抑郁症患者中阿米替林及其代谢产物去甲替林的临床反应和血浆浓度

Clinical response and plasma concentrations of amitriptyline and its metabolite-nortriptyline in depressive patients.

作者信息

Miljković B, Pokrajac M, Timotijević I, Varagić V

机构信息

Department of Pharmacokinetics, Faculty of Pharmacy, University of Belgrade, Yugoslavia.

出版信息

Eur J Drug Metab Pharmacokinet. 1996 Jul-Sep;21(3):251-5. doi: 10.1007/BF03189722.

DOI:10.1007/BF03189722

PMID:8980924

Abstract

Although many attempts have been made, to date no convincing evidence exists of a relationship between plasma concentrations of amitriptyline (AT), its active metabolite nortriptyline (NT) and clinical response. Fifteen patients with primary depression (according to DSM-IV) were divided in two groups according to given doses: (I) 6 patients received 3 x 50 mg of AT daily; and (II) 9 patients received 3 x 25 mg of AT daily, for 6 weeks. The clinical status was determined with Hamilton Depression Rating Scale. Both investigated doses were therapeutically effective. AT and NT plasma concentrations were assayed by high performance liquid chromatography. Following administration of 3 x 50 mg of AT daily, the correlation of concentrations of AT, NT, total AT + NT and clinical response were rAT = -0.702 (P < 0.1), rNT = -0.761 (P < 0.1), rAT + NT = -0.741 (P < 0.1). The linear and very high correlation were also present with concentrations of AT, NT, total AT + NT and clinical response in depressive patients on 3 x 25 mg AT daily: rAT = -0.785 (P < 0.02), rNT = -0.811 (P < 0.01), rAT + NT = -0.848 (P < 0.01). Our results support a high correlation between AT/NT plasma concentrations and clinical response indicating that therapeutic monitoring of AT and its metabolite, NT, can provide eventual clinical response.

摘要

尽管已经进行了许多尝试，但迄今为止，尚无令人信服的证据表明阿米替林（AT）及其活性代谢产物去甲替林（NT）的血浆浓度与临床反应之间存在关联。根据给药剂量将15例原发性抑郁症患者（根据《精神疾病诊断与统计手册》第四版）分为两组：（I）6例患者每天接受3×50mg的AT；（II）9例患者每天接受3×25mg的AT，持续6周。用汉密尔顿抑郁量表确定临床状态。两种研究剂量均具有治疗效果。通过高效液相色谱法测定AT和NT的血浆浓度。每天给予3×50mg的AT后，AT、NT、总AT+NT浓度与临床反应的相关性分别为rAT = -0.702（P < 0.1），rNT = -0.761（P < 0.1），rAT + NT = -0.741（P < 0.1）。对于每天接受3×25mg AT的抑郁症患者，AT、NT、总AT+NT浓度与临床反应之间也存在线性且高度的相关性：rAT = -0.785（P < 0.02），rNT = -0.811（P < 0.01），rAT + NT = -0.848（P < 0.01）。我们的结果支持AT/NT血浆浓度与临床反应之间存在高度相关性，这表明对AT及其代谢产物NT进行治疗监测可以预测最终的临床反应。