001). Conclusions: Combining duloxetine and aripiprazole leads to significantly higher drug concentra-tions of aripiprazole, most likely via an inhibition of cytochrome P450 CYP2D6 and to a lesser extent of CYP3A4 by duloxetine. Clinicians have to consider potentially occurring adverse drug reactions caused by increased plasma levels of aripiprazole when adding duloxetine to a treatment regimen with aripiprazole.
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