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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Elizabeth on August 5, 2001, at 8:38:46
Has anyone here had their serum level of a tricyclic antidepressant tested? If so, which TCA was it, what dose were you taking, and what was the serum level?
Thanks,
-elizabeth
Posted by Joe Schmoe on August 5, 2001, at 10:37:58
In reply to TCA serum levels, posted by Elizabeth on August 5, 2001, at 8:38:46
> Has anyone here had their serum level of a tricyclic antidepressant tested? If so, which TCA was it, what dose were you taking, and what was the serum level?
Wish I had more info for you, but....
I did, about a decade ago. I was on imipramine. I had the serum levels tested several times because we kept upping the dose and I still was not at the therapeutic level. I finally ended up on 300 mg/day before I reached the therapeutic serum level. The pdoc was very surprised and said my body must have been absorbing the medicine very poorly.
Posted by Mitch on August 5, 2001, at 13:51:39
In reply to TCA serum levels, posted by Elizabeth on August 5, 2001, at 8:38:46
> Has anyone here had their serum level of a tricyclic antidepressant tested? If so, which TCA was it, what dose were you taking, and what was the serum level?
>
> Thanks,
> -elizabethHad a nortriptyline blood draw last year. I was just taking 20mg/day, though, and I was definitely below the bottom of the "therapeutic" range (50-150), I believe the number was 13-14 if my memory serves me, BUT they did the draw about 16-17 hrs after my last dose not the 10 I think they are supposed to (and of course my pdoc never said anything-real bright). My guess given the half-life I probably was just hitting the bottom of the range a few hours after dosing.
Posted by Waterlily on August 5, 2001, at 14:52:00
In reply to TCA serum levels, posted by Elizabeth on August 5, 2001, at 8:38:46
> Has anyone here had their serum level of a tricyclic antidepressant tested? If so, which TCA was it, what dose were you taking, and what was the serum level?
>
> Thanks,
> -elizabethI'm on imipramine 75 mg./day. I had the level checked in December and it was at the upper end of the therapeutic range. I had another drawn this past week but haven't gotten the results yet.
Posted by stjames on August 5, 2001, at 19:53:44
In reply to Re: TCA serum levels » Elizabeth, posted by Mitch on August 5, 2001, at 13:51:39
>
> Had a nortriptyline blood draw last year. I was just taking 20mg/day, though, and I was definitely below the bottom of the "therapeutic" range (50-150), I believe the number was 13-14 if my memory serves me, BUT they did the draw about 16-17 hrs after my last dose not the 10 I think they are supposed to (and of course my pdoc never said anything-real bright). My guess given the half-life I probably was just hitting the bottom of the range a few hours after dosing.
Following oral administration of 50 mg 3 times daily for 10 days, the mean steady-state plasma concentration was 33 to 85 ng/mL for imipramine and 43 to 109 ng/mL for desmethylimipramine, an active metabolite. Peak plasma levels are reached in 2 to 5 hours, and plasma half-life ranges from 9 to 20 hours.
Posted by Elizabeth on August 5, 2001, at 21:43:37
In reply to Re: TCA serum levels, posted by Waterlily on August 5, 2001, at 14:52:00
> I'm on imipramine 75 mg./day. I had the level checked in December and it was at the upper end of the therapeutic range. I had another drawn this past week but haven't gotten the results yet.
Do you remember what the serum level was? (They probably checked both imipramine and desipramine levels.)
The reason I'm asking is because I was taking 300 mg/day of desipramine (the high end of the normal therapeutic dose range, but still within the window) and my level came back very high twice. (I've decreased the dose to 150 mg/day for the time being.) So I'm looking for a general idea as to what the relationship between dose and serum level is typically.
