Hollister L E
JAMA. 1979 Jun 8;241(23):2530-3.
Plasma concentrations of tricyclic antidepressants were monitored during treatment of 126 patients. Noncompliance in taking medication was suspected in 19 patients because of unusually low plasma concentrations in relation to the presumed dose. Determinations of plasma concentrations may also be useful for detecting inadequate treatment as judged by levels below the presumed therapeutic range. Attempts to correlate plasma concentrations with clinical response to amitriptyline hydrochloride and nortriptyline hydrochloride failed, probably because of the heterogeneity of depressive syndromes being treated. Plasma concentrations were correlated highly with dose in the case of amitriptyline, less so in the case of other drugs. Amitriptyline and imipramine hydrochloride generally produced plasma concentrations of the parent drug and metabolite higher in nanograms per milliliter than was the daily dose in milligrams; nortriptyline and desipramine hydrochloride did the opposite.
在对126名患者的治疗过程中监测了三环类抗抑郁药的血浆浓度。19名患者因相对于假定剂量而言血浆浓度异常低而被怀疑未遵医嘱服药。根据低于假定治疗范围的水平判断，血浆浓度测定对于检测治疗不足也可能有用。试图将血浆浓度与对盐酸阿米替林和盐酸去甲替林的临床反应相关联的尝试失败了，这可能是因为所治疗的抑郁综合征具有异质性。在阿米替林的情况下，血浆浓度与剂量高度相关，而在其他药物的情况下相关性较小。盐酸阿米替林和盐酸丙咪嗪通常产生的母体药物和代谢物的血浆浓度以每毫升纳克计高于每日剂量以毫克计；盐酸去甲替林和盐酸地昔帕明则相反。
