Elevated plasma tricyclic levels with therapeutic doses of imipramine

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Abstract
Of 59 patients 9 (15%) treated with imipramine at doses of 150-300 mg/day had steady-state plasma levels greater than 500 ng/ml. Low capacity for hydroxylation was found in all 6 patients for whom hydroxy metabolites were measured. Maximum tricyclic levels in the 9 study patients were comparable to levels found in tricyclic antidepressant overdoses (651-2439 ng/ml). No study patient experienced any adverse effects: QRS durations were all less than 100 ms, and a mildly dry mouth was the most commonly reported side effect (5 of 9 patients). Depressive symptoms recurred in 3 patients when their imipramine dose was decreased.