Toxicokinetics of nortriptyline and amitriptyline: Two case reports

E. J.F. Franssen; P. W.A. Kunst; P. M. Bet; R. J.M. Strack van Schijndel; A. C. Van Loenen; A. J. Wilhelm

doi:https://doi.org/10.1097/00007691-200304000-00018

Toxicokinetics of nortriptyline and amitriptyline: Two case reports

E. J.F. Franssen, P. W.A. Kunst, P. M. Bet, R. J.M. Strack van Schijndel, A. C. Van Loenen, A. J. Wilhelm

Research output: Contribution to journal › Article › Academic › peer-review

19 Citations (Scopus)

Abstract

Two cases are presented of intentional intoxications with the tricyclic antidepressants (TCAs) nortriptyline (NT) and amitriptyline (AT). The peak plasma concentrations were 2290 μg/L and 2900 μg/L, respectively. The active metabolites E-10-hydroxynortriptyline (EHNT) and Z-10-hydroxynortriptyline (ZHNT) profiles were quite different as monitored for 5 to 10 days after presumed drug intake. In conclusion, these cases illustrate that (1) metabolite formation and elimination after intake of an overdose dose of NT and AT are stereoselective, and (2) NT and EHNT toxicokinetics and toxicodynamics are quite different. It also shows that a patient with a severe TCA overdose can still survive if he or she receives appropriate and quick supportive care, even if the prognostic markers QRS time, coma grade, and serum TCA levels predict poor outcome.

Original language	English
Pages (from-to)	248-251
Number of pages	4
Journal	Therapeutic drug monitoring
Volume	25
Issue number	2
DOIs	https://doi.org/10.1097/00007691-200304000-00018
Publication status	Published - Apr 2003

Keywords

Critical care
Intoxication
Overdose
Prognostic factors
Tricyclic antidepressants

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title = "Toxicokinetics of nortriptyline and amitriptyline: Two case reports",

abstract = "Two cases are presented of intentional intoxications with the tricyclic antidepressants (TCAs) nortriptyline (NT) and amitriptyline (AT). The peak plasma concentrations were 2290 μg/L and 2900 μg/L, respectively. The active metabolites E-10-hydroxynortriptyline (EHNT) and Z-10-hydroxynortriptyline (ZHNT) profiles were quite different as monitored for 5 to 10 days after presumed drug intake. In conclusion, these cases illustrate that (1) metabolite formation and elimination after intake of an overdose dose of NT and AT are stereoselective, and (2) NT and EHNT toxicokinetics and toxicodynamics are quite different. It also shows that a patient with a severe TCA overdose can still survive if he or she receives appropriate and quick supportive care, even if the prognostic markers QRS time, coma grade, and serum TCA levels predict poor outcome.",

keywords = "Critical care, Intoxication, Overdose, Prognostic factors, Tricyclic antidepressants",

author = "Franssen, {E. J.F.} and Kunst, {P. W.A.} and Bet, {P. M.} and {Strack van Schijndel}, {R. J.M.} and {Van Loenen}, {A. C.} and Wilhelm, {A. J.}",

year = "2003",

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T2 - Two case reports

AU - Franssen, E. J.F.

AU - Kunst, P. W.A.

AU - Bet, P. M.

AU - Strack van Schijndel, R. J.M.

AU - Van Loenen, A. C.

AU - Wilhelm, A. J.

PY - 2003/4

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N2 - Two cases are presented of intentional intoxications with the tricyclic antidepressants (TCAs) nortriptyline (NT) and amitriptyline (AT). The peak plasma concentrations were 2290 μg/L and 2900 μg/L, respectively. The active metabolites E-10-hydroxynortriptyline (EHNT) and Z-10-hydroxynortriptyline (ZHNT) profiles were quite different as monitored for 5 to 10 days after presumed drug intake. In conclusion, these cases illustrate that (1) metabolite formation and elimination after intake of an overdose dose of NT and AT are stereoselective, and (2) NT and EHNT toxicokinetics and toxicodynamics are quite different. It also shows that a patient with a severe TCA overdose can still survive if he or she receives appropriate and quick supportive care, even if the prognostic markers QRS time, coma grade, and serum TCA levels predict poor outcome.

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KW - Critical care

KW - Intoxication

KW - Overdose

KW - Prognostic factors

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Toxicokinetics of nortriptyline and amitriptyline: Two case reports

Abstract

Keywords

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