title: Effects of divalproex sodium on amitriptyline and nortriptyline pharmacokinetics.
abstract: BACKGROUND
  Divalproex sodium has been found to be efficacious in the prophylaxis of migraine headaches and the management of the manic phase of bipolar syndrome. Because amitriptyline is also prescribed in these patient populations, data are needed on their potential for interaction.
  
  
  METHODS
  The effect of concomitant administration of divalproex sodium on the pharmacokinetics of amitriptyline and its active metabolite, nortriptyline, was investigated in an open-label, sequential, two-period phase I study. Ten healthy male and five healthy female subjects received 50 mg amitriptyline hydrochloride on two occasions: (1) alone (period 1) and (2) 2 hours after receiving the ninth dose of 500 mg divalproex sodium (Depakote) administered once every 12 hours (period 2).
  
  
  RESULTS
  Amitriptyline area under the curve was increased 31% from the combined effect of decreased first-pass metabolism and inhibition of systemic metabolism. The elevated nortriptyline plasma levels reflected primarily the increase in amitriptyline concentrations but also appeared to involve modest inhibition of nortriptyline elimination. For the sum of amitriptyline and nortriptyline concentrations, the peak plasma concentration mean was 19% higher with concomitant divalproex dosing. The mean area under the curve for the sum of amitriptyline and nortriptyline concentrations was 42% higher with concomitant divalproex dosing than it was for dosing with amitriptyline alone.
  
  
  CONCLUSIONS
  These results suggested that a lower dose of amitriptyline might be considered when divalproex is administered concomitantly.
authors.affiliation: Department of Pharmacokinetics, Abbott Laboratories, IL 60064-3500, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Cavanaugh
authors.forename: H
authors.initials: H
authors.lastname: Shi
authors.forename: W M
authors.initials: WM
authors.lastname: Awni
authors.forename: G R
authors.initials: GR
authors.lastname: Granneman
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000493:pharmacokinetics*; D000927:Anticonvulsants / Q000494:pharmacology*; D000929:Antidepressive Agents, Tricyclic / Q000493:pharmacokinetics*; D003577:Cytochrome P-450 Enzyme System / Q000502:physiology; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000493:pharmacokinetics*; D014635:Valproic Acid / Q000494:pharmacology*
chemical_list: D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D014635:Valproic Acid; D003577:Cytochrome P-450 Enzyme System; D009661:Nortriptyline