Impatto del genere sulla farmacocinetica e sul metabolismo dei farmaci psicotropi

Translated title of the contribution: Impact of gender on pharmacokinetics and metabolism of psychotropic drugs

Donatella Marazziti, A. Baldini, M. Carlini, L. Bevilacqua, M. Catena, F. Golia, M. Picchetti, L. Dell'Osso

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Aims: Data on the specific effects of gender on tolerability, safety and efficacy of psychotropic medications are still scanty, mainly because only recently have gender differences become a topic of pharmacological research. Methods: The most relevant publications on this topic were reviewed and commented on. Results: The pharmacokinetic profile seems to be influenced by gender at the level of absorption, distribution, metabolism and elimination, factors influencing the bioavailability, the efficacy and the side-effects of psychotropic medications (Tables Ia, Ib, II). Women, as compared with men, show a reduction in different gastric and intestinal parameters that change even in relation to menstrual cycle, lower body weight and blood volume, as well as greater percentage of body fat: all these factors influence the absorption and distribution of psychotropic medications: e.g., benzodiazepines are weak bases and, for this reason, are absorbed more rapidly in women, are lipophilic and tend to be stored in the adipose tissue, with an extension of half-life, represented more in elderly women. Both liver hydroxylation and glucoronidation, as well as renal excretion, are slower in women. Cytochrome P450 activity is also different in women and men, while contributing to changes in plasma concentrations of some psychotropic medications (Table IV). Although the clinical response to tricyclic antidepressants (TCAs) and serotonin reuptake inhibitors (SSRIs) seems to be independent from gender, TCAs are less protein-bound in women, with a higher rate of the free portion and, therefore, of increased plasma levels and of a higher risk of adverse effects. As far as SSRIs are concerned, women show a marked response to these treatments, probably on account of a positive effect of oestrogens; indeed, in the post-menopausal period, characterized by decreased levels of oestrogens, the response to SSRIs becomes the same in the two genders. Conclusions: In the light of these preliminary observations, it is evident that further studies are necessary to ascertain the impact of gender on psychotropic drugs in order to achieve the most appropriate and tailored prescription for each patient.

Translated title of the contributionImpact of gender on pharmacokinetics and metabolism of psychotropic drugs
Original languageUndefined/Unknown
Pages (from-to)69-75
Number of pages7
JournalGiornale Italiano di Psicopatologia
Volume13
Issue number1
StatePublished - Mar 2007
Externally publishedYes

Keywords

  • Benzodiazepines
  • Estrogens
  • Gender
  • Psychotropic drugs
  • SSRIs
  • Tricyclics

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