Skip to main content

Pharmacokinetics of tricyclic and related antidepressants

  • Chapter

Abstract

The last decade has seen growing concern over the use of medication in the elderly. Many drugs, including some antidepressants (nomifensine and zimeldine), have been introduced only to be withdrawn shortly afterwards because of side-effects. Although in the case of these antidepressants aged-related changes in pharmacokinetics were not the reason for their withdrawal, it has become clear that with increasing years the body’s ability to handle drugs declines and this has important implications both for therapeutic efficacy and for side-effects.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Abernethy, D.R., Greenblatt, D.J. and Shader, R.I. (1984) Trimipramine kinetics and absolute bioavailability: use of gas-liquid chromatography with nitrogen-phosphorus detection. Clin. Pharmacol. Ther., 35, 348–53.

    Article  PubMed  CAS  Google Scholar 

  • Abernethy, D.R. and Todd, E.L. (1986) Doxepin-cimetidine interaction: increased doxepin bioavailability during Cimetidine treatment. J. Clin. Psychopharmacol., 6, 8–12.

    Article  PubMed  CAS  Google Scholar 

  • Alexanderson, B. (1972) Pharmacokinetics of nortryptyline in man after single and multiple doses: the predictability of steady state plasma concentrations from single dose plasma level data. Eur. J. Clin. Pharmacol., 4, 82–91.

    Article  PubMed  CAS  Google Scholar 

  • Alexanderson, B. (1973) Prediction of steady state plasma levels of nortriptyline from single oral dose kinetics: a study in twins. Eur. J. Clinc. Pharmacol, 6, 44–53.

    Article  CAS  Google Scholar 

  • Altamura, A., Melorio, T., Invernizzi, G. and Gomeni, R. (1982) Influence of age on mianserin pharmacokinetics. Psychopharmacol., 78, 380–2.

    Article  CAS  Google Scholar 

  • Altamura, A.C., Melorio, T., Invernizzi, G. et al. (1983) Age-related differences in kinetics and side effects of viloxazine in man and their clinical implications. Psychopharmacol., 81, 281–5.

    Article  CAS  Google Scholar 

  • Ayesh, R., Dawling, S., Widdop, B. et al. (1988) Influence of quinidine on the pharmacokinetics of nortriptyline and desipramine in man. Br. J. Clin. Pharmacol. Soc, September 1987.

    Google Scholar 

  • Ballinger, B.R., Presly, A., Reid, A.H. and Stevenson, I.H. (1974) The effects of hypnotics on imipramine treatment. Psychopharmacologia (Berl)., 39, 267–74.

    Article  CAS  Google Scholar 

  • Bayer, A.J., Pathy, M.S.J. and Ankier, S.I. (1983) Pharmacokinetic and pharmacodynamic characteristics of trazodone in the elderly. Br. J. Clin. Pharmacol., 16, 371–6.

    Article  PubMed  CAS  Google Scholar 

  • Bertilsson, L., Braithwaite, R., Tybring, G. et al. (1979) Techniques for plasma protein binding of desmethylclomipramine. Clin. Pharmacol. Ther., 26, 265–71.

    PubMed  CAS  Google Scholar 

  • Bertilsson, L., Mellström, B. and Sjöqvist, F. (1979) Pronounced inhibition of noradrenaline uptake by 10-hydroxy metabolites of nortriptyline. Life Sci., 25, 1285–92.

    Article  PubMed  CAS  Google Scholar 

  • Bickel, M.H. (1975) Binding of chlorpromazine and Imipramine to red cells, albumin, lipoproteins and other blood components. J. Clin. Pharmacol., 27, 733–8.

    CAS  Google Scholar 

  • Bjerre, M., Gram, L.F., Kragh-Sørensen, P. et al. (1981) Dose-dependent kinetics of imipramine in elderly patients. Psychopharmacol., 75, 354–7.

    Article  CAS  Google Scholar 

  • Braithwaite, R.A., Flanagan, R.J. and Richens, A. (1975) Steady state plasma nortriptyline concentrations in epileptic patients. Br. J. Clin. Pharmacol., 2, 469–71.

