Vandel S, Vandel B, Sandoz M, Allers G, Bechtel P, Volmat R
Eur J Clin Pharmacol. 1978 Nov 27;14(3):185-90. doi: 10.1007/BF02089958.
Plasma levels of amitriptyline and nortriptyline were measured twice weekly in 62 patients treated for three weeks with i.m. amitriptyline 120 mg/day. In half the patients the ratio of amitriptyline to nortriptyline was under 1 and in the other half it was greater than 1. 30 of these 62 patients were clinically monitored with the Hamilton Rating Scale and the side effects of the drug were recorded. There was no correlation between plasma level of the drug and its side effects, but there was a statistically significant curvilinear correlation between the plasma levels of amitriptyline plus nortriptyline and nortriptyline alone, and the clinical effect. The practical value of this type of investigation was demonstrated by showing that patients whose drug plasma level was not in the therapeutic range, were clinically improved after adjustment of the dose. The plasma level of amitriptyline plus nortriptyline must lie between 60 to 220 ng/ml, and that of nortriptyline between 60 to 140 ng/ml, to obtain the best clinical effect. Associated treatments, age, weight and sex of patients, and the type of depression did not appear significantly to affect the plasma level of the drug.
对62例接受为期三周的每日120毫克肌内注射阿米替林治疗的患者，每周两次测量其血浆中阿米替林和去甲替林的浓度。在一半患者中，阿米替林与去甲替林的比例低于1，另一半患者则高于1。对这62例患者中的30例使用汉密尔顿评定量表进行临床监测，并记录药物的副作用。药物血浆浓度与其副作用之间没有相关性，但阿米替林加去甲替林的血浆浓度与单独去甲替林的血浆浓度和临床疗效之间存在统计学上显著的曲线相关性。通过显示药物血浆浓度不在治疗范围内的患者在调整剂量后临床症状得到改善，证明了这类研究的实用价值。为获得最佳临床疗效，阿米替林加去甲替林的血浆浓度必须介于60至220纳克/毫升之间，去甲替林的血浆浓度必须介于60至140纳克/毫升之间。相关治疗、患者的年龄、体重和性别以及抑郁症类型似乎对药物的血浆浓度没有显著影响。
