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Cimetidine's effect on steady-state serum nortriptyline concentrations.
Drug Intelligence & Clinical Pharmacy
|December 1, 1983
Summary
Cimetidine significantly alters nortriptyline levels in patients. Discontinuing cimetidine caused nortriptyline levels to drop, while reintroducing it caused them to rise, then fall again.
Area of Science:
- Pharmacology
- Drug Interactions
- Clinical Pharmacy
Background:
- Nortriptyline is a tricyclic antidepressant used to treat depression.
- Cimetidine is a histamine H2 receptor antagonist commonly used to treat peptic ulcers and gastroesophageal reflux disease.
Observation:
- A case study involving a 52-year-old male patient receiving both cimetidine and nortriptyline.
- Monitoring of serum nortriptyline concentrations revealed significant fluctuations.
- The patient was a black male.
Findings:
- Concomitant administration of cimetidine and nortriptyline for two weeks resulted in a 42% decrease in steady-state nortriptyline concentrations upon cimetidine discontinuation.
- Rechallenge with cimetidine led to a significant increase in serum nortriptyline concentrations, followed by a subsequent decrease upon cimetidine withdrawal.
Implications:
- This interaction highlights the potential for cimetidine to affect nortriptyline pharmacokinetics.
- Clinicians should be aware of this drug interaction when prescribing these medications concurrently.
- Monitoring of nortriptyline levels may be necessary in patients receiving cimetidine to avoid subtherapeutic or toxic concentrations.