    Article  PubMed  CAS  Google Scholar 

  • Braithwaite, R., Montgomery, S. and Dawling, S. (1978) Nortriptyline in depressed patients with high plasma levels (II) Clin. Pharmacol. Ther., 23, 303–8.

    PubMed  CAS  Google Scholar 

  • Braithwaite, R.A., Heard, R. and Snape, A. (1978) Plasma protein binding of maprotiline in geriatric patients — influence of alpha-1-acid glycoprotein. Br. J. Clin. Pharmacol., 6, 448–9.

    Article  Google Scholar 

  • Breyer-Pfaff, U., Gaertner, H.J., Kreuter, F. et al. (1982) Antidepressive effect and pharmacokinetics of amitriptyline with consideration of unbound drug and 10-hydroxynortriptyline plasma levels. Psychopharmacol., 76, 240–4.

    Article  CAS  Google Scholar 

  • Brøsen, K., Gram, L.F., Klysner, R. and Bech, P. (1986) Steady state levels of imipramine and its metabolites: significance of dose-dependent kinetics. Eur. J. Clin. Pharmacol., 30, 43–9.

    Article  PubMed  Google Scholar 

  • Brunswick, D.J., Amsterdam, J.D., Mendels, J. and Stern, S. (1979) Prediction of steady state imipramine and desmethylimipramine plasma concentrations from single-dose data. Clin. Pharmacol. Ther., 25, 605–10.

    PubMed  CAS  Google Scholar 

  • Carr, A.C. and Hobson, F.P. (1977) High serum concentrations of antidepressants in elderly patients. Br. Med. J., 2, 1151.

    Article  PubMed  CAS  Google Scholar 

  • Case, D.E. and Reeves, P.R. (1975) The disposition and metabolism of ICI 58,834 (viloxazine) in humans. Xenobiotica, 5, 113–29.

    Article  PubMed  CAS  Google Scholar 

  • Ciraulo, D.A., Barnhill, J. and Boxenbaum, H. (1985) Pharmacokinetic interaction of disulfiram and antidepressants. Am. J. Psychiat., 142, 1373–4.

    PubMed  CAS  Google Scholar 

  • Castleden, C.M. and George, C.F. (1979) The effect of ageing on the hepatic clearance of propranolol. Br. J. Clin. Pharmacol, 7, 49–54.

    Article  PubMed  CAS  Google Scholar 

  • Cooke, R.G., Warsh, J.J., Stancer, H.C. et al. (1984) The nonlinear kinetics of desipramine and 2-hydroxydesipramine. Clin. Pharmacol. Ther., 36, 343–9.

    Article  PubMed  CAS  Google Scholar 

  • Coppen, A. and Rama Rao, V.A. (1979) Amitriptyline and its demethylationrate. Lancet, i, 49.

    Article  Google Scholar 

  • Crampton, E.L., Glass, R.C., Marchant, B. and Rees, J.A. (1980) Chemical ionization mass fragmentographic measurement of dothiepin plasma concentrations following single oral dose in man. J. Chromatogr., 183, 141–8.

    PubMed  CAS  Google Scholar 

  • Curry, S.H. (1980) Drug Disposition and Pharmacokinetics, 3rd edn, Blackwell Scientific Publications, Oxford, pp. 99–101.

    Google Scholar 

  • Dawling, S. (1982) Monitoring of tricyclic antidepressant therapy. Clin. Chem., 15, 56–61.

    CAS  Google Scholar 

  • Dawling, S., Braithwaite, R., McAuley, R. and Montgomery, S. (1979) Single oral dose pharmacokinetics of amitriptyline and maprotiline in depressed patients — prediction of steady state plasma concentrations. Br. J. Clin. Vrac. Suppl., 7, 28–33.

    Google Scholar 

  • Dawling, S., Crome, P., Braithwaite, R.A. and Lewis, R.R. (1980) Nortriptyline therapy in elderly patients: dosage prediction after single dose pharmacokinetic study. Eur. J. Clin. Pharmacol., 18, 147–50.

