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Published on: April 26, 2012
Toxicokinetics of nortriptyline and amitriptyline: two case reports
E J F Franssen1, P W A Kunst, P M Bet
1Department of Pharmacy, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands. EJF.Franssen@vumc.nl
Severe overdoses of tricyclic antidepressants (TCAs) like nortriptyline and amitriptyline show stereoselective metabolite profiles. Prompt supportive care can lead to survival despite poor prognostic markers in TCA toxicity.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Chemistry
Background:
- Tricyclic antidepressants (TCAs) like nortriptyline (NT) and amitriptyline (AT) are commonly prescribed but can be dangerous in overdose.
- Understanding the toxicokinetics and toxicodynamics of TCAs and their metabolites is crucial for managing overdose cases.
Observation:
- Two cases of intentional overdose with NT and AT are presented, with peak plasma concentrations of 2290 µg/L and 2900 µg/L, respectively.
- Distinct profiles of active metabolites, E-10-hydroxynortriptyline (EHNT) and Z-10-hydroxynortriptyline (ZHNT), were observed over 5–10 days post-ingestion.
Findings:
- Metabolite formation and elimination of NT and AT after overdose are stereoselective.
- Nortriptyline (NT) and its metabolite EHNT exhibit different toxicokinetics and toxicodynamics.
- Severe TCA overdose can be survived with rapid, appropriate supportive care, even with poor prognostic indicators.
Implications:
- These findings highlight the importance of considering stereoselectivity in TCA metabolism and toxicity.
- Clinical management of TCA overdose should incorporate monitoring of active metabolites.
- Aggressive supportive care remains paramount in improving outcomes for patients with severe TCA poisoning.
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