Posted by Elizabeth on July 22, 2001, at 15:34:38
In reply to Re: Tricyclic Serum Levels, posted by SalArmy4me on July 20, 2001, at 21:37:13
OK, since you seem to think that an appeal to authority constitutes "proof," here's what Schatzberg & Nemeroff have to say:
"Despite a current appreciation for the great variability in metabolism of tricyclic drugs and a consequent need to individualize treatment, definitive therapeutic concentrations are not well established for all TCAs. Most critical analyses agree that therapeutic levels have been defined for only nortriptyline, imipramine, and desipramine (American Psychiatric Association Task Force 1989; Perry et al. 1987; Rudorfer and Potter 1987). Nonetheless, attempts have been made to provide estimates of reasonable therapeutic ranges for all marketed TCAs based on cumulative experience with therapeutic monitoring rather than on prospective controlled studies (Orsulak 1989). Lack of response, toxicity, minimizing adverse effects by using the minimal effective dose, and suspected pharmacokinetic interactions (e.g., with neuroleptics or SSRIs) are indications for measurements of plasma drug levels. Even without such measurements, daily doses of tricyclic drugs other than nortriptyline or protriptyline can be increased to 300-350 mg of imipramine or the equivalent if side effects allow. Dose increases of nortriptyline require monitoring because plasma levels greater than 150 ng/mL are as ineffective as those yielding a subtherapeutic (< 50 ng/mL) level."
IOW, tricyclic serum level monitoring is something that's only done when there's a specific reason to do it: it's not necessary as a general rule. In reality, a lot of doctors don't do it even when it is called for.
If there is a need for measurement of serum levels, you should arrange for the blood to be drawn about 10 hours after your last dose.
-e
poster:Elizabeth
thread:70659
URL: http://www.dr-bob.org/babble/20010720/msgs/71387.html