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Possible influence of carbamazepine on plasma imipramine concentrations in children with attention deficit

C S Brown1, B G Wells, J A Cold

  • 1Department of Clinical Pharmacy, University of Tennessee, Memphis 38163.

Journal of Clinical Psychopharmacology
|October 1, 1990
PubMed

Insights

Carbamazepine significantly lowers imipramine levels in children with ADHD, even at higher doses. This suggests increased imipramine dosage may be needed, and abrupt withdrawal could cause toxicity.

Area of Science:

  • Pharmacology
  • Child Psychiatry
  • Neuroscience

Background:

  • Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder.
  • Imipramine is a tricyclic antidepressant used to treat ADHD.
  • Carbamazepine is an anticonvulsant and mood-stabilizing drug.

Purpose of the Study:

  • To investigate the effect of carbamazepine on plasma concentrations of imipramine and its metabolite, desipramine.
  • To evaluate the impact of combined carbamazepine and imipramine therapy in children with ADHD.

Main Methods:

  • Retrospective study of 36 children with ADHD.
  • Comparison between a group receiving imipramine alone and a group receiving combined carbamazepine and imipramine.
  • Analysis of plasma imipramine, desipramine, and total tricyclic antidepressant levels.

Main Results:

  • The combined treatment group received higher imipramine dosages.
  • Despite higher doses, the combined group showed significantly lower plasma levels of imipramine, desipramine, and total tricyclic antidepressants.
  • This interaction between carbamazepine and imipramine has not been previously reported.

Conclusions:

  • Carbamazepine coadministration may necessitate increased imipramine dosages for therapeutic efficacy in children with ADHD.
  • Abrupt withdrawal of carbamazepine in patients on combined therapy could lead to imipramine toxicity due to increased plasma levels.
  • Further rigorous studies are required to confirm these findings and guide clinical practice.

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