Stereochemistry in Drug Action

The importance of stereochemistry in drug action is gaining greater attention in medical practice, and a basic knowledge of the subject will be necessary for clinicians to make informed decisions regarding the use of single-enantiomer drugs. Many of the drugs currently used in psychiatric practice are mixtures of enantiomers. For some therapeutics, single-enantiomer formulations can provide greater selectivities for their biological targets, improved therapeutic indices, and/or better pharmacokinetics than a mixture of enantiomers. This article reviews the nomenclature for describing stereochemistry and enantiomers, emphasizes the potential biological and pharmacologic differences between the 2 enantiomers of a drug, and highlights the clinical experience with single enantiomers of the selective serotonin reuptake inhibitors fluoxetine and citalopram. In some cases, both a mixture of enantiomers and a single-enantiomer formulation of a drug will be available simultaneously. In these cases, familiarity with stereochemistry and its pharmacologic implications will aid the practicing physician to provide optimal pharmacotherapy to his or her patients.