title: Pharmacokinetic interaction between nortriptyline and terbinafine.
abstract: OBJECTIVE
  To clarify the mechanism of interaction between nortriptyline and terbinafine.
  
  
  METHODS
  Nortriptyline intoxication secondary to terbinafine treatment was observed in a woman with a major depressive disorder. This is the second report of this interaction. A rechallenge was performed during which serum concentrations were measured of nortriptyline and the 2 hydroxy metabolites. To document the case, genotyping of CYP2D6 was also performed.
  
  
  CONCLUSIONS
  Metabolism by CYP2D6 is of major importance for the hydroxylation of nortriptyline, making it susceptible to competitive inhibition by terbinafine.
  
  
  CONCLUSIONS
  The pharmacokinetic interaction between nortriptyline and terbinafine is probably due to inhibition of CYP2D6 of the nortriptyline metabolism by terbinafine. The interaction is not restricted to a subpopulation, but may occur even in persons without deviations in CYP2D6.
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Academic Hospital Maastricht, Netherlands. hkuy@kfls.azm.nl
authors.forename: P-Hugo M
authors.initials: PH
authors.lastname: Van Der Kuy
authors.forename: Harrie A
authors.initials: HA
authors.lastname: Van Den Heuvel
authors.forename: Rob W
authors.initials: RW
authors.lastname: Kempen
authors.forename: Leo M L
authors.initials: LM
authors.lastname: Vanmolkot
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics / Q000502:physiology; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D003866:Depressive Disorder / Q000188:drug therapy* / Q000378:metabolism; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009281:Naphthalenes / Q000493:pharmacokinetics*; D009661:Nortriptyline / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D000077291:Terbinafine
chemical_list: D000929:Antidepressive Agents, Tricyclic; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D004791:Enzyme Inhibitors; D009281:Naphthalenes; D009661:Nortriptyline; D019389:Cytochrome P-450 CYP2D6; D000077291:Terbinafine