Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-18T21:44:04.612Z Has data issue: false hasContentIssue false
  • English
  • Français

Asymptomatic tricyclic toxicity associated with diltiazem

Published online by Cambridge University Press:  13 June 2014

Paul A Cotter ,
Peter W Raven  and
Marina Hudson
Peter W Raven
Affiliation:
Section of Metabolic Studies, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, England
Marina Hudson
Affiliation:
Maudsley Hospital, Denmark Hill, London SE5 8AE, England
Get access Rights & Permissions [Opens in a new window]

Abstract

Therapeutic drug monitoring of tricyclic antidepressants is a controversial issue. A case is reported in which a patient with recurrent depression developed asymptomatic tricyclic toxicity while on trimipramine, a tricyclic antidepressant, and diltiazem, a calcium channel blocker. A metabolic interaction involving cytochrome P450 3A (CYP3A) is postulated. It is suggested that routine therapeutic drug monitoring of tricyclic levels should be an essential part of the management of depression.

Keywords

DepressionTrimipramineTricyclic antidepressantsDiltiazemCalcium channel blockersCytochrome P450 enzymesTherapeutic drug monitoring
Type
Case Reports
Information
Irish Journal of Psychological Medicine , Volume 13 , Issue 4 , December 1996 , pp. 168 - 169
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Preskorn, SH. Tricyclic antidepressants: the whys and hows of therapeutic drug monitoring. J Clin Psychiatry 1989; 50(7): 34–46Google ScholarPubMed
2.Preskorn, SH, Burke, MJ, Fast, GA. Therapeutic drug monitoring. Principles and practice. Psychiatr Clin North Am 1993; 16(3): 611–41.CrossRefGoogle ScholarPubMed
3.Taylor, D, Duncan, D. Plasma levels of tricyclic and related antidepressants: are they necessary or useful? Psychiatric Bull 1995; 19(9): 548–50.CrossRefGoogle Scholar
4.American Psychiatric Association Task Force. Use of laboratory tests in psychiatry: tricyclic antidepressants – blood level measurements and clinical outcome. An APA Task Force Report. Am J Psychiatry 1985; 152: 155–62.Google Scholar
5.Braunwald, E. Mechanism of action of calcium channel blocking agents. N Engl J Med 1982; 307: 1618–27.Google ScholarPubMed
6.Bussey, HI, Talbert, RL. Promising uses of calcium channel blocking agents. Pharmacotherapy 1984; 4:137–43.CrossRefGoogle ScholarPubMed
7.Dubovsky, SL, Franks, RD, Allen, S, Murphy, J. Calcium antagonists in mania: a double-blind study of verapamil. Psychiatry Res 1986; 18: 309–20.CrossRefGoogle Scholar
8.Pollack, MH, Rosenbaum, JF. Verapamil in the treatment of recurrent unipolar depression. Biol Psychiatry 1987; 22: 779–82.CrossRefGoogle ScholarPubMed
9.Rehavi, M, Carmi, R, Weizman, A. Tricyclic antidepressants and calcium channel blockers: interactions at the (-) desmethoxyverapamil binding site and the serotonin transporter. Eur J Pharmacol 1988;155: 1–9.CrossRefGoogle ScholarPubMed
10.Muthal, A, Chopde, CT. Modification of tricyclic analgesia by calcium channel blockers. Indian J Physiol Pharmacol 1993; 37: 238–40.Google ScholarPubMed
11.Herman, DJ, Rrol, TF, Dukes, GE, et al.Comparison of verapamil, diltiazem and labetalol on the bioavailability and metabolism of imipramine. J Clin Pharmacol 1992; 32: 176–83.CrossRefGoogle Scholar
12.Guengerich, FP. Human cytochrome P450 enzymes. Life Sci 1992; 50: 1471–8.CrossRefGoogle Scholar
13.Crewe, HK, Lennard, MS, Tucker, GT, Woods, FR, Haddock, RE. The effect of selective serotonin re-uptake inhibitors on cytochrome P4502D6 (CYP2D6) activity in human liver microsomes. Br J Clin Pharmacol 1992; 34: 262–5.CrossRefGoogle ScholarPubMed
14.De Vane, CL. Pharmacokinetics of the newer antidepressants: clinical relevance. Am J Med 1994; 97(6A): 13S–23S.CrossRefGoogle ScholarPubMed
15.Lydiard, RB, Anton, RF, Cunningham, T. Interactions between sertraline and tricyclic antidepressants. Am J Psychiatry 1993; 150:1125–6.Google ScholarPubMed
16.Pichard, L, Gillet, G, Fabre, I, et al.Identification of the rabbit and human cytochromes P450 3A as the major enzymes involved in the N-demethylation of diltiazem. Drug Metab Dispos 1990: 8: 711–9.Google Scholar
17.Lemoine, A, Gautier, JC, Azoulay, D, et al.Major pathway of imipramine metabolism is catalyzed by cytochromes P450 1A2 and P450 3A4 in human liver. Mol Pharmacol 1993; 43: 827–32.Google ScholarPubMed
18.Jack, DB. Handbook of clinical pharmacokinetic data. Basingstoke: Macmillan, 1992.CrossRefGoogle Scholar
19.Dollery, CT. Therapeutic drugs. Edinburgh: Churchill Livingstone, 1991.Google Scholar
20.Preskorn, SH. Sudden death and tricyclic antidepressants (TCAs); a rare adverse event linked to high TCA plasma levels. Nord J Psych 1993; 47(30): 49–55.CrossRefGoogle Scholar
21.Preskorn, SH, Jerkovich, GS. Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and role of therapeutic drug monitoring. J Clin Psychopharmacol 1990; 10: 88–95.CrossRefGoogle ScholarPubMed
22.Spiker, DG, Weiss, AN, Chang, SS, Ruwich, JF, Biggs, JT. Tricyclic antidepressant overdose: clinical presentation and plasma levels. Clin Pharmacol Ther 1975; 18: 539–46.CrossRefGoogle ScholarPubMed