Kelly Cozza - Academia.edu (original) (raw)

Papers by Kelly Cozza

Research paper thumbnail of Antiretrovirals, Part II: Focus on Non-Protease Inhibitor Antiretrovirals (NRTIs, NNRTIs, and Fusion Inhibitors)

Psychosomatics, 2004

The second in a series reviewing the HIV/AIDS antiretroviral drugs. This review summarizes the no... more The second in a series reviewing the HIV/AIDS antiretroviral drugs. This review summarizes the non-protease inhibitor antiretrovirals: nucleoside and nucleotide analogue reverse transcriptase inhibitors (NRTIs), the nonnucleoside reverse transcriptase inhibitors (NNRTIs), and cell membrane fusion inhibitors. In an overview format for primary care physicians and psychiatrists, this review presents the mechanism of action, side effects, toxicities, and drug interactions of these agents.

Research paper thumbnail of Clozapine Case Series

Psychosomatics, Apr 30, 2007

Clozapine is not a drug that is ever used casually. Patients generally are afflicted with severe ... more Clozapine is not a drug that is ever used casually. Patients generally are afflicted with severe illnesses and have demonstrated treatment resistance and/or intolerance to other therapeutic options before clozapine is seriously considered. When the clinical stakes are this high, it is especially important that physicians gain an appreciation for the various drug-drug interactions that can significantly increase or decrease clozapine blood levels; such pharmacokinetic changes can derail clozapine treatment by producing clozapine toxicity or loss of antipsychotic efficacy, respectively. The authors present a case series of five drug-drug interactions involving clozapine, each of which illustrates different mechanisms by which the metabolism of clozapine can be altered. Exploring these cases should help clinicians anticipate and avoid these undesirable drugdrug interactions.

Research paper thumbnail of The Dosing of Atypical Antipsychotics

Psychosomatics, May 1, 2005

Research paper thumbnail of Interações medicamentosas: casos clínicos: o sistema do citocromo P450 e mais

Research paper thumbnail of Psychiatric treatment of persons with HIV/AIDS: an HIV-psychiatry consensus survey of current practices

Psychosomatics, Nov 1, 2010

Background: Only sparse evidence from controlled clinical trials is available to guide the psychi... more Background: Only sparse evidence from controlled clinical trials is available to guide the psychiatric treatment of persons with HIV/AIDS. Objective: The authors assessed and determined current treatment trends in AIDS psychiatry. Method: Members of the Organization of AIDS Psychiatry (OAP) participated in a web-based survey. Results: Of 159 members, 62 (39%) responded to the survey. Consensus emerged regarding first-line treatment for depression (escitalopram/citalopram), for psychosis and secondary mania (quetiapine), and for anxiety (clonazepam). Conclusion: Consensus statements can serve as a preliminary step toward providing some standardization of care for persons with HIV/AIDS.

Research paper thumbnail of Med-psych drug-drug interactions update. Antiretrovirals, part III: antiretrovirals and drugs of abuse

Psychosomatics

The third in a series reviewing the HIV/AIDS antiretroviral drugs, this report summarizes the int... more The third in a series reviewing the HIV/AIDS antiretroviral drugs, this report summarizes the interactions between antiretrovirals and common drugs of abuse. In an overview format for primary care physicians and psychiatrists, the metabolism and drug interactions in the context of antiretroviral therapy are presented for the following drugs of abuse: alcohol, benzodiazepines, cocaine, GHB (liquid X), ketamine (special K), LSD (acid), MDMA (Ecstasy), opiates, PCP (angel dust), and THC (marijuana).

