title: Placebo-controlled comparison of three dose-regimens of 5-hydroxytryptophan challenge test in healthy volunteers.
abstract: Single-dose administration of 5-hydroxytryptophan (5-HTP) is regularly used as a challenge test of the serotonergic system. The use of 5-HTP has been limited by an apparent small window between the occurrence of neuroendocrine endpoints and the occurrence of side effects. Therefore, many dosing strategies have been tried with and without concurrent administration of carbidopa, a peripheral inhibitor of the decarboxylation from 5-HTP to serotonin. The aim of the current study was to assess the relation between pharmacokinetics and pharmacodynamics of 5-HTP. Twelve healthy male volunteers were included in a placebo-controlled, randomized, four-way crossover, double-blind, single-dose investigation of oral 5-HTP with or without coadministration of carbidopa. The four dose regimens were placebo, 5-HTP 100 mg, 5-HTP 200 mg, and 5-HTP 100 mg with coadministration of carbidopa 100 mg and 50 mg at 3 hours before and 3 hours after the administration of 5-HTP, respectively. The last regimen resulted in a doubling of the elimination half-life, an apparent clearance at least 14 times smaller, and a 15.4 times greater area under the curve compared with 5-HTP 100 mg without carbidopa. Furthermore, it was the only regimen to induce a significant change in cortisol and prolactin. It did not induce any change in subjective psychologic symptoms or cardiovascular parameters, but it was the only regimen to induce some nausea in three participants. The authors conclude that this regimen of 5-HTP 100 mg plus carbidopa is a relatively simple, effective, and tolerable challenge of the presynaptic serotonergic system. Further increase of the dose of 5-HTP might improve the size of the effect on endpoints as long as the tolerability remains good.
authors.affiliation: Centre for Human Drug Research, Department of Clinical Pharmacology, Leiden University, Leiden, The Netherlands. harm.gijsman@doctors.org.uk
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Gijsman
authors.forename: Joop M A
authors.initials: JM
authors.lastname: van Gerven
authors.forename: Marieke L
authors.initials: ML
authors.lastname: de Kam
authors.forename: Rik C
authors.initials: RC
authors.lastname: Schoemaker
authors.forename: Monique S M
authors.initials: MS
authors.lastname: Pieters
authors.forename: Margo
authors.initials: M
authors.lastname: Weemaes
authors.forename: Roel
authors.initials: R
authors.lastname: de Rijk
authors.forename: Jeroen
authors.initials: J
authors.lastname: van der Post
authors.forename: Adam F
authors.initials: AF
authors.lastname: Cohen
mesh_terms: D006916:5-Hydroxytryptophan / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D002230:Carbidopa / Q000008:administration & dosage; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008657:Metabolic Clearance Rate; D011388:Prolactin / Q000097:blood*; D017661:Receptors, Presynaptic / Q000187:drug effects* / Q000502:physiology; D011985:Receptors, Serotonin / Q000187:drug effects* / Q000502:physiology
chemical_list: D017661:Receptors, Presynaptic; D011985:Receptors, Serotonin; D011388:Prolactin; D006916:5-Hydroxytryptophan; D002230:Carbidopa; D006854:Hydrocortisone