Pharmacokinetics of selective serotonin reuptake inhibitors

The five selective serotonin reuptake inhibitors (SSRIs), fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram, have similar antidepressant efficacy and a similar side effect profile. They differ, however, in their pharmacokinetic properties. Under steady-state concentrations, their half-...

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Bibliographic Details
Published in:Pharmacology & therapeutics (Oxford) 2000, Vol.85 (1), p.11-28
Main Authors: Hiemke, Christoph, Härtter, Sebastian
Format: Article
Language:English
Subjects:
Citalopram
Citalopram - blood
Citalopram - pharmacokinetics
Clinical Trials as Topic
Drug Interactions
Drug-drug interactions
Fluoxetine
Fluoxetine - blood
Fluoxetine - pharmacokinetics
Fluvoxamine
Fluvoxamine - blood
Fluvoxamine - pharmacokinetics
Humans
Paroxetine
Paroxetine - blood
Paroxetine - pharmacokinetics
Serotonin Uptake Inhibitors - blood
Serotonin Uptake Inhibitors - pharmacokinetics
Sertraline
Sertraline - blood
Sertraline - pharmacokinetics
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Summary:The five selective serotonin reuptake inhibitors (SSRIs), fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram, have similar antidepressant efficacy and a similar side effect profile. They differ, however, in their pharmacokinetic properties. Under steady-state concentrations, their half-lives range between 1 and 4 days for fluoxetine (7 and 15 days for norfluoxetine) and between 21 (paroxetine) and 36 (citalopram) hr for the other SSRIs. Sertraline and citalopram show linear and fluoxetine, fluvoxamine, and paroxetine nonlinear pharmacokinetics. SSRIs underlie an extensive metabolism with high interindividual variability, whereby cytochrome P450 (CYP) isoenzymes play a major role. Therefore, resulting blood concentrations are highly variable between individuals. Except for N-demethylated fluoxetine, metabolites of SSRIs do not contribute to clinical actions. Therapeutically effective blood concentrations are unclear so far, although there is evidence for minimal effective and upper-threshold concentrations that should not be exceeded. Paroxetine and, to a lesser degree, fluoxetine and norfluoxetine are potent inhibitors of CYP2D6 and fluvoxamine of CYP1A2 and CYP2C19. This can give rise to drug-drug interactions that may have no effect, lead to intoxication, or improve the therapeutic response. These different pharmacokinetic properties of the five SSRIs, especially their drug-drug interaction potential, should be considered when selecting a distinct SSRI for treatment of depression or other disorders with a suggested dysfunction of the serotonergic system in the brain.
ISSN:0163-7258
1879-016X
DOI:10.1016/S0163-7258(99)00048-0