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Rapid desipramine dose adjustment using 24-hour levels.

J C Nelson, P I Jatlow, C Mazure

Journal of Clinical Psychopharmacology

|April 1, 1987

Summary

This study shows that predicting antidepressant dosage using 24-hour plasma levels is effective. Rapid dose adjustments based on these levels help achieve therapeutic tricyclic antidepressant concentrations faster.

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Area of Science:

Pharmacokinetics and Therapeutic Drug Monitoring
Psychopharmacology and Antidepressant Treatment

Background:

Previous research suggests a correlation between 24-hour post-dose plasma tricyclic levels and steady-state concentrations.
Prospective testing of using 24-hour levels for predicting optimal antidepressant dosage has been limited.

Purpose of the Study:

To prospectively evaluate a strategy for predicting antidepressant dosage based on 24-hour plasma levels.
To assess patient tolerance for rapid dose adjustments guided by this predictive method.

Main Methods:

Established the relationship between 24-hour and steady-state plasma desipramine levels in 16 inpatients on a fixed dose.
Applied this regression equation to 26 depressed inpatients, using their 24-hour levels after a test dose to estimate the dose for a target steady-state level of 140 ng/ml.
Administered the estimated full dose rapidly and monitored steady-state drug concentrations.

Main Results:

89% (16 of 18) of patients completing the dose adjustment phase achieved therapeutic steady-state desipramine concentrations (125-300 ng/ml).
This success rate significantly contrasts with the 23% observed in previous fixed-dose studies.
The rapid dose adjustment strategy was well tolerated by patients.

Conclusions:

Predicting antidepressant dosage using 24-hour plasma levels enables rapid achievement of therapeutic concentrations.
This method improves treatment efficiency, potentially reducing hospitalization for depressed inpatients.
The technique is valuable for research requiring uniform plasma level control.

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