Therapeutic drug monitoring of antidepressants in haemodialysis patients.
OBJECTIVE
The co-morbidity of depressive disorder and chronic kidney failure is remarkably common. However, knowledge about the influence of haemodialysis on the serum concentration of antidepressants is sparse. In this study we examined the influence of haemodialysis on the serum concentrations of the antidepressants amitriptyline (and its active metabolite nortriptyline) and mirtazapine.


METHODS
The authors retrospectively evaluated therapeutic drug monitoring (TDM)-analyses obtained in eight different regional medical dialysis centres before and after haemodialysis and compared serum concentrations of amitriptyline and mirtazapine using t-tests.


RESULTS
Mean serum concentrations of the sum of amitriptyline + nortriptyline (before: 75.52 ng/mL; after: 59.35 ng/mL; p < 0.001) and mirtazapine (before: 53.45 ng/mL; after: 38.31 ng/mL; p < 0.036) decreased significantly with haemodialysis. Haemodialysis patients received rather low doses of amitriptyline (mean 36.5 mg; SD 17.6; range 10-75 mg) and mirtazapine (mean 24.7 mg; SD 9.1; range 15-45 mg).


CONCLUSIONS
For haemodialysis patients with depression an adequate antidepressant drug dosage must be administered. TDM is necessary in order to optimize antidepressant therapy in patients with chronic kidney disease.
Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany. Unterecker_S@klinik.uni-wuerzburg.de
Stefan
S
Unterecker
Philip
P
Müller
Christian
C
Jacob
Peter
P
Riederer
Bruno
B
Pfuhlmann
D000928:Antidepressive Agents / Q000097:blood / Q000627:therapeutic use*; D016903:Drug Monitoring; D006801:Humans; D006435:Renal Dialysis
D000928:Antidepressive Agents