Research paper thumbnail of Antihistamines

Psychosomatics

Antihistamines and their drug-drug interactions are reviewed in depth. The metabolism of "cl... more Antihistamines and their drug-drug interactions are reviewed in depth. The metabolism of "classic" or sedating antihistamines is coming to light through in vivo and in vitro studies. The polymorphic CYP 2D6 metabolic enzyme appears to be potently inhibited by many of these over-the-counter medications. The history of the discontinued "second-generation" antihistamines terfenadine and astemizole is reviewed to remind the reader why the understanding of the cytochrome P450 system became increasingly important when the cardiotoxicity of these drugs became apparent. The "third-generation" nonsedating antihistamines are also listed and compared. They have been exhaustively scrutinized for drug-drug interactions and cardiotoxicity, and they appear to have no serious drug-drug interactions at recommended doses.

Research paper thumbnail of Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II

Pharmacokinetic drug-drug interactions with codeine, dihydrocodeine, hydrocodone, oxycodone, and ... more Pharmacokinetic drug-drug interactions with codeine, dihydrocodeine, hydrocodone, oxycodone, and buprenorphine are reviewed in this column. These compounds have a very similar chemical structure to morphine. Unlike morphine, which is metabolized chiefly through conjugation reactions with uridine diphosphate glucuronosyl transferase (UGT) enzymes, these five drugs are metabolized both through oxidative reactions by the cytochrome P450 (CYP450) enzyme and conjugation by UGT enzymes. There is controversy as to whether codeine, dihydrocodeine, and hydrocodone are actually prodrugs requiring activation by the CYP450 2D6 enzyme or UGT enzymes. Oxycodone and buprenorphine, however, are clearly not prodrugs and are metabolized by the CYP450 2D6 and 3A4 enzymes, respectively. Knowledge of this metabolism assists in the understanding for the potential of drug-drug interactions with these drugs. This understanding is important so that clinicians can choose the proper dosages for analgesia and anticipate potential drug-drug interactions.

Research paper thumbnail of Clinical Manual of Drug Interactions for Medical Practice

Research paper thumbnail of Overview of Drug Interactions in Psychosomatic Medicine

Research paper thumbnail of An Overview of Psychotropic Drug-Drug Interactions

Psychosomatics, 2005

The psychotropic drug-drug interactions most likely to be relevant to psychiatrists' practices ar... more The psychotropic drug-drug interactions most likely to be relevant to psychiatrists' practices are examined. The metabolism and the enzymatic and P-glycoprotein inhibition/induction profiles of all antidepressants, antipsychotics, and mood stabilizers are described; all clinically meaningful drug-drug interactions between agents in these psychotropic classes, as well as with frequently encountered nonpsychotropic agents, are detailed; and information on the pharmacokinetic/pharmacodynamic results, mechanisms, and clinical consequences of these interactions is presented. Although the range of drug-drug interactions involving psychotropic agents is large, it is a finite and manageable subset of the much larger domain of all possible drug-drug interactions. Sophisticated computer programs will ultimately provide the best means of avoiding drug-drug interactions. Until these programs are developed, the best defense against drug-drug interactions is awareness and focused attention to this issue.

Research paper thumbnail of SRIs and Bleeding; Transporters; Metformin and Olanzapine

Research paper thumbnail of Smoking and Metabolism; Asenapine; Irreversible MAOIs

Research paper thumbnail of The Misdiagnosis of Delirium

Psychosomatics, 1997

The authors examined the ability of nonpsychiatric house staff to accurately diagnose delirium at... more The authors examined the ability of nonpsychiatric house staff to accurately diagnose delirium at the time of consultation. Of 221 consultations over a 5-year period. 46% were misdiagnosed by the house staff. House staff on the general medicine wards and the nonintensive care unit environment did significantly better than those on the surgical wards and intensive care units. Age. gender, and race of the patient did not overall influence incorrect diagnoses; however; when a misdiagnosis occurred. women were more often given a diagnosis of a depressive disorder; whereas men were more often given a "no diagnosis" label. Finally, the consultees improved over an academic year in accurately identifying women as delirious. whereas no such learning curve existed for men.

