| Title: | Molecular mechanisms of acute drug toxicity in polypharmacy : analgesic–psychotropic interactions |
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| Authors: | ID Rijavec, Nikolina (Author)
ID Rijavec, Boris (Author) |
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| Files: |  PDF - Presentation file, download (1,24 MB)
MD5: 35B2809A44545F06CDBE2617DDEFE52C
 URL - Source URL, visit https://www.mdpi.com/1422-0067/27/16/7168
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| Language: | English |
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| Typology: | 1.02 - Review Article |
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| Organization: |  UKC LJ - Ljubljana University Medical Centre
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| Abstract: | Concurrent exposure to analgesic and psychotropic drugs is frequent in patients with pain, psychiatric comorbidity, frailty, or acute-care needs. The clinically important question is whether analgesics and psychotropic drugs act on the same metabolic, transporter, receptor, ion-channel, or cellular stress systems. This narrative mechanistic review discusses those points of contact. CYP-mediated inhibition or induction, phenoconversion, altered parent-to-metabolite ratios, and blood–brain barrier transporter effects can change both systemic and central exposure, particularly through CYP2D6, CYP3A4, CYP2C9, CYP2B6, and P-glycoprotein. Pharmacodynamic toxicity may involve serotonergic excess, opioid and GABAergic effects in respiratory-control networks, hERG/IKr-related loss of repolarization reserve, or dopamine D2 receptor blockade. Non-opioid analgesics and psychotropic background therapy add further pathways involving renal and gastrointestinal vulnerability, hematological toxicity, mitochondrial injury, and altered central nervous system function. At the cellular level, mitochondrial dysfunction, oxidative stress, calcium dysregulation, and endoplasmic reticulum stress are discussed primarily as mechanistic or preclinical contributors unless direct clinical evidence is available. Overall, analgesic–psychotropic co-exposure is presented as a clinically important example of pathway convergence, while pharmacogenomic and computational approaches are interpreted in relation to drug exposure, organ reserve, and patient-specific vulnerability. |
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| Keywords: | analgesics, psychotropic drugs, polypharmacy, acute toxicity, cytochrome P450 |
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| Publication status: | Published |
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| Publication version: | Version of Record |
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| Year of publishing: | 2026 |
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| Number of pages: | str. 1-24 |
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| Numbering: | Vol. 27, issue 16, [article no.] 7168 |
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| PID: | 20.500.12556/DiRROS-31895  |
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| UDC: | 615 |
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| ISSN on article: | 1422-0067 |
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| DOI: | 10.3390/ijms27167168 |
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| COBISS.SI-ID: | 287907587 |
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| Note: | Nasl. z nasl. zaslona;
Opis vira z dne 17. 8. 2026;
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| Publication date in DiRROS: | 17.08.2026 |
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| Views: | 40 |
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| Downloads: | 22 |
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