Leinonen E, Lillsunde P, Laukkanen V, Ylitalo P
Harjamäki Hospital, Siilinjärvi, Finland.
J Clin Psychopharmacol. 1991 Oct;11(5):313-8.
The combination of carbamazepine and an antidepressant (doxepin, amitriptyline, mianserin) was given to 22 psychiatric inpatients with 29 measurements of their serum antidepressant concentrations. For comparison, sex-, age-, and dose-matched inpatients, treated with the antidepressant but not with carbamazepine, were selected as controls (N = 29). All the patients were treated with their routine daily dose for at least 7 days before the gas-chromatographic measurement of serum predose concentrations of the antidepressants. In patients with carbamazepine, serum doxepin and doxepin + nordoxepin concentrations (N = 17) were decreased significantly (p less than 0.05), on average to 46% and 45%, respectively, as compared to that in subjects without carbamazepine. Also in carbamazepine + amitriptyline patients, serum nortriptyline and amitriptyline + nortriptyline concentrations (N = 8) were significantly lower than in those not receiving carbamazepine (p less than 0.05). The mean serum antidepressant levels were decreased to 42% and 40%, respectively. The serum mianserin concentration of carbamazepine patients (N = 4) was reduced to 30% of that in patients not treated with carbamazepine (p less than 0.01). The percentage fractions of demethylated metabolites (nordoxepin, nortriptyline) from the total antidepressant levels were not influenced by carbamazepine. In patients treated with carbamazepine, serum total antidepressant concentrations remained more often below the suggested therapeutic ranges than in those patients without carbamazepine. The results suggest that serum antidepressant concentrations are reduced by concurrent carbamazepine therapy, and that the concentrations should be carefully monitored when carbamazepine is added to the antidepressant regimen.
对22名精神科住院患者联合使用卡马西平和一种抗抑郁药（多塞平、阿米替林、米安色林），并对其血清抗抑郁药浓度进行了29次测量。作为对照，选择性别、年龄和剂量匹配但仅接受抗抑郁药治疗而未使用卡马西平的住院患者（N = 29）。在通过气相色谱法测量抗抑郁药血清给药前浓度之前，所有患者均按常规日剂量治疗至少7天。在使用卡马西平的患者中，血清多塞平和多塞平+去甲多塞平浓度（N = 17）显著降低（p < 0.05），与未使用卡马西平的受试者相比，平均分别降至46%和45%。在卡马西平+阿米替林患者中，血清去甲替林和阿米替林+去甲替林浓度（N = 8）也显著低于未接受卡马西平治疗的患者（p < 0.05）。平均血清抗抑郁药水平分别降至42%和40%。使用卡马西平的患者（N = 4）血清米安色林浓度降至未使用卡马西平患者的30%（p < 0.01）。卡马西平对去甲基代谢产物（去甲多塞平、去甲替林）占总抗抑郁药水平的百分比没有影响。与未使用卡马西平的患者相比，使用卡马西平治疗的患者血清总抗抑郁药浓度更常低于建议治疗范围。结果表明，联合使用卡马西平治疗会降低血清抗抑郁药浓度，当在抗抑郁治疗方案中添加卡马西平时，应仔细监测其浓度。
