DRUG-INTERACTIONS IN HUMAN NEUROPATHIC PAIN PHARMACOTHERAPY

Current practice predicates the use of multiple drug combinations in t he treatment of neuropathic pain. These combinations may be required b ecause of multiple pain symptoms directly arising from neuropathic pat hology, other symptoms attributable to the chronicity and severity of the patient's pain or conditions unrelated to their pain. A fear exist s that combination drug use or the addition of a new drug to a therape utic regimen may lead to increased drug toxicity or decreased efficacy . Many of the drug interactions of significance to neuropathic pain ph ysicians involve the cytochromes P450 2D6 and 3A3/4 isoenzymes. Drug i nteractions should be more predictable based on the knowledge of which compounds induce, inhibit or are metabolized by specific cytochrome P 450 enzymes. Mechanisms of induction or inhibition of biotransformatio n via the P450 hepatic enzyme system are discussed and various inducer s, inhibitors and substrates relating to neuropathic pain pharmacother apy are listed. (C) 1997 International Association for the Study of Pa in. Published by Elsevier Science B.V.