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Serum Concentrations of Antidepressant Drugs in a Naturalistic Setting: Compilation Based on a Large Therapeutic Drug Monitoring Database
Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-6041-0744
St Olaf Hospital, Norway.
St Olaf Hospital, Norway.
Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
2009 (English)In: THERAPEUTIC DRUG MONITORING, ISSN 0163-4356, Vol. 31, no 1, 42-56 p.Article in journal (Refereed) Published
Abstract [en]

A compilation of therapeutic drug monitoring data for 15 antidepressant drugs in a naturalistic routine clinical setting is presented. A substantial number of serum concentrations, at different daily doses, are outlined, and the intraindividual and overall serum concentration coefficient of variation for a respective substance is presented. Also, concentration comparisons between women and men, and patients older or younger than 65 years are made. The drugs included are amitriptyline (n = 394), citalopram (n = 5457), clomipramine (n = 400), escitalopram (n = 3066), fluoxetine (n = 793), fluvoxamine (n = 165), mianserin (n = 1063), mirtazapine (n = 1427), moclobemide (n = 200), nortriptyline (n = 206), paroxetine (n = 1677), reboxetine (n = 85), sertraline (n = 2998), trimipramine (n = 158), and venlafaxine (n = 1781). Of the 9 drugs exhibiting linear (first order) kinetics, all but reboxetine gave a significant negative dose-to-dose-normalized correlation with concentrations, that is an increased clearance with higher dose. When dose was correlated to the metabolite: parent substance ratio for drugs exhibiting linear kinetics, citalopram and mianserin gave a positive slope, contrary to a negative slope shown for sertraline and venlafaxine. The intraindividual variations of the serum concentrations were lower than the overall variations, and the intraindividual variation of the metabolite: parent substance ratio was lower than the intraindividual variation of respective parent substance (except clomipramine and mianserin). Women had significantly higher serum concentrations than men (significant for citalopram, escitalopram, mianserin, mirtazapine, and venlafaxine), and patients older than 65 years had higher serum concentrations than the younger ones for all drugs except amitriptyline, moclobemide, and trimipramine. By presenting a comprehensive compilation of therapeutic drug monitoring data for each drug, a reference toot is created, in addition to improved pharmacokinetic knowledge of antidepressant drugs.

Place, publisher, year, edition, pages
2009. Vol. 31, no 1, 42-56 p.
Keyword [en]
antidepressant drugs, SSRI, serotonin-noradrenaline reuptake inhibitor, TCA, TDM
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16828OAI: oai:DiVA.org:liu-16828DiVA: diva2:174355
Available from: 2009-02-20 Created: 2009-02-20 Last updated: 2013-10-28

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Reis, MargaretaAhlner, Johan

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