Skip to main content
Log in

Pharmacokinetics of desmethylimipramine and nortriptyline in man after single and multiple oral doses — A cross-over study

  • Originals
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

Eight healthy volunteers received single oral doses (1 mg/kg) and 6 received multiple doses (0.4 mg/kg t.i.d. for 2 weeks) of desmethylimipramine (DMI) and nortriptyline (NT) on different occasions. Kinetic analysis of plasma levels of the drugs showed that the ratios between single-dose peak-levels, plasma half-lives and apparent mean “steady-state” plasma levels of the two drugs were constant in all the subjects, and averaged 0.6. Despite their closely related chemical structures the apparent plasma clearance rate of DMI was about twice that of NT, and this might be associated with their different degrees of binding to plasma proteins. — The “steady-state” plasma level of NT in man is known to be genetically determined, and the conformity within each individual of the plasma clearance rates of DMI and NT indicates that the plasma kinetics of both these drugs are controlled by common genetic factors. — The study also shows that the “steady-state” plasma level of DMI, like that of NT, can be predicted accurately from single-dose plasma-level data. Thus, if the kinetic characteristics of one of these drugs in a subject are known, it is possible to predict the plasma kinetics of the other compound.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Alexanderson, B.: Pharmacokinetics of nortriptyline in man after single and multiple oral doses: The predictability of steady-state plasma concentrations from single-dose plasma-level data. Europ. J. clin. Pharmacol.4, 82–91 (1972).

    Google Scholar 

  2. Alexanderson, B., Bertilsson, L., Borgå, O., Sjöqvist, F.: Studies on the metabolism and the pharmacokinetics of nortriptyline and desmethylimipramine in man. Chem.-Biol. Interactions3, 235–236 (1971).

    Google Scholar 

  3. Alexanderson, B., Evans, D.A.P., Sjöqvist, F.: Steady-state plasma levels of nortriptyline in twins: Influence of genetic factors and drug therapy. Brit. med. J.1969 IV, 764–768.

    Google Scholar 

  4. Alexanderson, B., Sjöqvist, F.: Individual differences in the pharmacokinetics of monomethylated tricyclic antidepressants: Role of genetic and environmental factors and clinical importance. Ann. N.Y. Acad. Sci.179, 739–751 (1971).

    Google Scholar 

  5. Amundson, M.E., Manthey, J.A.: Excretion of nortriptyline hydrochloride in man I. Detection and determination of urinary nortriptyline. J. Pharmacol. Sci.55, 277–280 (1966).

    Google Scholar 

  6. Bernhard, K., Beer, H.: Aktivitäten der Expirationskohlensäure, des ZNS und anderer Organe nach Gaben von14C-signiertem N-(γ-Dimethyl-aminopropyl)-iminodibenzyl (Psychopharmakon Tofranil) an Ratten und Hunde. Helv. Physiol. Acta20, 114–121 (1961).

    Google Scholar 

  7. Bickel, M.H., Brochon, R., Friolet, B., Herrman, B., Stofer, A.R.: Clinical and biochemical results of a fatal case of desipramine intoxication. Psychopharmacology10, 431–436 (1967).

    Google Scholar 

  8. Bickel, M.H., Minder, R.: Metabolism and biliary excretion of the lipophilic drug molecules, imipramine and desmethylimipramine in the rat — I. Experimentsin vivo and with isolated perfused livers. Biochem. Pharmacol.19, 2425–2435 (1970).

    Google Scholar 

  9. Borgå, O., Azarnoff, D.L., Plym Forshell, G., Sjöqvist, F.: Plasma protein binding of tricyclic antidepressants in man. Biochem. Pharmacol.18, 1251–1260 (1969).

    Google Scholar 

  10. Borgå, O., Palmér, L., Linnarsson, A., Holmstedt, B.: Quantitative determination of nortriptyline and desmethyl-imipramine in human plasma by combined gas chromatography-mass spectrometry. Anal. Letters4, 837–849 (1971).

    Google Scholar 

  11. Braithwaite, R.A., Widdop, B.: A specific gas-chromatographic method for the measurement of “steady-state” plasma levels of amitriptyline and nortriptyline in patients Clin. Chim. Acta35, 461–472 (1971).

    Google Scholar 

  12. Cavalieri, R.R., Searle, G.L.: The kinetics of distribution between plasma and liver of131I-labeled L-thyroxine in man: Observations of subjects with normal and decreased serum thyroxine-binding globulin. J. clin. Invest.6, 939–949 (1966).

    Google Scholar 

  13. Crammer, J.L., Scott, B.: New metabolites of imipramine. Psychopharmacologia (Berl.)8, 461–468 (1966).

    Google Scholar 

  14. Crammer, J.L., Scott, B., Rolfe, B.: Metabolism of14C-imipramine: II. Urinary metabolites in man. Psychopharmacologia (Berl.)15, 207–225 (1969).