    Article  PubMed  CAS  Google Scholar 

  • Dawling, S., Braithwaite, R., McAuley, R. and Montgomery, S. (1980a) Single oral dose pharmacokinetics of clomipramine in depressed patients. Postgrad. Med. J., 56 (Suppl. 1) 115–16.

    PubMed  Google Scholar 

  • Dawling, S., Crome, P. and Braithwaite, R. (1980b) Pharmacokinetics of single oral doses of nortriptyline in depressed hospital patients and young healthy volunteers. Clin. Pharmacol., 5, 394–401.

    Article  CAS  Google Scholar 

  • Dawling, S., Crome, P., Heyer, E.J. and Lewis, R.R. (1981) Nortriptyline therapy in elderly patients: dosage prediction from plasma concentration at 24 hours after a single 50 mg dose. Br. J. Psychiat., 139, 413–16.

    Article  CAS  Google Scholar 

  • Dawling, S., Lynn, K., Rosser, R. and Braithwaite, R. (1982) Nortriptyline metabolism in chronic renal failure: metabolite elimination. Clin. Pharmacol. Ther., 32, 322–9.

    Article  PubMed  CAS  Google Scholar 

  • Dawling, S., Ford, S., Rangedara, D.C. and Lewis, R.R. (1984) Amitriptyline dosage prediction in elderly patients from plasma concentrations at 24 hours after a single 100 mg dose. Clin. Pharmacokin., 9, 261–6.

    Article  CAS  Google Scholar 

  • Dawling, S., Ford, S., Ariyanayagam, P. et al. (1987) Plasma concentrations of mianserin after single dose and at steady state in depressed elderly patients. Clin. Pharmacokin., 12, 73–8.

    Article  CAS  Google Scholar 

  • de Vane, C.L., Savett, M. and Jusko, W.J. (1981) Desipramine and 2-hydroxy-desipramine pharmacokinetics in normal volunteers. Eur. J. Clin. Pharmacol, 19, 61–4.

    Article  Google Scholar 

  • Duphar Report No. H. 114.621 (1984) Duphar, Weesp.

    Google Scholar 

  • Duphar Report No. H. 114.625 (1985a) Duphar, Weesp.

    Google Scholar 

  • Duphar Report No. H.114.623 (1985b) Duphar, Weesp.

    Google Scholar 

  • Garland, W.A., Min, B.H. and Birkett, D.J. (1978) The kinetics of amitriptyline following single oral dose administration to man. Res. Commun. Chem. Pathol. Pharmacol, 22, 475–84.

    PubMed  CAS  Google Scholar 

  • Gram, L.F. (1975) Effects of perphenazine on imipramine metabolism in man. Psychopharmacol. Commun., 1, 165–7.

    PubMed  CAS  Google Scholar 

  • Gram, L.F. and Overø, R.F. (1972) Drug interaction: inhibitory effect of neuroleptics on metabolism of tricyclic antidepressants in man. Br. Med. J., 1, 463–5.

    Article  PubMed  CAS  Google Scholar 

  • Gram, L.F. and Christiansen, J. (1975) First-pass metabolism of imipramine in man. Clin. Pharmacol. Ther., 17, 555–63.

    PubMed  CAS  Google Scholar 

  • Gram, L.F., Pedersen, O.L., Kristensen, C.B. et al. (1982) Drug level monitoring in psychopharmacology: usefulness and clinical problems, with special reference to tricyclic antidepressants. Ther. Drug Monitoring, 4, 17–25.

    Article  CAS  Google Scholar 

  • Heikkila, R.E., Goldfinger, S.S. and Orlansky, H. (1976) The effect of various phenothiazines and tricyclic antidepressants on the accumulation and release of (3H) norepinephrine and (3H) 5-hydroxytryptamine in slices of rat occipital cortex. Res. Commun. Chem. Pathol. Pharmacol., 13, 237–50.

