Nortriptyline Therapy in Elderly Patients: Dosage Prediction from Plasma Concentration at 24 Hours after a Single 50 mg Dose

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Abstract
Summary: Ten depressed elderly female patients in hospital (mean age 82 years) received a single oral dose of 50 mg nortriptyline prior to commencing treatment with this drug. The nortriptyline concentration in a plasma sample obtained 24 hours afterwards was used to predict the daily dose required to achieve a steady-state concentration within the range of 50–150 μg.l-1. The mean daily dose prescribed was 50 mg (range 20–100 mg). These dosage regimes provided a mean observed steady-state nortriptyline concentration of 104 μg.l-1, with a range of 76–180 μg.l-1 (S.D. 30 μg.l-1). Use of this prediction test can prevent the development of toxic plasma concentrations and enhance the possibility of therapeutic success.