    Google Scholar 

  15. Cucinell, S., Perl, W.: Application of clearance and volume of distribution to the plateau principle of drugs. J. Pharm. Sci.59, 1423–1427 (1970).

    Google Scholar 

  16. Davies, D.S., Thorgeirsson, S.S.: Individual differences in the plasma half-lives of lipid soluble drugs in man. In symposium on “Biological and pharmaceutical aspects of pharmacokinetics and therapeutics”. Acta Pharmacol. Toxicol.29, Suppl. 3, pp. 181–190 (1971).

    Google Scholar 

  17. De Leenheer, A., Heyndrickx, A.: Identification of a major metabolite of nortriptyline in human urine. J. Pharm. Sci.60, 1403–1405 (1971).

    Google Scholar 

  18. Eschenhof, E., Rieder, J.: Untersuchungen über das Schicksal des Antidepressivums Amitriptylin im Organismus der Ratte und des Menschen. Arzneimittel-Forsch.19, 957–966 (1969).

    Google Scholar 

  19. Gibaldi, M., Nagashima, R., Levy, G.: Relationship between drug concentration in plasma or serum and amount of drug in the body. J. Pharm. Sci.58, 193–197 (1969).

    Google Scholar 

  20. Gibaldi, M., Boyes, R.N., Feldman, S.: Influence of first-pass effect on availability of drugs on oral administration. J. Pharm. Sci.60, 1338–1340 (1971).

    Google Scholar 

  21. Gillette, J.R.: Mechanisms of oxidation by enzymes in the endoplasmatic reticulum. FEBS Symposium16, 109–124 (1969).

    Google Scholar 

  22. Gram, L.F., Fredricson Overø, K.: Drug interaction: Inhibitory effect of neuroleptics on metabolism of tricyclic antidepressants in man. Brit. med. J.1972 I, 463–465.

    Google Scholar 

  23. Hammar, C.-G., Alexanderson, B., Holmstedt, B., Sjöqvist, F.: Gas chromatography — mass spectrometry of nortriptyline in body fluids of man. Clin. Pharmacol. Therap.12, 496–505 (1971).

    Google Scholar 

  24. Hammer, W.M., Brodie, B.B.: Application of isotope derivative technique to assay of secondary amines: Estimation of desipramine by acetylation with H3-acetic anhydride. J. Pharmacol. exp. Ther.157, 503–508 (1967).

    Google Scholar 

  25. Hammer, W., Ideström, C.-M., Sjöqvist, F.: Chemical control of antidepressant drug therapy. In: Garattini, S., Dukes, M.N.G. (eds.), Proc. First Internat. Symp. Antidepressant Drugs, Milan, Italy, 1966, Excerpta Med. Internat. Congr. Ser. No. 122, 301–310 (1966).

  26. Hammer, W., Mårtens, S., Sjöqvist, F.: A comparative study of the metabolism of desmethylimipramine, nortriptyline and oxyphenylbutazone in man. Clin. Pharmacol. Therap.10, 44–49 (1969).

    Google Scholar 

  27. Hammer, W., Sjöqvist, F.: Plasma levels of monomethylated tricyclic antidepressants during treatment with imipraminelike compounds. Life Sci.6, 1895–1903 (1967).

    Google Scholar 

  28. Haydu, G.G., Dhrymiotis, A., Quinn, G.P.: Plasma imipramine level in syndromes of depression. Amer. J. Psychiat.119, 574–575 (1962).

    Google Scholar 

  29. Herrmann, B.: Quantitative Methoden zur Untersuchung des Stoffwechsels von Tofranil. Helv. Physiol. Acta21, 402–408 (1963).

    Google Scholar 

  30. Herrman, B., Pulver, R.: Der Stoffwechsel des Psychopharmakons Tofranil. Arch. int. pharmacodyn.126, 454–469 (1960).

    Google Scholar 

  31. Herrman, B., Schindler, W., Pulver, R.: Papierchromatographischer Nachweis von Stoffwechselprodukten des Tofranil. Med. exp.1, 381–385 (1959).

    Google Scholar 

  32. Ingbahr, H.S.: Clinical and physiological observations in a patient with an idiopathic decrease in thyroxine-binding globulin of plasma. J. clin. Invest.40, 2053–2063 (1961).

    Google Scholar 

  33. Kalow, W.: The influence of genetic factors in drug action. In the Symposium on the Physiological Equivalence of Drug Dosage Forms by the Food and Drug Directorate in Ottowa, Canada, June 26–27, 1969. Queen's Printer for Canada, Ottowa, Cat, No. 444–2969, pp. 44–47 (1970).

  34. McMahon, R.E., Marshall, F.J., Culp, H.W., Miller, W.M.: The metabolism of nortriptyline-N-methyl-14C in rats. Biochem. Pharmacol.12, 1207–1217 (1963).

    Google Scholar 

  35. Maxwell, C., Seldrup, J.: Factors relating to the optimum effect of imipramine in the treatment of enuresis. Arzneimittel-Forsch.21, 1352–1356 (1971).