    PubMed  CAS  Google Scholar 

  • Henry, J.F., Altamura, C., Gomeni, R. et al. (1981) Pharmacokinetics of amitriptyline in the elderly. Int. J. Clin. Pharmacol. Ther. Toxicol., 19, 1–5.

    PubMed  CAS  Google Scholar 

  • Hessauer, S.A. and Hollister, L.E. (1984) Cimetidine interaction with Imipramine and nortriptyline. Clin. Pharmacol. Ther., 35, 183–7.

    Article  Google Scholar 

  • Hrdina, P.D., Rovei, V., Henry, J.F. et al. (1980) Comparison of single-dose pharmacokinetics of Imipramine and maprotiline in the elderly. Psychopharmacol., 70, 29–34.

    Article  CAS  Google Scholar 

  • Jandhyala, B.S., Steenberg, M.L., Perel, J.M. et al. (1977) Effects of several tricyclic antidepressants on the haemodynamics and myocardial contractibility. Eur. J. Pharmcol., 42, 403–10.

    Article  CAS  Google Scholar 

  • John, V.A., Luscombé, D.K. and Kemp, H. (1980) Effects of age, cigarette smoking and the oral contraceptive on the pharmacokinetics of clomipramine and its desmethyl metabolite during chronic dosing. J. Int. Med. Res., 8 (Suppl. 3) 88–95.

    PubMed  Google Scholar 

  • Jones, R.B. and Luscombe, D.K. (1976) Single-dose study with maprotiline in normal subjects. In: Depression — the Biochemical and Physiological Role of Ludiomil (ed. A. Jukes) Metropolis Press Ltd., London, pp. 135–43.

    Google Scholar 

  • Joyce, P.R. and Sharman, J.R. (1985) Doxepin plasma concentrations in clinical practice. Could there be a pharmacokinetic explanation for low concentrations? Clin. Pharmacokinetics, 10, 365–70.

    Article  CAS  Google Scholar 

  • Jungkunz, G. and Kus, H.J. (1980) On the relationship of nortriptyline: amitriptyline ratio to clinical improvement of amitriptyline treated depressive patients. Pharmacopsychiat., 13, 111–16.

    Article  CAS  Google Scholar 

  • Kitanaka, I., Ross, R.J., Cutler, N.R. et al. (1982) Altered hydroxydesipramine concentrations in elderly depressed patients. Clin. Pharmacol. Ther., 31, 51–5.

    Article  PubMed  CAS  Google Scholar 

  • Kragh-Sørensen, P. and Larsen, N.E. (1980) Factors influencing nortriptyline steady state kinetics: plasma and saliva levels. Clin. Pharmacol. Ther., 28, 769–803.

    Article  Google Scholar 

  • Lieberman, J.A., Suckow, R.F., Borenstein, M. and Kane, J.M. (1985) Tricyclic antidepressants and metabolite levels in chronic renal failure. Clin. Pharmacol. Ther., 37, 301–7.

    Article  PubMed  CAS  Google Scholar 

  • Linnoila, M., Seppala, T., Mattila, M.J. et al.(1980) Clomipramine and doxepin in depressive neurosis: plasma levels and therapeutic response. Arch. Gen. Psyhiat., 37, 1295–9.

    Article  CAS  Google Scholar 

  • Linnoila, M., Insel, T., Kilts, C. et al. (1982) Plasma steady state concentrations of hydroxylated metabolites of clomipramine. Clin. Pharmacol. Ther., 32, 208–11.

    Article  PubMed  CAS  Google Scholar 

  • Lynn, K., Braithwaite, R., Dawling, S. and Rosser, R. (1981) Comparison of serum protein binding of maprotiline and phenytoin in uraemic patients on haemodialysis. Eur. J. Clin. Pharmacol., 19, 73–7.

    Article  PubMed  CAS  Google Scholar 

  • Madakasira, S. and Khazanie, P.G. (1985) Reliability of amitriptyline dose prediction based on single-dose plasma levels. Clin. Pharmacol. Ther., 37, 145–9.

