The authors present a clinical approach for predicting and using plasma
concentrations of tricyclic antidepressants in the treatment of depressed
patients. They review the pharmacokinetics of this group of drugs and their
side effects and toxicity. There is a suggested therapeutic range for
plasma concentrations of imipramine, amitriptyline, and nortriptyline; more
definitive studies are needed to determine the necessary plasma levels for
achieving clinical response with the other tricyclic antidepressants
(desmethylimipramine, protriptyline, doxepin, clomipramine, impiramine
N-oxide, and butriptyline). A more thorough knowledge of the clinical
pharmacokinetics of tricyclic antidepressants should lead to more rational
use of these drugs, with a higher response rate and fewer adverse
reactions.
Abstract Teaser