Concomitant intake of nortriptyline and carbamazepine.
A 73-year-old woman with bipolar manic-depressive illness was treated with nortriptyline, 75 mg/day, for more than 2 years. At this dose her mean (+/- SD) serum nortriptyline concentration (SNT) was 355 +/- 49 nM (n = 13). Nevertheless, the patient again was depressed and was admitted to initiate prophylactic treatment with carbamazepine. During concomitant intake of 500-600 mg/day carbamazepine, the SNT decreased to 140 and 134 nM and the depression persisted. The nortriptyline dose was therefore increased to 150 mg/day; the mean SNT rose to 402 +/- 69 nM (n = 4) and the depression disappeared. This case shows that carbamazepine induces nortriptyline metabolism.
Brøsen
K
K
Department of Clinical Pharmacology, Odense University, Denmark.
Kragh-Sørensen
P
P
D000368:Aged; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy; D002220:Carbamazepine / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D009661:Nortriptyline / Q000097:blood* / Q000627:therapeutic use
D002220:Carbamazepine; D009661:Nortriptyline