    Article  PubMed  CAS  Google Scholar 

  • Maguire, K., Norman, T.R., Burrows, G.D. and Scoggins, B.A. (1980) An evaluation of maprotiline: intravenous kinetics and comparison of two oral doses. Eur. J. Clin. Pharmacol., 18, 249–54.

    Article  PubMed  CAS  Google Scholar 

  • Maguire, K.P., Burrows, G.D., Norman, T.R. and Scoggins, B.A. (1981) Metabolism and pharmacokinetics of dothiepin. Br. J. Clin. Pharmacol., 12, 405–9.

    Article  PubMed  CAS  Google Scholar 

  • Maguire, K.P., McIntyre, I., Norman, T. and Burrows, G.D. (1983) The pharmacokinetics of mianserin in elderly depressed patients. Psychiatry Research, 8, 281–7.

    Article  PubMed  CAS  Google Scholar 

  • Mellström, B. and Tybring, G. (1977) Ion-pair liquid chromatography of steady state plasma levels of chlorimipramine and desmethyl-chlorimipramine. J. Chromatogr., 143, 597–605.

    PubMed  Google Scholar 

  • Miller, D.D., Sawyer, J.B. and Duffy, J.P. (1983) Cimetidine effect on steady state serum nortriptyline concentrations. Drug. Intell. Clin. Pharm., 17, 904–5.

    PubMed  CAS  Google Scholar 

  • Miller, L.G., Greenblatt, D.J., Friedman, H. et al. (1987) Trazodone kinetics in old age. Clin. Pharm. Ther., 41, 210.

    Google Scholar 

  • Montgomery, S., McAuley, R., Montgomery, D.B., Dawling, S. and Braithwaite, R.A. (1980) Plasma concentration of clomipramine and desmethylclomi-pramine and clinical response in depressed patients. Postgrad. Med. J., 56 (Suppl. 1) 130–3.

    PubMed  Google Scholar 

  • Moody, J.P., Whyte, S.F., MacDonald, A.J. and Naylor, G.J. (1977) Pharmacokinetic aspects of protriptyline plasma levels. Eur. J. Clin. Pharmacol, 11, 51–6.

    Article  PubMed  CAS  Google Scholar 

  • Nelson, J.C. and Jatlow, P.I. (1987) Nonlinear desipramine kinetics: prevalence and importance. Clin. Pharmacol. Ther., 41, 666–70.

    Article  PubMed  CAS  Google Scholar 

  • Nelson, J.C., Jatlow, P., Quinlan, D.M. and Bowers, M.B. (1982) Desipramine plasma concentration and antidepressant response. Arch. Gen. Psychiat., 39, 1419–22.

    Article  PubMed  CAS  Google Scholar 

  • Nelson, J.C., Jatlow, P.I. and Mazure, C. (1987) Rapid desipramine dose adjustment using 24-hour levels. J. Clin. Psychopharmacol., 7, 72–7.

    PubMed  CAS  Google Scholar 

  • Nies, A., Robinson, D., Friedman, M.J. et al. (1977) Relationship between age and tricyclic antidepressant plasma levels. Am. J. Psychiat., 134, 790–3.

    PubMed  CAS  Google Scholar 

  • Perry, P.J., Browne, J.L., Alexander, B.A. et al. (1984) Two prospective dosing methods for nortriptyline. Clin. Pharmacokinet., 9, 555–63.

    Article  PubMed  CAS  Google Scholar 

  • Perucca, E. and Richens, A. (1977) Interactions between phenytoin and Imipramine. Br. J. Clin. Pharmacol., 4, 485–6.

    Article  PubMed  CAS  Google Scholar 

  • Piafsky, K.M. and Borgå, O. (1977) Plasma protein binding of basic drugs. Clin. Pharmacol. Ther., 22, 545–9.

    PubMed  CAS  Google Scholar 

  • Potter, W.Z., Calil, H.M., Manian, A.A. et al (1979) Hydroxylated metabolites of tricyclic antidepressants: preclinical assessment of activity. Biol. Psychiat., 14, 601–13.

