Therapeutic drug monitoring of tricyclic antidepressants in everyday clinical practice

Pfuhlmann, Bruno; Gerlach, Manfred; Burger, R.; Gonska, S; Unterecker, Stefan; Jabs, B.; Riederer, Peter; Deckert, Jürgen

doi:10.1007/978-3-211-73574-9_35

Cited by 22 publications

(8 citation statements)

References 13 publications

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“…It is further known that pharmacokinetic results may differ between naturalistic settings and controlled clinical settings [127]. In many naturalistic and therapeutic drug monitor studies, patient compliance may be a possible caveat: patients do not necessarily receive the prescribed dose and thus human behavior increases data variability.…”

Section: Resultsmentioning

confidence: 99%

Sex differences in pharmacokinetics of antidepressants

Kokras

Dalla

Papadopoulou-Daifoti

2010

Expert Opinion on Drug Metabolism & Toxicology

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Although the available pharmacokinetic evidence indicates that women should receive lower doses of antidepressants and men should receive higher doses, current guidelines do not recommend dose adjustment, because these sex differences are considered to be clinically insignificant. Unless we understand the link between pharmacokinetics and pharmacodynamics of antidepressants, it will be difficult to determine whether sex differences are of clinical importance or not. Thus, further systematic and particularly focused research is needed on sex differences in pharmacokinetics.

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Section: Resultsmentioning

confidence: 99%

Sex differences in pharmacokinetics of antidepressants

Kokras

Dalla

Papadopoulou-Daifoti

2010

Expert Opinion on Drug Metabolism & Toxicology

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“…While associations between plasma levels and clinical response have been demonstrated for TCAs, in particular imipramine and nortriptyline (Pfuhlmann et al, 2007;Ulrich & Lauter, 2002), similar dose-response relationships have rarely been observed for SSRIs (Rasmussen & Brosen, 2000). This fundamental difference between TCAs and SSRIs suggests that women may respond differently to either class of antidepressant.…”

Section: Plasma Levels Of Antidepressantsmentioning

confidence: 88%

Gender differences in antidepressant drug response

Keers

Aitchison

2010

International Review of Psychiatry

157

103

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Epidemiological studies suggest there are considerable differences in the prevalence and presentation of depression in men and women. Women are more than twice as likely to be diagnosed with depression and may also report more atypical and anxiety symptoms than men. Men and women also differ in the metabolism and distribution of antidepressants and the presence of oestrogen in women of childbearing age may interfere with the mechanism of action of a number of antidepressants. These differences have led many researchers to question whether antidepressants are equally effective and tolerated in men and women. While some reports suggest that selective serotonin re-uptake inhibitors (SSRIs) are more effective and result in fewer adverse drug reactions in women than tricyclic antidepressants (TCAs), gender differences in antidepressant response remains a controversial topic. The potential effects of antidepressant exposure in utero and in breast milk further complicate treatment options for antenatal and postnatal depression. While some research suggests the SSRI paroxetine is teratogenic, further carefully designed naturalistic studies are required to fully evaluate these effects. Finally, response to antidepressants and the occurrence of adverse drug reactions is marked by inter-individual variability which may be in part due to genetic differences. Future studies should therefore consider genotypes of the mother, foetus and infant in antidepressant response.

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“…[7][8][9][10][11][12][13][14][15][16][17] Therapeutic ranges have been established for some major psychotropic drug classes, including mood stabilizers (eg, lithium), 7,9 tricyclic antidepressants (TCAs), and "atypical" antipsychotics (eg, clozapine). 18,19 For the selective serotonin reuptake inhibitors (SSRI), therapeutic concentration ranges have been demonstrated, 20 but toxicity is generally not a major concern because these drugs have a wide therapeutic index. 11 On the basis of these findings, therapeutic drug monitoring has been shown to be clinically useful for a number of TCAs.…”

Section: Introductionmentioning

confidence: 99%