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Therapeutic drug monitoring of escitalopram in an outpatient setting

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Author

  • Margareta Reis
  • Maria D. Cherma
  • Bjorn Carlsson
  • Finn Bengtsson

Summary, in English

The main objectives of this study were to outline the inter-and intraindividual and overall pharmacokinetic variability of S-citalopram, S-desmethylcitalopram, and S-didesmethylcitalopram in serum by means of therapeutic drug monitoring; and to investigate potential correlations between the serum concentration and simultaneously collected clinical data. The study was conducted on outpatients in Sweden in 2002 to 2005. Included in the pharmacokinetic evaluation were 155 patients (68% women and 32% men) aged 17 to 95 years (average, 51 years). One serum sample per patient, taken as a trough value insteady state, was assessed. For the inter- and intraindividual variation calculation, 16 patients were included with two eligible samples each. The median daily dose was 20 mg/day (range, 5-40 mg). Extensive overall serum concentration variability was seen for all dose levels. The interindividual coefficient of variation for dose-normalized concentrations was 71% for S-citalopram, 36% for S-desmethylcitalopram, and 50% for S-didesmethylcitalopram. The intraindividual variations over time for the same parameters were approximately 30%, except for the ratio S-desmethylcitalopram/Scitalopram, which was 23%. The median S-desmethylcitalopram level was approximately 60% of the parent substance and the S-didesmethylcitalopram level approximately 9%. Higher age was correlated with higher serum concentrations, but no gender-related concentration differences were found. A majority (76%) of the patients took one or more drugs in addition to escitalopram, but concomitant medication did not seem to interact with escitalopram. However, women taking oral contraceptives showed a lower metabolic ratio compared with age-matched women. As a result of the wide range of the ratio in this population, these findings are not considered of clinical relevance.

Publishing year

2007

Language

English

Pages

758-766

Publication/Series

Therapeutic Drug Monitoring

Volume

29

Issue

6

Document type

Journal article

Publisher

Lippincott Williams & Wilkins

Topic

  • Medicinal Chemistry
  • Pharmacology and Toxicology

Keywords

  • serum concentration
  • SSRI
  • therapeutic drug monitoring
  • escitalopram

Status

Published

ISBN/ISSN/Other

  • ISSN: 0163-4356