氟西汀的药代动力学及其与CYP450酶的作用

Pharmacokinetics of fluoxetine and its effects on cytochrome P450 isoenzymes

氟西汀是近年来开发的一种新型 5 羟色胺重摄取抑制剂 ,它通过选择性抑制突触间 5 羟色胺 (5 HT)的重摄取和代谢 ,增加突触间 5 HT的传递而发挥作用。氟西汀由细胞色素P45 0 (CYP45 0 )酶进行氧化代谢 ,现已证明CYP2C9,CYP2C19和CYP2D6是介导氟西汀N 去甲基代谢的主要CYP45 0同工酶。由于氟西汀及代谢产物去甲氟西汀分别为CYP2D6、CYP3A4、CYP2C19和CYP2C9的抑制剂 ,因此它可与经这些CYP同工酶催化代谢的药物产生明显的相互作用 ;从而导致不同个体间的药代动力学差异和疗效差异。

Fluoxetine is a relatively novel class of selective serotonin reuptake inhibitors (SSRIs) with antidepressant properties. It seems to facilitate serotonergic transmission via down regulation of presynaptic inhibitory autoreceptors, with no effect on muscarinic receptors and doubtful effects on β adrenergic receptors. Fluoxetine is mainly metabolized by cytochrome P450 (CYP) isoenzymes. It has been shown that CYP2C9、CYPD6, and CYP2C19 are major CYP isoforms responsible for the N demethylation of fluoxetine. Since both fluoxetine and its main metabolite norfluoxetine are the inhibitors of CYP2D6, CYP3A4, CYP2C9, and CYP2C19, there are some drug drug interactions of fluoxetine with other drugs for metabolism by those CYP isoenzymes, which results in interindividual differences in the pharmacokinetics and efficacy.