Tricyclic plasma levels. Effect of age, race, sex, and smoking

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Abstract
Steady-state plasma tricyclic antidepressant levels were determined in 65 patients undergoing treatment for depression with amitriptyline hydrochloride or nortriptyline hydrochloride to determine if common factors such as age, race, sex or smoking status were predictors of steady-state drug levels that were shown to vary up to 36-fold. Evaluation of these factors did not disclose differences in rate of demethylation of amitriptyline to nortriptyline or steady-state tricyclic levels in amitriptyline-treated patients. No differences were found in nortriptyline-treated patients except regarding race. Black patients had significantly higher (50%) nortriptyline plasma levels than did white patients, which may explain the more rapid response to tricyclic treatment demonstrated in blacks. Decreased rates of nortriptyline metabolism in blacks can result in increased side effects and treatment failure if the therapeutic plasma range is exceeded.

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