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Drug-drug Interactions in Psychiatric Practice, Part 4

Classification of Neuropsychiatric Medications Based on Their Principal Mechanisms of Action (With Updated Neuroscience-based Nomenclature)


Journal of Psychiatric Practice®: March 2019 - Volume 25 - Issue 2 - p 118–127
doi: 10.1097/PRA.0000000000000375

This column is the fourth in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. This column discusses how drugs with multiple mechanisms of action have the potential to interact pharmacodynamically by the mechanism(s) mediating their therapeutic indication and for some drugs by other mechanisms (ie, drugs with multiple mechanisms of action). In this and the next column in this series, we present a classificatory system in the form of 2 tables that prescribers can use to predict the action of a neuropsychiatric drug when used alone as well as DDIs that can occur when it is used in combination with other drugs. The table in this column presents neuropsychiatric medications classified according to their mechanism(s) of action. The next column in this series will present a parallel table summarizing major types of pharmacodynamic DDIs based on mechanism of action and discuss strategies for minimizing adverse outcomes from such unintended DDIs. The authors recommend that health care providers’ knowledge of the drugs they frequently prescribe include both their generic and brand names (to avoid confusion leading to dispensing the wrong drugs), routinely used doses, pharmacokinetics including half-lives, pharmacodynamics including mechanism(s) of action and binding profile for specific receptor(s) (not specifically discussed here but available in other columns by the first author), adverse effect profiles, potential DDIs, and the evolving research literature on these agents.

PRESKORN and GERMANN: Kansas University School of Medicine-Wichita, Wichita, KS

The column has been adapted with updates conforming to Neuroscience-based Nomenclature with permission from table 2 in Preskorn SH’s Drug-Drug Interactions With an Emphasis on Psychiatric Medications, First Edition, West Islip, NY and Durant, OK: Professional Communications; 2018. To order a copy of the book, readers can call 1-800-337-9838 or visit the Professional Communications website at

S.H.P. has worked with over 137 pharmaceutical and biotech companies in the United States and throughout the world. Over the past year, he has received grants/research support from or has served as a consultant, on the advisory board, or on the speaker’s bureau for Alkermes, Allergan, Bionomics, BioXcel, Janssen, National Institute of Mental Health, Perception Neuroscience, Pfizer, and Sunovion. All clinical trial and study contracts were with and payments made to the Kansas University Medical Center Research Institute, a research institute affiliated with Kansas University School of Medicine-Wichita. A.G. declares no conflicts of interest.

Please send correspondence to: Sheldon H. Preskorn, MD, University of Kansas Medical Center, 1010 N. Kansas, Wichita, KS 67214.

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