PMID: 8946674Dec 1, 1996Paper

Thioridazine interferences with imipramine metabolism and measurement

Therapeutic Drug Monitoring
G L Maynard, P Soni

Abstract

A case is presented in which toxic concentrations of imipramine (Tofranil) resulted from the co-administration of low-dose thioridazine (Mellaril). This probably occurred in an individual with genetically reduced capacity for oxidative drug metabolism, specifically via thioridazine's interference with the hepatic cytochrome P450IID6 isoenzyme (CYP2D6). In addition, coelution of thioridazine and its metabolites resulted in false elevations of imipramine and desipramine as measured by a common high-performance liquid chromatography (HPLC) method (cyanopropyl column). In contrast, an enzyme immunoassay (Abbott TDxFLx) and a second reference HPLC method (silica column) accurately resolved the analytes. This combination of psychiatric drugs is not uncommon in the pediatric population and is one of which both clinicians and laboratorians need to be aware. To the author's knowledge, this is the first report of interferences of thioridazine with both the metabolism and measurement of imipramine in a pediatric patient.

References

Jan 1, 1991·European Journal of Clinical Pharmacology·E SpinaJ Benitez
Jan 1, 1995·International Journal of Law and Psychiatry·F J Porporino, L L Motiuk
May 1, 1993·Electrophoresis·W BeckH Engelhardt

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Citations

Dec 10, 1999·Journal of Clinical Psychopharmacology·J A CarrilloJ Benítez
Nov 11, 2003·Clinical Pharmacokinetics·David R P Guay
Sep 8, 2005·Psychosomatics·Neil B SandsonKelly L Cozza
Apr 19, 2003·European Journal of Clinical Pharmacology·Roland BereczAdrián LLerena
Aug 15, 2000·Therapeutic Drug Monitoring·A LlerenaJ Benítez
Feb 13, 2001·British Journal of Clinical Pharmacology·J G ShinD A Flockhart

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