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Titolo:
Doxepin plasma concentrations: Is there really a therapeutic range?
Autore:
Leucht, S; Steimer, W; Kreuz, S; Abraham, D; Orsulak, PJ; Kissling, W;
Indirizzi:
Tech Univ Munich, Klinikum Rechts Isar, Dept Psychiat & Psychotherapy, D-81675 Munich, Germany Tech Univ Munich Munich Germany D-81675 therapy, D-81675 Munich, Germany Tech Univ Munich, Klinikum Rechts Isar, Inst Klin Chem & Pathobiochem, Munich, Germany Tech Univ Munich Munich Germany in Chem & Pathobiochem, Munich, Germany Univ Texas, SW Med Ctr, Dept Psychiat, Dallas, TX USA Univ Texas Dallas TX USA exas, SW Med Ctr, Dept Psychiat, Dallas, TX USA Univ Texas, SW Med Ctr, Dept Pathol, Dallas, TX USA Univ Texas Dallas TX USA Texas, SW Med Ctr, Dept Pathol, Dallas, TX USA
Titolo Testata:
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
fascicolo: 4, volume: 21, anno: 2001,
pagine: 432 - 439
SICI:
0271-0749(200108)21:4<432:DPCITR>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRICYCLIC ANTIDEPRESSANTS; DEPRESSED-PATIENTS; GUIDELINES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Leucht, S Tech Univ Munich, Klinikum Rechts Isar, Dept Psychiat & Psychotherapy, Ismaningerstr 22, D-81675 Munich, Germany Tech Univ Munich Ismaningerstr 22 Munich Germany D-81675 ermany
Citazione:
S. Leucht et al., "Doxepin plasma concentrations: Is there really a therapeutic range?", J CL PSYCH, 21(4), 2001, pp. 432-439

Abstract

Despite the introduction of numerous new agents, tricyclic antidepressantsremain an important option for the treatment of depression. Doxepin is still in wide use, and determining its concentration is a standard procedure in many psychiatric clinics. Some widely cited reviews indicate a therapeutic range from 150 to 250 ng/mL, (parent plus desmethyl metabolite). The vastmajority of the authors' patients fell short of these concentrations undercustomary doses. To resolve this issue, the authors' serum-level databank was analyzed, a questionnaire was sent to U.S. and German psychiatric university departments and laboratories, and the literature was reviewed. The main results were the following: (1) Only 9% of all samples analyzed (N = 217) displayed plasma levels (highperformance liquid chromatography) between 150 and 250 ng/mL; 88% were subtherapeutic. The mean doxepin + desmethyldoxepin steady-state serum concentration was 89 +/- 75 ng/mL (N = 32, doxepin >3 weeks). The mean daily dose was 143 +/- 30 mg. There was no correlation between concentrations and improvement. (2) A wide variety of recommendations is given by the different university departments (10-1,000 ng/mL). (3) According to the studies published to date, there is not enough evidence for recommending a therapeutic range. The preliminary suggestions given in someinfluential reviews have been widely adopted without critical re-evaluation. Compared with the concentrations found in the original studies, the therapeutic ranges suggested are too high. A methodologically sound study to determine a therapeutic range is required for the rational monitoring of thisdrug. Meanwhile, a preliminary working range of 50 to 250 ng/ml; is proposed on the basis critical reassessment of published data.

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Documento generato il 20/01/20 alle ore 22:17:46