Amitai Y, Erickson T, Kennedy E J, Leikin J B, Hryhorczuk D O, Noble J, Hanashiro P K, Frischer H
Department of Pharmacology, Rush-Presbyterian St. Luke's Medical Center, Rush University, Chicago, IL 60612.
Clin Pharmacol Ther. 1993 Aug;54(2):219-27. doi: 10.1038/clpt.1993.133.
Tricyclic antidepressant levels in red blood cells and plasma in acute overdose and their association with cardiotoxicity were studied.
This was a prospective study in 15 patients with acute tricyclic antidepressant overdose. Tricyclic antidepressant parent compounds and metabolites were measured in red blood cells and plasma, and tricyclic antidepressant levels were correlated with ECG indexes of toxicity.
Plasma levels of the parent compounds were higher than their red blood cell levels on admission (mean +/- SD, 691 +/- 409 and 337 +/- 220 ng/ml, respectively). Admission metabolite levels were higher in red blood cells than in plasma (264 +/- 180 and 190 +/- 164 ng/ml, respectively). QRS duration and the red blood cell levels of the metabolites were significantly correlated at the time of admission (r = 0.77, p < 0.01), as well as at 6 to 10 hours (r = 0.74, p < 0.01).
In acute overdose, a shift of tricyclic antidepressants from plasma to red blood cells and increased levels of red blood cell metabolites reflect tissue redistribution of the drug. Tricyclic antidepressant red blood cell metabolites are the best markers for impaired intraventricular conduction.
研究急性过量服用三环类抗抑郁药时红细胞和血浆中的药物水平及其与心脏毒性的关系。
这是一项针对15例急性过量服用三环类抗抑郁药患者的前瞻性研究。测定红细胞和血浆中三环类抗抑郁药母体化合物及其代谢产物，并将三环类抗抑郁药水平与毒性心电图指标进行关联分析。
入院时母体化合物的血浆水平高于红细胞水平（分别为平均±标准差，691±409和337±220 ng/ml）。入院时红细胞中的代谢产物水平高于血浆（分别为264±180和190±164 ng/ml）。入院时QRS波时限与红细胞代谢产物水平显著相关（r = 0.77，p < 0.01），在6至10小时时也显著相关（r = 0.74，p < 0.01）。
在急性过量服用时，三环类抗抑郁药从血浆向红细胞转移以及红细胞代谢产物水平升高反映了药物的组织再分布。三环类抗抑郁药红细胞代谢产物是心室内传导受损的最佳标志物。
