Nortriptyline Plasma Levels and Subjective Side Effects*

1978 ◽  
Vol 132 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Vincent E. Ziegler ◽  
John R. Taylor ◽  
Richard D. Wetzel ◽  
John T. Biggs
Keyword(s):  
Side Effects ◽  
Plasma Level ◽  
Plasma Levels ◽  
Tricyclic Antidepressants ◽  
Dry Mouth ◽  
Severity Of Depression ◽  
The Common ◽  
Pre Treatment ◽  
The Individual ◽  
Subjective Side

Nortriptyline plasma levels and the incidence and severity of the common subjective side effects of the tricyclic antidepressants were determined in 26 patients during six weeks of treatment with nortriptyline. The total corrected (treatment minus pre-treatment) score of the eight side effects most independent of the severity of depression correlated (0 · 60) with the nortriptyline plasma level. Increased perspiration (o · 59) and dry mouth (o · 54) were the individual corrected side effects which most consistently correlated with the plasma level. These subjective side effects may serve as clinically useful guides to dosage adjustments during treatment, though their value is limited by the magnitude of the correlations and the need to correct for their presence prior to treatment.

scholarly journals High doses of carbamazepine for refractory partial epilepsy

1996 ◽  
Vol 54 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Cristiana Borges Pereira ◽  
Carlos Otto Heise ◽  
Arthur Cukiert
Keyword(s):  
Side Effects ◽  
Plasma Level ◽  
Plasma Levels ◽  
Partial Epilepsy ◽  
The Other ◽  
Partial Seizures ◽  
High Doses ◽  
Higher Doses ◽  
Refractory Partial Epilepsy

Forty-eight patients with partial seizures were analysed during treatment with 1200 mg/d or more of carbamazepine (CBZ). Thirty-three were on monotherapy and fifteen on polytherapy. The other drugs were kept unchanged in the patients on polytherapy. The dose of CBZ was increased if no control was observed and the patient had no side effects. The doses used ranged between 1200 and 1900 mg/day (1200 mg/day, n=18; 1300mg/day, n=1; 1400 mg/day, n=7; 1600 mg/day, n=9; 1700 mg/day, n=4; 1800 mg/day, n=8; 1900 mg/day, n=1). Anticonvulsant plasma levels were taken to confirm patient compliance. The average plasma level was 9.6 ug/mL. The period of follow up varied from 3 to 96 months (M=25.6). Seizure's control was observed in 7 (14.48%) patients taking 1200 mg/day and in 2 (4.16%) patients taking 1400 mg/day of CBZ. Thirty-nine patients did not show any control (81.21%). Ten patients (20.81%) had signs of intoxication. When patients have no improvement with 1400 mg/day, it is difficult to obtain any control despite the use of higher doses of CBZ, which frequently expose the patient to significant side effects.

Ecg Changes in Pure Imipramine Overdose as Function of Plasma Level*

1978 ◽  
Vol 23 (8) ◽  
pp. 573-577 ◽  
Author(s):  
K. Reed ◽  
H.R. Mckim
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Plasma Level ◽  
Plasma Levels ◽  
Tricyclic Antidepressants ◽  
Lethal Effect ◽  
Acute Management ◽  
Relative Toxicity ◽  
Ecg Changes ◽  
Therapeutic Doses

ECG changes occur with therapeutic doses of tricyclic antidepressants and cardiovascular conduction alteration is the lethal effect in overdoses on these drugs. These ECG changes depend on the plasma level and metabolism of the particular antidepressant. Information about the relative toxicity and metabolism characteristics can be obtained by studying overdoses if the attempt simply involves one tricyclic and no other drug ingestion. Such a case report involving a known quantity of imipramine is presented. The early toxic signs leading to cardiac arrest and the recovery from coma are discussed. The ECG along with corresponding plasma levels of imipramine and its metabolite desmethylimipramine are given as a function of time after ingestion. The relative toxicity of these metabolites and the use of anticholinesterase in the acute management is considered.

Monitoring of tricyclic antidepressant plasma levels and clinical response: a review of the literature. Part I.

1989 ◽  
Vol 4 (1) ◽  
pp. 43-60 ◽  
Author(s):  
I.R. De Oliveira ◽  
P.A.S. Do Prado-Lima ◽  
B. Samuel-Lajeunesse
Keyword(s):  
Plasma Concentration ◽  
Plasma Level ◽  
Clinical Response ◽  
Plasma Levels ◽  
Tricyclic Antidepressants ◽  
Tricyclic Antidepressant ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Plasma Level Monitoring ◽  
Level Monitoring

SummaryPart I of this paper presents a comprehensive review of plasma level monitoring of tricyclic antidepressants (TCAs) and their relationship to clinical response to antidepressant therapy. Imipramine, nortriptyline, amitriptyline, clomipramine and desipramine are the most widely studied TCAs in this regard. Typical therapeutic plasma concentration ranges are suggested for some of these agents, although a consensus is lacking.

