Ramelteon (Rozerem) Pharmacology Podcast

On this episode, I discuss the pharmacology, adverse effects, and drug interactions of ramelteon (Rozerem).

Ramelteon is primarily only helpful for sleep onset and generally is not that helpful in sleep maintenance.

CNS depressant drug interactions will be a common concern to monitor. Opioids, benzodiazepines, and alcohol are common sedatives that can add to the effects of ramelteon.

Some of the CYP enzymes break down Ramelteon. I discuss this in greater length in this podcast episode.

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Prazosin (Minipress) Pharmacology Podcast

On this episode, I discuss prazosin pharmacology, adverse effects, drug interactions and much more.

Prazosin is an alpha-blocker but lacks selectivity. A reduction in blood pressure is expected, but it is notorious for causing orthostatic hypotension.

Prazosin may be used off-label for nightmares, when this is the case, you will likely only see this drug dosed at bedtime.

Alpha agonist medications (such as pseudoephedrine and ADHD stimulants) may counteract the effects of prazosin.

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Brexpiprazole (Rexulti) Pharmacology Podcast

Brexpiprazole (Rexulti) is a second generation antipsychotic. I discuss its pharmacology, adverse effects, drug interactions, and more in this podcast episode.

I like to associate brexpiprazole with aripiprazole. They have a lot of overlapping characteristics, particularly in relation to the adverse effect profile.

Brexpiprazole tends to have a low incidence of metabolic adverse effects which makes it a nice selection for patients who have diabetes, hypercholesterolemia, or who are overweight.

CYP3A4 and CYP2D6 are the two primary enzymes that break down brexpiprazole. I discuss the pharmacogenomic considerations associated with this medication.

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Lorazepam (Ativan) Pharmacology Podcast

On this podcast episode, I discuss lorazepam (Ativan) pharmacology, adverse effects, and common drug interactions.

Lorazepam has numerous dosage forms and the IV formulation does contain propylene glycol which can accumulate if it is used for longer periods of time.

There is a boxed warning for lorazepam when it is used with opioids. The risk for opioid overdose, coma, and death increases significantly.

Lorazepam is an intermediate acting benzodiazpine. It’s half-life for most adult patients is in the 12-18 hour range.

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Clonazepam Pharmacology Podcast

On this podcast episode, I discuss clonazepam pharmacology, adverse effects, pharmacokinetics, and drug interactions.

Clonazepam is a benzodiazepine that enhances the activity of GABA which is an inhibitory neurotransmitter in the central nervous system.

It is important to try to avoid using benzodiazepines like clonazepam with opioids as it can increase the risk of respiratory depression and death.

Clonazepam is an intermediate-acting benzodiazepine that is only commercially available as an oral dosage form.

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Lurasidone Pharmacology

On this podcast episode, I discuss lurasidone pharmacology, adverse effects, and drug interactions.

CYP3A4 is an important enzyme in the breakdown of lurasidone. I discuss this further on this episode.

Lurasidone is best taken with food as this enhances absorption and helps improve drug concentrations.

Lurasidone tends to have a lower risk for metabolic syndrome compared to other antipsychotics which is a nice advantage.

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Desvenlafaxine Pharmacology

On this episode, I discuss desvenlafaxine pharmacology, adverse effects, pharmacokinetics, and drug interactions.

Desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor that can be used for depression.

Renal elimination is an important method of deactivation of desvenlafaxine. Dose adjustments may be recommended as renal function drops below 50 mls/min.

Withdrawal syndrome due is a risk with desvenlafaxine as it has a significantly short half-life.

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Venlafaxine Pharmacology

In this episode, I discuss venlafaxine pharmacology, adverse effect, dose conversion of IR to ER, and drug interactions.

Venlafaxine is notorious for producing withdrawal symptoms when discontinued abruptly. I discuss these in detail on the podcast.

How significant is the interaction of venlafaxine with antiplatelet agents? I discuss that in this episode.

The onset of action is a critical education point that patients must be aware of as it takes some time for venlafaxine to work.

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Trihexyphenidyl (Artane) Pharmacology

On this episode, I breakdown trihexyphenidyl (Artane) pharmacology, adverse effects, and drug interactions.

Trihexyphenidyl is highly anticholinergic and can cause constipation, dry eyes, dry mouth, and urinary retention.

Dementia medications like donepezil can have their effects blunted by the use of trihexyphenidyl.

Trihexyphenidyl is an older anticholinergic that is rarely used for the management of EPS caused by antipsychotics.

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Duloxetine Pharmacology

On this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions.

Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia.

Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen.

CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.

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