Clinical Drug Investigation

, Volume 32, Issue 8, pp 539–545 | Cite as

Therapeutic Drug Monitoring of Antidepressants in Haemodialysis Patients

  • Stefan Unterecker
  • Philip Müller
  • Christian Jacob
  • Peter Riederer
  • Bruno Pfuhlmann
Short Communication
First Online:
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Abstract

Background and Objective: The co-morbidity of depressive disorder and chronic kidney failure is remarkably common. However, knowledge about the influence of haemodialysis on the serum concentration of antidepressants is sparse. In this study we examined the influence of haemodialysis on the serum concentrations of the antidepressants amitriptyline (and its active metabolite nortriptyline) and mirtazapine.

Methods: The authors retrospectively evaluated therapeutic drug monitoring (TDM)-analyses obtained in eight different regional medical dialysis centres before and after haemodialysis and compared serum concentrations of amitriptyline and mirtazapine using t-tests.

Results: Mean serum concentrations of the sum of amitriptyline+nortriptyline (before: 75.52 ng/mL; after: 59.35 ng/mL; p < 0.001) and mirtazapine (before: 53.45 ng/mL; after: 38.31 ng/mL; p < 0.036) decreased significantly with haemodialysis. Haemodialysis patients received rather low doses of amitriptyline (mean 36.5mg; SD 17.6; range 10–75mg) and mirtazapine (mean 24.7mg; SD 9.1; range 15–45mg).

Conclusion: For haemodialysis patients with depression an adequate antidepressant drug dosage must be administered. TDM is necessary in order to optimize antidepressant therapy in patients with chronic kidney disease.

Keywords

Chronic Kidney Disease Serum Concentration Amitriptyline Haemodialysis Patient Therapeutic Drug Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

Acknowledgements

We gratefully acknowledge the participating haemodialysis centres in Würzburg, Ochsenfurt, Kitzingen, Lohr, Aschaffenburg, Marktheidenfeld, Schweinfurt and Wertheim as well as Rainer Burger and the staff of the TDM laboratory of the Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg.

The authors have no conflicts of interest. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Stefan Unterecker
    • 1
  • Philip Müller
    • 2
  • Christian Jacob
    • 1
  • Peter Riederer
    • 1
  • Bruno Pfuhlmann
    • 1
  1. 1.Department of Psychiatry, Psychosomatics and PsychotherapyUniversity Hospital of WürzburgWürz burgGermany
  2. 2.Department of DermatologyUniversity Hospital of WürzburgWürzburgGermany

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