Bebchuk J M, Stewart D E
St. Michael's Hospital, Toronto, Canada.
Int J Psychiatry Med. 1991;21(2):183-7. doi: 10.2190/KBVT-M0K5-8FPD-439H.
This case illustrates a pharmacokinetic interaction between the tricyclic antidepressant, nortriptyline, and the antituberculosis drug, rifampin. Higher than expected doses of nortriptyline were required to obtain a therapeutic drug level while the patient was receiving rifampin. Following the discontinuation of rifampin, the patient became drowsy and the serum nortriptyline levels rose precipitously into the toxic range. The authors suggest that patients receiving rifampin and nortriptyline, (or other psychotropic drugs) be monitored closely and that similar drug interactions be anticipated.
该病例说明了三环类抗抑郁药去甲替林与抗结核药利福平之间的药代动力学相互作用。在患者接受利福平治疗期间，需要高于预期剂量的去甲替林才能达到治疗药物水平。停用利福平后，患者出现嗜睡，血清去甲替林水平急剧上升至中毒范围。作者建议，对接受利福平和去甲替林（或其他精神药物）治疗的患者进行密切监测，并预期会出现类似的药物相互作用。