Research paper thumbnail of Psychiatric Treatment of Persons With HIV/AIDS: An HIV-Psychiatry Consensus Survey of Current Practices

Psychosomatics, 2010

Background: Only sparse evidence from controlled clinical trials is available to guide the psychi... more Background: Only sparse evidence from controlled clinical trials is available to guide the psychiatric treatment of persons with HIV/AIDS. Objective: The authors assessed and determined current treatment trends in AIDS psychiatry. Method: Members of the Organization of AIDS Psychiatry (OAP) participated in a web-based survey. Results: Of 159 members, 62 (39%) responded to the survey. Consensus emerged regarding first-line treatment for depression (escitalopram/citalopram), for psychosis and secondary mania (quetiapine), and for anxiety (clonazepam). Conclusion: Consensus statements can serve as a preliminary step toward providing some standardization of care for persons with HIV/AIDS.

Research paper thumbnail of Immunosuppressants

Research paper thumbnail of Gastrointestinal Medications

Psychosomatics, 2007

Medications to address gastrointestinal disorders are among the most commonly dispensed somatic m... more Medications to address gastrointestinal disorders are among the most commonly dispensed somatic medications. The authors examine proton pump inhibitors, H(2) blockers, 5-HT(3) receptor-antagonists, and a few other drugs that are used to address this domain of medical concerns. The metabolic pathways, interactions with the P-glycoprotein transporter, and capabilities of inhibiting or inducing metabolic enzymes are elucidated for each drug. Specific drug-drug interactions with each agent are also detailed, including both psychotropic and non-psychotropic agents. Also, the article explores how different genotypic variants for specific cytochrome P450 enzymes have an impact on the effectiveness and likelihood of drug-drug interactions relating to specific gastro-intestinal medications.

Research paper thumbnail of Clinical Guidelines for Psychiatrists for the Use of Pharmacogenetic Testing for CYP450 2D6 and CYP450 2C19

Psychosomatics, 2006

Pharmacogenetics has arrived in clinical psychiatric practice with the FDA approval of the AmpliC... more Pharmacogenetics has arrived in clinical psychiatric practice with the FDA approval of the AmpliChip CYP450 Test that genotypes for two cytochrome P450 2D6 (CYP2D6) and 2C19 (CYP2C19) genes. Other pharmacogenetic tests, including those focused on pharmacodynamic genes, are far from ready for clinical application. CYP2D6 is important for the metabolism of many antidepressants and antipsychotics, and CY2C19 is important for some antidepressant metabolism. Poor metabolizers (PMs), lacking the enzyme, account for up to 7% of Caucasians for CYP2D6 and up to 25% of East Asians for CYP2C19. Patients having three or more active CYP2D6 alleles (up to 29% in North Africa and the Middle East), are called CYP2D6 ultrarapid metabolizers (UMs). CYP2D6 phenotypes (particularly PMs) are probably important in patients taking tricyclic antidepressants (TCAs), venlafaxine, typical antipsychotics, and risperidone. The CYP2C19 PM phenotype is probably important in patients taking TCAs and perhaps citalopram, escitalopram, and sertraline. On the basis of the literature and the authors' clinical experience, the authors provide provisional recommendations for identifying and treating CYP2D6 PMs, CYP2C19 PMs, and CYP2D6 UMs. The next few years will determine whether CYP2D6 genotyping is beneficial for patients taking the new drugs aripiprazole, duloxetine, and atomoxetine. Practical recommendations for dealing with laboratories offering CYP2D6 and CYP2C29 genotyping are provided.

Research paper thumbnail of Oral Contraceptives

Research paper thumbnail of Triptans

Psychosomatics, 2002

Triptans are potent serotonin (5-HT) 1B/1D receptor agonists used to abort and treat migraine hea... more Triptans are potent serotonin (5-HT) 1B/1D receptor agonists used to abort and treat migraine headaches. Although the triptans share pharmacodynamic characteristics at 5-HT 1B/1D receptors, they differ pharmacokinetically. This coulmn reviews how the triptans are metabolized. Generally, the triptans are metabolized by phase I monoamine oxidases (MAOs) and by various cytochrome P450 enzymes. However, each triptan has a unique metabolic profile, leading to significant differences in each triptan's potential for drug-drug interactions. These differences are detailed in this review.

