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Possible interaction between imipramine and butalbital

K W Garey¹, G W Amsden, C A Johns

¹Clinical Pharmacology Research Center, and Department of Pharmacy, Bassett Healthcare, Cooperstown, New York 13326-1394, USA.

Pharmacotherapy

|November 5, 1997

Summary

Butalbital, found in headache medications, may significantly lower imipramine levels in patients with depression. This drug interaction necessitates monitoring antidepressant concentrations when these medications are co-prescribed.

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Area of Science:

Pharmacology
Clinical Psychiatry
Drug Interactions

Background:

Depressive disorder management often involves tricyclic antidepressants like imipramine.
Chronic headache disorders are frequently treated with butalbital-containing medications.
Cytochrome P-450 (CYP) enzymes, particularly CYP1A2, play a crucial role in drug metabolism.

Observation:

A patient experiencing a depressive disorder relapse showed a 50% decrease in imipramine blood concentrations.
The patient was concurrently prescribed butalbital for a chronic headache disorder.
Initial imipramine levels were therapeutic before butalbital administration.

Findings:

Barbiturates, including butalbital, are known inducers of the CYP1A2 enzyme system.
This enzyme system is responsible for metabolizing imipramine.

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The concurrent use of butalbital likely accelerated imipramine metabolism, leading to reduced efficacy.

Implications:

This case highlights a potential drug interaction between butalbital and imipramine, previously undocumented.
Clinicians should consider monitoring imipramine levels in patients starting butalbital therapy.
Adjusting imipramine dosage based on therapeutic drug monitoring is recommended to manage potential relapses.