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Relationship between age and tricyclic antidepressant plasma levels
The American Journal of Psychiatry
|July 1, 1977
Summary
Older adults taking imipramine or amitriptyline experienced higher drug levels. This suggests slower drug elimination, explaining increased side effects and supporting lower dosage use in elderly patients.
Area of Science:
- Pharmacology
- Geriatric Medicine
- Psychiatry
Background:
- Tricyclic antidepressants (TCAs) like imipramine and amitriptyline are commonly prescribed for depression.
- Older adults may exhibit altered drug metabolism and elimination compared to younger populations.
Purpose of the Study:
- To investigate the pharmacokinetic differences of TCAs in older depressed patients.
- To explore the relationship between TCA plasma levels and drug elimination rates in the elderly.
- To provide a rationale for dosage adjustments in geriatric populations.
Main Methods:
- Plasma levels of imipramine, desipramine, and amitriptyline were measured in older depressed patients.
- Drug elimination rates were assessed in imipramine-treated patients.
- Correlations between plasma levels and elimination rates were analyzed.
Main Results:
- Older patients showed higher steady-state plasma levels of imipramine, desipramine, and amitriptyline.
- A decreased rate of drug elimination from plasma was observed in imipramine-treated older adults.
- Higher plasma concentrations were linked to slower drug metabolism.
Conclusions:
- Altered drug elimination contributes to higher TCA plasma levels in older adults.
- These findings partially explain increased TCA side effect susceptibility in the elderly.
- Lower TCA dosages are pharmacologically recommended for geriatric patients.