Research paper thumbnail of Antiretrovirals, Part II: Focus on Non-Protease Inhibitor Antiretrovirals (NRTIs, NNRTIs, and Fusion Inhibitors)

Psychosomatics, 2004

The second in a series reviewing the HIV/AIDS antiretroviral drugs. This review summarizes the no... more The second in a series reviewing the HIV/AIDS antiretroviral drugs. This review summarizes the non-protease inhibitor antiretrovirals: nucleoside and nucleotide analogue reverse transcriptase inhibitors (NRTIs), the nonnucleoside reverse transcriptase inhibitors (NNRTIs), and cell membrane fusion inhibitors. In an overview format for primary care physicians and psychiatrists, this review presents the mechanism of action, side effects, toxicities, and drug interactions of these agents.

Research paper thumbnail of Clozapine Case Series

Psychosomatics, Apr 30, 2007

Clozapine is not a drug that is ever used casually. Patients generally are afflicted with severe ... more Clozapine is not a drug that is ever used casually. Patients generally are afflicted with severe illnesses and have demonstrated treatment resistance and/or intolerance to other therapeutic options before clozapine is seriously considered. When the clinical stakes are this high, it is especially important that physicians gain an appreciation for the various drug-drug interactions that can significantly increase or decrease clozapine blood levels; such pharmacokinetic changes can derail clozapine treatment by producing clozapine toxicity or loss of antipsychotic efficacy, respectively. The authors present a case series of five drug-drug interactions involving clozapine, each of which illustrates different mechanisms by which the metabolism of clozapine can be altered. Exploring these cases should help clinicians anticipate and avoid these undesirable drugdrug interactions.

Research paper thumbnail of The Dosing of Atypical Antipsychotics

Psychosomatics, May 1, 2005

Research paper thumbnail of Interações medicamentosas: casos clínicos: o sistema do citocromo P450 e mais

Research paper thumbnail of Psychiatric treatment of persons with HIV/AIDS: an HIV-psychiatry consensus survey of current practices

Psychosomatics, Nov 1, 2010

Background: Only sparse evidence from controlled clinical trials is available to guide the psychi... more Background: Only sparse evidence from controlled clinical trials is available to guide the psychiatric treatment of persons with HIV/AIDS. Objective: The authors assessed and determined current treatment trends in AIDS psychiatry. Method: Members of the Organization of AIDS Psychiatry (OAP) participated in a web-based survey. Results: Of 159 members, 62 (39%) responded to the survey. Consensus emerged regarding first-line treatment for depression (escitalopram/citalopram), for psychosis and secondary mania (quetiapine), and for anxiety (clonazepam). Conclusion: Consensus statements can serve as a preliminary step toward providing some standardization of care for persons with HIV/AIDS.

Research paper thumbnail of Med-psych drug-drug interactions update. Antiretrovirals, part III: antiretrovirals and drugs of abuse

Psychosomatics

The third in a series reviewing the HIV/AIDS antiretroviral drugs, this report summarizes the int... more The third in a series reviewing the HIV/AIDS antiretroviral drugs, this report summarizes the interactions between antiretrovirals and common drugs of abuse. In an overview format for primary care physicians and psychiatrists, the metabolism and drug interactions in the context of antiretroviral therapy are presented for the following drugs of abuse: alcohol, benzodiazepines, cocaine, GHB (liquid X), ketamine (special K), LSD (acid), MDMA (Ecstasy), opiates, PCP (angel dust), and THC (marijuana).

Research paper thumbnail of Antihistamines

Psychosomatics

Antihistamines and their drug-drug interactions are reviewed in depth. The metabolism of "cl... more Antihistamines and their drug-drug interactions are reviewed in depth. The metabolism of "classic" or sedating antihistamines is coming to light through in vivo and in vitro studies. The polymorphic CYP 2D6 metabolic enzyme appears to be potently inhibited by many of these over-the-counter medications. The history of the discontinued "second-generation" antihistamines terfenadine and astemizole is reviewed to remind the reader why the understanding of the cytochrome P450 system became increasingly important when the cardiotoxicity of these drugs became apparent. The "third-generation" nonsedating antihistamines are also listed and compared. They have been exhaustively scrutinized for drug-drug interactions and cardiotoxicity, and they appear to have no serious drug-drug interactions at recommended doses.

