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Excretion of nortriptyline into saliva
International Journal of Clinical Pharmacology, Therapy, and Toxicology
|February 1, 1981
Summary
Saliva nortriptyline concentrations correlate with serum levels but are unreliable for predicting them. Saliva pH and flow rate significantly impact the saliva-to-serum ratio, complicating drug monitoring.
Area of Science:
- Pharmacokinetics
- Analytical Chemistry
- Biomarker Discovery
Background:
- Nortriptyline is a tricyclic antidepressant with a narrow therapeutic index.
- Accurate therapeutic drug monitoring is crucial for optimizing nortriptyline efficacy and minimizing toxicity.
- Saliva offers a non-invasive matrix for drug concentration analysis, but its utility for nortriptyline requires further investigation.
Purpose of the Study:
- To investigate the relationship between serum and mixed saliva concentrations of nortriptyline.
- To assess the influence of stimulated saliva flow and pH on the saliva-to-serum ratio of nortriptyline.
Main Methods:
- Seven healthy volunteers received a single 50 mg oral dose of nortriptyline.
- Serum and unstimulated/stimulated mixed saliva samples were collected.
- Nortriptyline concentrations, saliva pH, and flow rates were measured.
Main Results:
- A statistically significant, albeit variable, correlation was observed between serum and saliva nortriptyline concentrations.
- Stimulated saliva flow significantly increased saliva pH and decreased the saliva-to-serum ratio.
- The saliva-to-serum ratio demonstrated significant correlation with increased flow rate and pH.
Conclusions:
- While saliva nortriptyline concentrations correlate with serum levels, they are not reliable for predicting them due to significant variability.
- Changes in saliva flow rate and pH markedly influence the saliva-to-serum ratio, limiting the utility of saliva for accurate nortriptyline dose calculation.
- Further research is needed to refine saliva-based drug monitoring methods for nortriptyline.