Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
Pharmacokinetic fluvoxamine-clomipramine interaction with favorable therapeutic consequences in therapy-resistant depressive patient.
Publication types: Case Reports ; Journal ArticlePublication Status: ppublish
We describe the case of a depressive patient who was a rapid metabolizer of CYP2D6 substrates and a heavy smoker, and who did not respond to several courses of treatment with antidepressants, as a result of unusually low drug-plasma levels. During hospitalization, he did not improve after treatment with clomipramine (150-225 mg/day during three weeks), but showed a response within four days after addition of fluvoxamine (100 mg/day). Plasma levels of clomipramine and desmethylclomipramine changed from 58 ng/ml and 87 ng/ml to 223 ng/ml and 49 ng/ml respectively one week after addition of fluvoxamine. Present knowledge of the role of cytochrome P-450 isozymes, such as CYP1A2, CYP2C19, CYP2D6, and CYP3A4, in the metabolism of psychotropic drugs as well as therapeutic drug-plasma level monitoring may thus help to determine individual treatment.
Antidepressive Agents, Second-Generation/pharmacokinetics, Antidepressive Agents, Second-Generation/therapeutic use, Antidepressive Agents, Tricyclic/pharmacokinetics, Antidepressive Agents, Tricyclic/therapeutic use, Clomipramine/pharmacokinetics, Clomipramine/therapeutic use, Combined Modality Therapy, Cytochrome P-450 CYP2D6/genetics, Cytochrome P-450 CYP2D6/metabolism, Depressive Disorder/drug therapy, Depressive Disorder/metabolism, Drug Interactions, Drug Resistance, Electroconvulsive Therapy, Fluvoxamine/pharmacokinetics, Fluvoxamine/therapeutic use, Humans, Male, Middle Aged, Phenotype, Psychiatric Status Rating Scales, Smoking/metabolism
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