Research paper thumbnail of Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II

Pharmacokinetic drug-drug interactions with codeine, dihydrocodeine, hydrocodone, oxycodone, and ... more Pharmacokinetic drug-drug interactions with codeine, dihydrocodeine, hydrocodone, oxycodone, and buprenorphine are reviewed in this column. These compounds have a very similar chemical structure to morphine. Unlike morphine, which is metabolized chiefly through conjugation reactions with uridine diphosphate glucuronosyl transferase (UGT) enzymes, these five drugs are metabolized both through oxidative reactions by the cytochrome P450 (CYP450) enzyme and conjugation by UGT enzymes. There is controversy as to whether codeine, dihydrocodeine, and hydrocodone are actually prodrugs requiring activation by the CYP450 2D6 enzyme or UGT enzymes. Oxycodone and buprenorphine, however, are clearly not prodrugs and are metabolized by the CYP450 2D6 and 3A4 enzymes, respectively. Knowledge of this metabolism assists in the understanding for the potential of drug-drug interactions with these drugs. This understanding is important so that clinicians can choose the proper dosages for analgesia and anticipate potential drug-drug interactions.

Research paper thumbnail of Clinical Manual of Drug Interactions for Medical Practice

Research paper thumbnail of Overview of Drug Interactions in Psychosomatic Medicine

Research paper thumbnail of An Overview of Psychotropic Drug-Drug Interactions

Psychosomatics, 2005

The psychotropic drug-drug interactions most likely to be relevant to psychiatrists' practices ar... more The psychotropic drug-drug interactions most likely to be relevant to psychiatrists' practices are examined. The metabolism and the enzymatic and P-glycoprotein inhibition/induction profiles of all antidepressants, antipsychotics, and mood stabilizers are described; all clinically meaningful drug-drug interactions between agents in these psychotropic classes, as well as with frequently encountered nonpsychotropic agents, are detailed; and information on the pharmacokinetic/pharmacodynamic results, mechanisms, and clinical consequences of these interactions is presented. Although the range of drug-drug interactions involving psychotropic agents is large, it is a finite and manageable subset of the much larger domain of all possible drug-drug interactions. Sophisticated computer programs will ultimately provide the best means of avoiding drug-drug interactions. Until these programs are developed, the best defense against drug-drug interactions is awareness and focused attention to this issue.

Research paper thumbnail of SRIs and Bleeding; Transporters; Metformin and Olanzapine

Research paper thumbnail of Smoking and Metabolism; Asenapine; Irreversible MAOIs

Research paper thumbnail of The Misdiagnosis of Delirium

Psychosomatics, 1997

The authors examined the ability of nonpsychiatric house staff to accurately diagnose delirium at... more The authors examined the ability of nonpsychiatric house staff to accurately diagnose delirium at the time of consultation. Of 221 consultations over a 5-year period. 46% were misdiagnosed by the house staff. House staff on the general medicine wards and the nonintensive care unit environment did significantly better than those on the surgical wards and intensive care units. Age. gender, and race of the patient did not overall influence incorrect diagnoses; however; when a misdiagnosis occurred. women were more often given a diagnosis of a depressive disorder; whereas men were more often given a "no diagnosis" label. Finally, the consultees improved over an academic year in accurately identifying women as delirious. whereas no such learning curve existed for men.