-elizabeth
Posted by dove on August 6, 2001, at 3:16:17
In reply to Re: TCA serum levels, posted by Elizabeth on August 5, 2001, at 21:43:37
Does everyone's P-Doc order serum levels? I have never had any blood work-ups nor any kind of lab work since I began with ADs years ago. Currently taking 6 meds per day:
Adderall (40 mgs per/d),
Prozac (20 mgs per/d),
Neurontin (1,500 - 2,400 mgs per/d)
Serzone (600 mgs p/day)
Klonopin (1.5 - 2 mgs per/d)
Amitriptyline (100 mgs per/d)Would or could this med combo use a serum level check? And if so, why haven't any of my Doc's ordered one?
Just curious I guess.
dove
Posted by Mitch on August 6, 2001, at 7:58:09
In reply to Re: TCA serum levels, posted by dove on August 6, 2001, at 3:16:17
> Does everyone's P-Doc order serum levels? I have never had any blood work-ups nor any kind of lab work since I began with ADs years ago. Currently taking 6 meds per day:
>
> Adderall (40 mgs per/d),
> Prozac (20 mgs per/d),
> Neurontin (1,500 - 2,400 mgs per/d)
> Serzone (600 mgs p/day)
> Klonopin (1.5 - 2 mgs per/d)
> Amitriptyline (100 mgs per/d)
>
> Would or could this med combo use a serum level check? And if so, why haven't any of my Doc's ordered one?
>
> Just curious I guess.
>
> doveProzac, is likely to increase the blood level of your amitriptyline. It wouldn't hurt to have the the AMI checked (not frequently)-especially if you have insurance to cover most of the cost. You possibly could be taking more of the AMI than you need.
Mitch
Posted by Elizabeth on August 6, 2001, at 12:16:23
In reply to Re: TCA serum levels » dove, posted by Mitch on August 6, 2001, at 7:58:09
> Prozac, is likely to increase the blood level of your amitriptyline. It wouldn't hurt to have the the AMI checked (not frequently)-especially if you have insurance to cover most of the cost. You possibly could be taking more of the AMI than you need.
I would add that amitriptyline (and its active metabolite nortriptyline) have a therapeutic window -- serum levels higher than the effective range (for notriptyline, this is 50-150 ng/mL; I don't recall what it is for amitriptyline) are as ineffective as levels below the therapeutic range.
-elizabeth
Posted by Waterlily on August 6, 2001, at 21:54:31
In reply to Re: TCA serum levels, posted by Elizabeth on August 5, 2001, at 21:43:37
> > I'm on imipramine 75 mg./day. I had the level checked in December and it was at the upper end of the therapeutic range. I had another drawn this past week but haven't gotten the results yet.
>
> Do you remember what the serum level was? (They probably checked both imipramine and desipramine levels.)
>Nope, but my psychiatrist is supposed to call me this week with the results of last week's test, so I'll ask him then.
Posted by Elizabeth on August 7, 2001, at 15:49:36
In reply to Re: TCA serum levels, posted by Waterlily on August 6, 2001, at 21:54:31
> > Do you remember what the serum level was? (They probably checked both imipramine and desipramine levels.)
>
> Nope, but my psychiatrist is supposed to call me this week with the results of last week's test, so I'll ask him then.Thanks. I'm trying to get a feel for the relationship between dose and serum level in normal and slow metabolisers.
-elizabeth
Posted by Waterlily on August 8, 2001, at 16:15:52
In reply to Re: TCA serum levels » Waterlily, posted by Elizabeth on August 7, 2001, at 15:49:36
> > > Do you remember what the serum level was? (They probably checked both imipramine and desipramine levels.)
> >
> > Nope, but my psychiatrist is supposed to call me this week with the results of last week's test, so I'll ask him then.
>
> Thanks. I'm trying to get a feel for the relationship between dose and serum level in normal and slow metabolisers.
>
> -elizabethElizabeth, I still don't have the results, but I can tell you that my doctor said that it was unusual but not unheard of for my serum level to be so high given the low dose I'm on.
This is the end of the thread.
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