Large Variations of Plasma Levels During Maintenance Treatment with Depot Neuroleptics

1996 ◽  
Vol 169 (5) ◽  
pp. 618-621 ◽  
Author(s):  
Eva Tuninger ◽  
Sten Levander
Keyword(s):  
Side Effects ◽  
Plasma Level ◽  
Plasma Levels ◽  
Clinical Effect ◽  
Clinical Symptoms ◽  
Repeated Measurements ◽  
Neuroleptic Treatment ◽  
Neuroleptic Medication ◽  
Depot Neuroleptics ◽  
Depot Neuroleptic

BackgroundStability of neuroleptic medication has been associated with optimal clinical effect and minimal side-effects. Depot administration is assumed to yield better stability.MethodThirty patients on depot neuroleptic treatment were followed during three years with repeated measurements of plasma level and concurrent ratings of clinical symptoms and side-effects.ResultsOf 120 blood samples 35 (29%) measurements were outside ± 2 s.d. measurement error (expected 5%). Perphenazine levels were more variable (46%) than haloperidol (25%) and flupenthixol (12.5%). No relationship was found between side-effect ratings and fluctuations of plasma levels.ConclusionDepot neuroleptic medication does not eliminate a clinically unwanted and sometimes marked variation in plasma level.

Plasma Concentrations of Protriptyline and Clinical Effects in Depressed Women

1976 ◽  
Vol 128 (4) ◽  
pp. 384-390 ◽  
Author(s):  
S. F. Whyte ◽  
A. J. Macdonald ◽  
G. J. Naylor ◽  
J. P. Moody
Keyword(s):  
Side Effects ◽  
Plasma Levels ◽  
Side Effect ◽  
Plasma Concentrations ◽  
Clinical Effects ◽  
Drug Plasma ◽  
Pre Treatment ◽  
Positive Correlations ◽  
Drug Plasma Levels ◽  
The Relationship

SummaryWe studied the relationship between side effects, clinical outcome and the drug plasma levels in 28 female depressed patients treated with protriptyline. After 3½ weeks treatment, patients with plasma levels within a median range (630 to 900 nmol/1) showed better responses to the drug than patients with plasma levels outside this range.There were no statistically significant correlations between plasma levels and side effect scores or ‘corrected’ side effect scores (scores after subtracting pre-treatment values) for the group at any time after starting the treatment. But we found positive correlations between plasma levels and ‘corrected’ side effect scores for the neurotic subgroup after 14 and 21 days of treatment. Other correlations between plasma levels and side effect scores were non-significant.

scholarly journals Interest of Fluvoxamine as an Add-On to Clozapine in Children With Severe Psychiatric Disorder According to CYP Polymorphisms: Experience From a Case Series

2021 ◽  
Vol 12 ◽  
Author(s):  
Camille Berel ◽  
Ulysse Mossé ◽  
Julien Wils ◽  
Lauriane Cousin ◽  
Laurent Imbert ◽  
...  
Keyword(s):  
Side Effects ◽  
Plasma Level ◽  
Psychiatric Disorder ◽  
Drug Interactions ◽  
Psychiatric Disorders ◽  
Plasma Levels ◽  
Case Series ◽  
A Minor ◽  
Enzymatic Inhibitor ◽  
Cyp Inhibitors

Despite its drastic efficacy in resistant psychiatric disorders, clozapine remains rarely used in youth due to its side effects. Clozapine plasma level is determined through its metabolism involving several isoforms of cytochromes 450 (CYP450) family. Isoform CYP1A2 appears as a limiting enzyme involved in the metabolism of clozapine, while isoforms 2C19, 2D6, 3A4, and 3A5 also contribute in a minor way. Clozapine efficacy is limited by a significant inter-patient variability in exposure according to CYP's polymorphisms. Clozapine plasma levels may be increased with CYP inhibitors such as fluvoxamine. This drug is a potent enzymatic inhibitor of CYP1A2 and, to a lesser extent, of CYP3A4 and CYP2D6. Hence, in case of CYP's polymorphisms in youth, the use of fluvoxamine as add-on to clozapine could help in reaching clinical and biological efficacy and allowing lower clozapine dosage and a better tolerance profile as it has already been described in adults. We report four pediatric cases with severe psychiatric disorders underlying our experience with CYP polymorphism explorations and the use of fluvoxamine as add-on to clozapine. Our four patients clinically improved after the introduction of fluvoxamine, enhancing clozapine metabolism and therefore the clozapine plasma level within therapeutic range. Despite the interesting results of fluvoxamine, we report a severe issue of tolerance for one patient, emphasizing the need for caution regarding possible drug interactions when fluvoxamine is considered. Hence, we propose a detailed step-by-step multidisciplinary protocol.