    Google Scholar 

  36. Meyer, M.C., Guttman, D.E.: The binding of drugs by plasma proteins. J. Pharm. Sci.57, 895–918 (1968).

    Google Scholar 

  37. Moody, J.P., Tait, A.C., Todrick, A.: Plasma levels of imipramine and desmethylimipramine during therapy. Brit. J. Psychiat.113, 183–193 (1967).

    Google Scholar 

  38. Perel, J.M., Black, N., Warthon, R.N., Malitz, S.: Inhibition of imipramine by methylphenidate. Fed. Proc.28, 418 (1969).

    Google Scholar 

  39. Schildkraut, J.J., Kety, S.S.: Biogenic amines and emotion. Science156, 21–30 (1967).

    Google Scholar 

  40. Schneider, G., Schneider, G.: Über den Ort der Metabolisierung des Imipramin im Organismus der Ratte. Arzneimittel-Forsch.20, 1708–1711 (1970).

    Google Scholar 

  41. Sjöqvist, F., Berglund, F., Borgå, O., Hammer, W., Anderson, S., Thorstrand, C.: The pH-dependent excretion of monomethylated tricyclic antidepressants in the dog and in man. Clin. Pharmacol. Therap.10, 826–833 (1969).

    Google Scholar 

  42. Sjöqvist, F., Hammer, W., Borgå, O., Azarnoff, D.L.: Pharmacological significance of the plasma level of monomethylated tricyclic antidepressants. Proc. Coll. Internat. Neuro-psychopharmacol. Tarragona, Spain, April 1968. Excerpta Med. Internat. Congr. Ser. No.180, 128–136 (1969).

  43. Sjöqvist, F., Hammer, W., Ideström, C.-M., Lind, M., Tuck, D., Åsberg, M.: Plasma levels of monomethylated tricyclic antidepressants and side-effects in man. Proc. Eur. Soc. Study Drug Toxicity, Paris 1967, Excerpta Med. Internat. Congr. Ser. No.145, 246–257 (1968).

  44. Snedecor, G.W., Cochran, W.G.: Statistical Methods, 6th ed., Ames, The Iowa State University Press, p. 285 (1967).

    Google Scholar 

  45. Vesell, E.S., Passanati, G.T., Greene, F.E., Page, J.G.: Genetical control of drug levels and of the induction of drug-metabolizing enzymes in man: Individual variability in the extent of allopurinol and nortriptyline inhibition of drug metabolism. Ann. N.Y. Acad. Sci.179, 752–773 (1971).

    Google Scholar 

  46. Vessman, J.., Alexanderson, B., Sjöqvist, F., Strindberg, B., Sundwall, A.: Comparative pharmacokinetics of oxazepam and nortriptyline after single oral doses in man. In Symposium on Benzodiazepines, Millan, Italy, 1970 (in press).

  47. von Bahr, C., Borgå, O.: Uptake, metabolism and excretion of desmethylimipramine and its metabolites in the isolated perfused rat liver. Acta Pharmacol. Toxicol.29, 359–374 (1971).

    Google Scholar 

  48. Wagner, J.G., Northam, J.I., Alway, C.D., Carpenter, O.S.: Blood levels of drug at equilibrium state after multiple dosing. Nature (Lond.)207, 1301–1302 (1965).

    Google Scholar 

  49. Yates, C.M., Todrick, A., Tait, A.C.: Aspects of the clinical chemistry of desmethylimipramine in man. J. Pharm. Pharmacol.15, 432–439 (1963).

    Google Scholar 

  50. Zeidenberg, P., Perel, J.M., Kanzler, M., Warthon, R.N., Malitz, S.: Clinical and metabolic studies with imipramine in man. Amer. J. Psychiat.127, 1321–1326 (1971).

    Google Scholar 

  51. Åsberg, M., Cronholm, B., Sjöqvist, F., Tuck, D.: The correlation of subjective side-effects with plasma concentrations of nortriptyline. Brit. med. J.1970 IV, 18–21.

    Google Scholar 

  52. Åsberg, M., Cronholm, B., Sjöqvist, F., Tuck, D.: Relationship between plasma level and therapeutic effect of nortriptyline. Brit. med. J.1971 III, 331–334.

    Google Scholar 

  53. Åsberg, M., Evans, D.A.P., Sjöqvist, F.: Genetic control of nortriptyline kinetics in man: A study of the relatives of propositi with high plasma concentration. J. med. Genetics8, 129–135 (1971).

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Licentiate in Medicine, Research Assistant in Clinical Pharmacology.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alexanderson, B. Pharmacokinetics of desmethylimipramine and nortriptyline in man after single and multiple oral doses — A cross-over study. Eur J Clin Pharmacol 5, 1–10 (1972). https://doi.org/10.1007/BF00560888

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00560888

Key words

Navigation