title: Dynamic and kinetic effects of chronic citalopram treatment in experimental hepatic encephalopathy.
abstract: Chronic hepatic encephalopathy (HE) is a neuropsychiatric syndrome that arises in liver-impaired subjects. Patients with HE display various neuropsychiatric symptoms including affective disturbances and may therefore likely receive treatment with novel thymoleptics like citalopram (CIT). The simultaneous pharmacokinetic and pharmacodynamic outcome of the commonly used serotonin-selective thymoleptic drugs in liver-impaired subjects with pending chronic HE is far from understood today. We therefore investigated the effects of chronic, body-weight-adjusted (10 mg x kg(-1) x day(-1)), treatment with CIT in rats with and without portacaval shunts (PCS). Open-field activity was monitored. The 5-HT, 5-HIAA, noradrenaline (NA), and dopamine (DA) output were assessed in the frontal neocortex. The racemic levels of CIT and its metabolites DCIT and DDCIT, including the S- and R-enantiomers, were determined in serum, brain parenchyma, and extracellular fluid. The rats with PCS showed higher (2-3-fold) levels of CIT than rats undergoing a sham treatment with CIT in all compartments investigated. The PCS rats also showed elevated levels of DCIT and DDCIT. No major differences in the S/R ratios between PCS rats and control rats could be detected. The CIT treatment resulted in neocortical output differences between PCS rats and control rats mainly within the 5-HT and DA systems but not within the NA system. For the 5-HT system, this change was further evidenced by outspoken elevation in 5-HT output after KCI-depolarizing challenges. Moreover, the CIT treatment to PCS rats was shown to "normalize" the metabolic turnover of 5-HT, measured as a profound lowering of a basal elevation in the 5-HIAA levels. The CIT treatment resulted in an increased or "normalized" behavioral activity in the PCS group. Therefore, a dose-equal chronic treatment with CIT in PCS rats produced pharmacokinetic and pharmacodynamic changes not observed in control rats. The results further support the contention of an altered 5-HT neurotransmission prevailing in the chronic HE condition. However, the tentatively beneficial behavioral response also seen following chronic CIT treatment to PCS rats in this study has to be viewed in relation to both the pharmacokinetic and pharmacodynamic changes observed.
authors.affiliation: Department of Clinical Pharmacology, Institute of Laboratory Medicine, Lund University, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Apelqvist
authors.forename: C
authors.initials: C
authors.lastname: Wikell
authors.forename: B
authors.initials: B
authors.lastname: Carlsson
authors.forename: S
authors.initials: S
authors.lastname: Hjorth
authors.forename: P B
authors.initials: PB
authors.lastname: Bergqvist
authors.forename: J
authors.initials: J
authors.lastname: Ahlner
authors.forename: F
authors.initials: F
authors.lastname: Bengtsson
mesh_terms: D000818:Animals; D000928:Antidepressive Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D001522:Behavior, Animal / Q000187:drug effects; D001923:Brain Chemistry / Q000187:drug effects; D015283:Citalopram / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D004298:Dopamine / Q000378:metabolism; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000523:psychology; D006897:Hydroxyindoleacetic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis; D009043:Motor Activity / Q000187:drug effects; D009638:Norepinephrine / Q000378:metabolism; D011189:Potassium Chloride / Q000494:pharmacology; D051381:Rats; D017207:Rats, Sprague-Dawley; D012701:Serotonin / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D013237:Stereoisomerism
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D004298:Dopamine; D006897:Hydroxyindoleacetic Acid; D009638:Norepinephrine; D011189:Potassium Chloride; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors