Evaluation of risk factors for elevated tricyclic antidepressant plasma concentrations

Pharmacoepidemiology and Drug Safety
Sarah J BillupsDaniel Dugan

Abstract

To quantify the effect of clinical and demographic factors on the risk of elevated and toxic tricyclic antidepressant (TCA) plasma concentrations (Cp) and to describe the rates of elevated and toxic TCA Cp. This matched, case-control study was conducted among adult patients enrolled in a group model HMO who had a TCA Cp laboratory measurement and purchased at least one TCA prescription for either amitriptyline or nortriptyline during the 70 days preceding the TCA Cp measurement. Predictive models of experiencing an elevated or toxic Cp were created using multivariate conditional logistic regression. At least one Cp was drawn in 1057 unique patients with a TCA purchase. Of these, 18.4% (194/1057) patients (cases) had an elevated TCA Cp and were matched to 716 non-elevated Cp patients. Additionally, 27.3% (53/194) of the cases (matched to 196 controls) experienced a toxic TCA Cp. The best fitting model of an elevated TCA Cp included TCA dose category (daily doses >or=150 mg, OR = 4.08; doses of 50 to <100 mg, OR = 0.36; and doses <50 mg, OR = 0.18, p < 0.05 for all comparisons), female gender (OR = 1.78, p < 0.05) and concurrent use of fluoxetine or paroxetine (OR = 1.75, p < 0.05). The best fitting predictive model of a toxic TC...Continue Reading

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Citations

Dec 21, 2012·Journal of Neural Transmission·S UntereckerB Pfuhlmann
May 2, 2014·Journal of Analytical Toxicology·Kelley RameyCandis M Morello
Aug 23, 2011·European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences·Jakob JornilKristian Linnet
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Jul 26, 2017·Der Nervenarzt·M Hahn, S C Roll
Jul 13, 2019·Current Opinion in Pharmacology·Yasmin SchmidSimon M Mueller

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