Rapamycin Has Biological Activity in a Subset of Patients with Myelodysplastic Syndrome - Results of a Phase I/II Trial.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1449-1449
Author(s):  
Uwe Platzbecker ◽  
Michael Haase ◽  
Regina Herbst ◽  
Anette Hanel ◽  
Karsten Voigtmann ◽  
...  
Keyword(s):  
Biological Activity ◽  
Side Effects ◽  
Plasma Level ◽  
Myelodysplastic Syndrome ◽  
Phase I ◽  
Plasma Levels ◽  
Immune Surveillance ◽  
Therapeutic Benefit ◽  
Significant Difference ◽  
Median Plasma

Abstract The pathophysiology of myelodysplastic syndrome (MDS) involves disturbed regulation of angiogenesis, apoptosis, proliferation and differentiation as well as immune surveillance. There is increasing evidence that rapamycin (sirolimus) might affect these pathways positively thus possibly being of therapeutic benefit in patients with this disease. These data prompted us to perform a phase I/II study to evaluate the safety and efficacy of rapamycin in the treatment of patients with MDS. Nineteen patients (median age 72 years) diagnosed with MDS according to the WHO classification received rapamycin orally with a target blood concentration of 3–12 ng/ml. Rapamycin was administered for a median of 3.7 months (range 0.3–11). Three patients (1 x RAEB-2, 1 x RAEB-1, 1 x RCMD) showed either a major (1 x platelet, 1 x neutrophil) or a minor (1 x erythroid, 2 x platelet) hematological response according to the IWG criteria. There was no statistically significant difference in the rapamycin plasma levels between the three responders (median plasma level 3.62, range 1.63–4.39) and non-responders (median plasma level 4.22, range 2.81–7.4). Major side effects were hyperlipidemia (n=4), stomatitis (n=3), thrombocytopenia (n=2) and urinary tract infection (n=1). Study medication had to be stopped due to side effects in five patients (26 %), one of them being a responder to rapamycin. Plasma levels of rapamycin were not elevated in patients experiencing toxicity. Taken together these data demonstrate that rapamycin might have biological activity in patients with rather advanced MDS. New and possibly less toxic analogues of rapamycin are currently developed. They could be candidates for future trials in patients with MDS.

The Red Neuronal Pigment in the Nervous System of the Mussel, Mytilus Edulis: Localization and Its Effect on Lateral Ciliary Activity with Spectral and Analytical Changes

1981 ◽  
Vol 39 ◽  
pp. 494-495
Author(s):  
Anthony A. Paparo ◽  
Judith A. Murphy
Keyword(s):  
Nervous System ◽  
Mytilus Edulis ◽  
Neuronal Cell ◽  
Ciliary Activity ◽  
Neuronal Cell Bodies ◽  
The Central Nervous System ◽  
Intracellular Organelles ◽  
The Common ◽  
The Individual ◽  
Cryostat Sections

The purpose of this study was to localize the red neuronal pigment in Mytilus edulis and examine its role in the control of lateral ciliary activity in the gill. The visceral ganglia (Vg) in the central nervous system show an over al red pigmentation. Most red pigments examined in squash preps and cryostat sec tions were localized in the neuronal cell bodies and proximal axon regions. Unstained cryostat sections showed highly localized patches of this pigment scattered throughout the cells in the form of dense granular masses about 5-7 um in diameter, with the individual granules ranging from 0.6-1.3 um in diame ter. Tissue stained with Gomori's method for Fe showed bright blue granular masses of about the same size and structure as previously seen in unstained cryostat sections.Thick section microanalysis (Fig.l) confirmed both the localization and presence of Fe in the nerve cell. These nerve cells of the Vg share with other pigmented photosensitive cells the common cytostructural feature of localization of absorbing molecules in intracellular organelles where they are tightly ordered in fine substructures.

Side Effects of Chemotherapy and Cancer Treatment in Tertiary Care Teaching Hospital

2016 ◽  
Vol 2 (1) ◽  
pp. 62-78
Author(s):  
. Hemraj ◽  
Raj Kumar ◽  
Sourabh Kosey ◽  
Amit Sharma ◽  
Nalini Negi
Keyword(s):  
Side Effects ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Informational Needs ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Medical College ◽  
Related Information ◽  
The Common ◽  
Chemotherapy Patients

To determine the most common physical side effects experienced by local chemotherapy patients. Their perceptions of these side effects and informational needs from clinical pharmacists were also evaluated. This was a single center, observational cross-sectional study conducted at department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. A face to face interview was conducted. Information collected included chemotherapy related side effects after last chemotherapy experience, the most worrisome side effects, overlooked by healthcare professionals and the preferred method, amount and source of receiving related information. In this study, hundred patients were enrolled out of them 48 were male and 52 were female. When differential calculations was done, common side effects or adverse effects of chemotherapy in the patients of breast, lung cancer, Ovarian Cancer, Colon cancer, Prostate cancer, Lymphoma Cancer, Cervix cancer where there is much irregular medicine intake 57.4% may be due to common problem of joint pain reported by all the patients under study, with the consecutive problem of nausea and vomiting. The high prevalence of chemotherapy related side effects among local patients is a major concern and findings of their perceptions and informational needs may serve as a valuable guide for clinical pharmacists and physicians to help in side effect management. This study shows the common problems reported by the patients when they are suffering from cancer condition, according to their incidence perceptions as experienced by the patient, this will allow the physician and clinical pharmacist to effectively counsel and manage the common symptoms as reported prior to its occurrence in the patient, so that withdrawal can be checked.

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