    PubMed  CAS  Google Scholar 

  • Potter, W.Z., Zavadil, A.P., Kopin, I.J. and Goodwin, F.K. (1980) Single-dose kinetics predict steady state concentrations of imipramine and desipramine. Arch. Gen. Psychiat., 37, 314–20.

    Article  PubMed  CAS  Google Scholar 

  • Rawlins, M.D., James, O.F.W., Williams, F.M. et al. (1987) Age and the metabolism of drugs. Q. J. Med., 64, 545–7.

    PubMed  CAS  Google Scholar 

  • Reidenberg, M.M. (1977) The binding of drugs to plasma proteins and the interpretation of measurements of plasma concentrations of drugs in patients with poor renal function. Am. J. Med., 62, 466–70.

    Article  PubMed  CAS  Google Scholar 

  • Roy, D. and Dawling, S. (1987) Application of an individually predicted dosage of amitriptyline to the treatment of depression. Int. J. Clin. Psychopharmacol., 2, 307–16.

    Article  CAS  Google Scholar 

  • Schulz, P., Turner-Tamiyasu, K., Smith, G. et al. (1983) Amitriptyline disposition in young and elderly normal men. Clin. Pharmacol. Ther., 33, 360–6.

    Article  PubMed  CAS  Google Scholar 

  • Shami, M., Elliott, H.L., Kelman, A.W., and Whiting, B. (1983) The pharmacokinetics of mianserin. Br. J. Clin. Pharmacol., 15, 313S–322S.

    Article  CAS  Google Scholar 

  • Spina, E. and Yoike, Y. (1986) Differential effects of Cimetidine and randitidine on imipramine demethylation and desmethylimipramine hydroxylation by human liver microsomes. Eur. J. Clin. Pharmacol, 30, 239–42.

    Article  PubMed  CAS  Google Scholar 

  • Swift, C.G. and Triggs, E.J. (1987) Clinical pharmacokinetics in the elderly. In: Clinical Pharmacology in the Elderly (ed. C.G. Swift), Marcel Dekker, New York and Basel, pp. 31–82.

    Google Scholar 

  • Tollefson, G. and Lesar, T. (1984) Effect of propanolol on maprotilineclearance. Am. J. Psychiat., 141, 148–9.

    PubMed  CAS  Google Scholar 

  • Turbott, J., Norman, T.R., Burrows, G.D. and Maguire, K.P. (1980) Pharmacokinetics of nortriptyline in elderly volunteers. Commun. Psychopharmacol, 4, 225–31.

    PubMed  CAS  Google Scholar 

  • Young, R.C., Alexopoulos, G.S., Shamoian, C.A. et al. (1984) Plasma 10-hydroxynortriptyline in elderly depressed patients. Clin. Pharmacol Ther., 35, 540–4.

    Article  PubMed  CAS  Google Scholar 

  • Young, R.C., Alexopoulos, G.S., Shamoian, C.A., Kent, E., Dhar, A.K. and Kutt, H. (1985) Plasma 10-hydroxynortriptyline and ECG changes in elderly depressed patients. Am. J. Psychiat., 142, 866–8.

    PubMed  CAS  Google Scholar 

  • Yu, D.K., Dimmitt, D.C., Lanman, R.C. and Giesing, D.H. (1986) Pharmacokinetics of dothiepin in humans: a single dose-proportionality study. J. Pharm. Sci., 75, 582–5.

    Article  PubMed  CAS  Google Scholar 

  • Ziegler, V.E., Biggs, J.T., Wylie, L.T. et al. (1978a) Protriptyline kinetics. Clin. Pharmacol. Ther., 23, 580–4.

    PubMed  CAS  Google Scholar 

  • Ziegler, V.E., Biggs, J.T., Wylie, L.T. et al. (1978b) Doxepin kinetics. Clin. Pharmacol. Ther., 23, 573–9.

    PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1989 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Crome, P., Dawling, S. (1989). Pharmacokinetics of tricyclic and related antidepressants. In: Ghose, K. (eds) Antidepressants for Elderly People. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3436-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-3436-9_8

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-412-32460-4

  • Online ISBN: 978-1-4899-3436-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics