Psychotropic drugs and CYP2D6 in late-life psychiatric and neurological disorders. What do we know?

Davide Seripa, Madia Lozupone, Eleonora Stella, Giulia Paroni, Paola Bisceglia, Maddalena La Montagna, Grazia D’onofrio, Carolina Gravina, Maria Urbano, Maria Giovanna Priore, Angela Lamanna, Antonio Daniele, Antonello Bellomo, Giancarlo Logroscino, Antonio Greco, Francesco Panza

Research output: Contribution to journalReview article

Abstract

Introduction: Late-life psychiatric and neurological disorders (LLPND) are interesting models to understand the potential role of pharmacogenetics in drug management, since several pharmacological approaches for treating LLPND have proven to be ineffective or deleterious, thus resulting in therapeutic failures (TF) and adverse drug reactions (ADR). Common variants in the genes encoding the cytochrome P450 (CYP) enzyme system, the ‘engine room’ of drug metabolism, together with well-known age-related increased polypharmacy also contributed to the prevalence of TF and ADR observed in these patients, also rising number and time of hospital readmissions and rate of institutionalizations. Areas covered: The genetics of CYP and how it may be used for the management of the outcomes of the most frequent drugs (antidepressants, antipsychotics, anticholinesterase inhibitors, and anxiolytics) used in LLPND. Expert opinion: Tailored CYP-based pharmacological treatments of LLPND will reduce TFs and ADRs, improving patient’s life, reducing number and dosage of administered drugs, and the number and duration of hospital readmissions, saving costs for clinical management of LLPND. Pharmacokinetic interactions are less predictable than pharmacodynamic ones and several requests are made to regulatory organisms for the pharmacological management of frail older patients affected by LLPND.

Original languageEnglish
Pages (from-to)1373-1385
Number of pages13
JournalExpert Opinion on Drug Safety
Volume16
Issue number12
DOIs
Publication statusPublished - Dec 2 2017

Keywords

  • Adverse drug reaction
  • cytochrome P450
  • late-life neurological disorders
  • late-life psychiatric disorders
  • therapeutic failure

ASJC Scopus subject areas

  • Pharmacology (medical)

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  • Cite this

    Seripa, D., Lozupone, M., Stella, E., Paroni, G., Bisceglia, P., La Montagna, M., D’onofrio, G., Gravina, C., Urbano, M., Priore, M. G., Lamanna, A., Daniele, A., Bellomo, A., Logroscino, G., Greco, A., & Panza, F. (2017). Psychotropic drugs and CYP2D6 in late-life psychiatric and neurological disorders. What do we know? Expert Opinion on Drug Safety, 16(12), 1373-1385. https://doi.org/10.1080/14740338.2017.1389891