探索炎症对抗抑郁药和抗精神病药药代动力学的影响：系统综述
Exploring the Influence of Inflammation on the Pharmacokinetics of Antidepressants and Antipsychotics: A Systematic Review.
摘要(中文译文)
有力证据表明，炎症可影响负责多种精神科药物代谢的细胞色素P450（CYP）同工酶的活性。这在重性抑郁障碍（MDD）等疾病中可能尤为重要，因为相当比例的患者报告治疗无应答。因此，关于炎症对MDD中使用且经这些途径代谢的药物（如抗抑郁药和抗精神病药）影响的相关现有知识，需要进一步评估。在本系统综述中，检索了PubMed、Scopus和Web of Science数据库，并获取了2010年1月1日至2025年5月25日期间发表的文章。研究策略基于与药代动力学、炎症以及抗抑郁药或抗精神病药相关的关键词组合。共纳入五项观察性研究和队列研究，以及十项在人类受试者中探讨该主题的病例系列或病例报告。现有证据似乎不均衡，且对抗抑郁药而言严重有限。唯一可用的单研究提示，在炎症状态下西酞普兰和文拉法辛的药代动力学变化有限。相比之下，抗精神病药的现有数据提示炎症对其药代动力学的影响存在差异。特别是，氯氮平与血浆浓度显著升高相关。总体而言，炎症与精神科药物药代动力学之间的关系似乎较为复杂。此外，现有数据大多受到局限性的困扰，如样本量小、回顾性设计以及患者遗传和免疫学特征描述不佳。考虑到当前证据基础非常有限，尤其是对抗抑郁药而言，开展更大规模前瞻性研究的必要性依然迫切。进一步的研究应纳入药物基因组学和免疫学特征分析，以更好地支持临床实践建议。
Abstract
Strong evidence suggests that inflammation can affect the activity of Cytochrome P450 (CYP) isoforms responsible for the metabolism of numerous psychiatric drugs. This is likely of particular importance in conditions such as Major Depressive Disorder (MDD), where a relevant percentage of patients report non-response to treatment. Thus, the existing knowledge on the impact of inflammation on medications used in MDD, and metabolised via these pathways (e.g., antidepressants and antipsychotics), needs to be further evaluated. In this systematic review, the PubMed, Scopus, and Web of Science databases were screened, and published articles between January 1st, 2010, and May 25th, 2025, were retrieved. The research strategy was based on combinations of key terms related to pharmacokinetics, inflammation, and antidepressants or antipsychotics. A total of five observational and cohort studies were included, along with ten case series or case reports that investigated the topic in human subjects. The available evidence appears unbalanced and severely limited for antidepressants. The single study available suggests limited changes in the pharmacokinetics of citalopram and venlafaxine in inflammatory conditions. By contrast, the available data for antipsychotics suggest variable effects of inflammation on their pharmacokinetics. In particular, clozapine is associated with substantial increases in plasma concentrations. Overall, the relationship between inflammation and the pharmacokinetics of psychiatric drugs appears to be complex. Furthermore, much of the available data is plagued by limitations, such as small sample sizes and retrospective designs, as well as poor characterisation of patients' genetic and immunological profiles. Considering the current, very limited evidence base, especially for antidepressants, the necessity for larger prospective studies remains pressing. Further studies should incorporate pharmacogenetics and immunological profiling to better support clinical practice recommendations.
如何引用
AMA
Giuseppe Cicala, Maria Antonietta Barbieri, Alessandro Gialluisi, Letizia Scandiffio, Nadia Cattane, Annamaria Cattaneo, et al. Exploring the Influence of Inflammation on the Pharmacokinetics of Antidepressants and Antipsychotics: A Systematic Review.. Current neuropharmacology. 2026; doi:10.2174/011570159X465955260311043235.
APA
Giuseppe Cicala, Maria Antonietta Barbieri, Alessandro Gialluisi, Letizia Scandiffio, Nadia Cattane, Annamaria Cattaneo, et al (2026). Exploring the Influence of Inflammation on the Pharmacokinetics of Antidepressants and Antipsychotics: A Systematic Review.. Current neuropharmacology. https://doi.org/10.2174/011570159X465955260311043235
GB/T 7714
Giuseppe Cicala, Maria Antonietta Barbieri, Alessandro Gialluisi, Letizia Scandiffio, Nadia Cattane, Annamaria Cattaneo, et al. Exploring the Influence of Inflammation on the Pharmacokinetics of Antidepressants and Antipsychotics: A Systematic Review.[J]. Current neuropharmacology, 2026 doi:10.2174/011570159X465955260311043235.
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