Research paper thumbnail of Psychiatric Treatment of Persons With HIV/AIDS: An HIV-Psychiatry Consensus Survey of Current Practices

Psychosomatics, 2010

Background: Only sparse evidence from controlled clinical trials is available to guide the psychi... more Background: Only sparse evidence from controlled clinical trials is available to guide the psychiatric treatment of persons with HIV/AIDS. Objective: The authors assessed and determined current treatment trends in AIDS psychiatry. Method: Members of the Organization of AIDS Psychiatry (OAP) participated in a web-based survey. Results: Of 159 members, 62 (39%) responded to the survey. Consensus emerged regarding first-line treatment for depression (escitalopram/citalopram), for psychosis and secondary mania (quetiapine), and for anxiety (clonazepam). Conclusion: Consensus statements can serve as a preliminary step toward providing some standardization of care for persons with HIV/AIDS.

Research paper thumbnail of Immunosuppressants

Research paper thumbnail of Gastrointestinal Medications

Psychosomatics, 2007

Medications to address gastrointestinal disorders are among the most commonly dispensed somatic m... more Medications to address gastrointestinal disorders are among the most commonly dispensed somatic medications. The authors examine proton pump inhibitors, H(2) blockers, 5-HT(3) receptor-antagonists, and a few other drugs that are used to address this domain of medical concerns. The metabolic pathways, interactions with the P-glycoprotein transporter, and capabilities of inhibiting or inducing metabolic enzymes are elucidated for each drug. Specific drug-drug interactions with each agent are also detailed, including both psychotropic and non-psychotropic agents. Also, the article explores how different genotypic variants for specific cytochrome P450 enzymes have an impact on the effectiveness and likelihood of drug-drug interactions relating to specific gastro-intestinal medications.

Research paper thumbnail of Clinical Guidelines for Psychiatrists for the Use of Pharmacogenetic Testing for CYP450 2D6 and CYP450 2C19

Psychosomatics, 2006

Pharmacogenetics has arrived in clinical psychiatric practice with the FDA approval of the AmpliC... more Pharmacogenetics has arrived in clinical psychiatric practice with the FDA approval of the AmpliChip CYP450 Test that genotypes for two cytochrome P450 2D6 (CYP2D6) and 2C19 (CYP2C19) genes. Other pharmacogenetic tests, including those focused on pharmacodynamic genes, are far from ready for clinical application. CYP2D6 is important for the metabolism of many antidepressants and antipsychotics, and CY2C19 is important for some antidepressant metabolism. Poor metabolizers (PMs), lacking the enzyme, account for up to 7% of Caucasians for CYP2D6 and up to 25% of East Asians for CYP2C19. Patients having three or more active CYP2D6 alleles (up to 29% in North Africa and the Middle East), are called CYP2D6 ultrarapid metabolizers (UMs). CYP2D6 phenotypes (particularly PMs) are probably important in patients taking tricyclic antidepressants (TCAs), venlafaxine, typical antipsychotics, and risperidone. The CYP2C19 PM phenotype is probably important in patients taking TCAs and perhaps citalopram, escitalopram, and sertraline. On the basis of the literature and the authors' clinical experience, the authors provide provisional recommendations for identifying and treating CYP2D6 PMs, CYP2C19 PMs, and CYP2D6 UMs. The next few years will determine whether CYP2D6 genotyping is beneficial for patients taking the new drugs aripiprazole, duloxetine, and atomoxetine. Practical recommendations for dealing with laboratories offering CYP2D6 and CYP2C29 genotyping are provided.

Research paper thumbnail of Oral Contraceptives

Research paper thumbnail of Triptans

Psychosomatics, 2002

Triptans are potent serotonin (5-HT) 1B/1D receptor agonists used to abort and treat migraine hea... more Triptans are potent serotonin (5-HT) 1B/1D receptor agonists used to abort and treat migraine headaches. Although the triptans share pharmacodynamic characteristics at 5-HT 1B/1D receptors, they differ pharmacokinetically. This coulmn reviews how the triptans are metabolized. Generally, the triptans are metabolized by phase I monoamine oxidases (MAOs) and by various cytochrome P450 enzymes. However, each triptan has a unique metabolic profile, leading to significant differences in each triptan's potential for drug-drug interactions. These differences are detailed in this review.