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Clinical Chemistry 34: 822-828, 1988;
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Clinical Chemistry, Vol 34, 822-828, Copyright © 1988 by American Association for Clinical Chemistry

Therapeutic drug monitoring of tricyclic antidepressants

SH Preskorn, RC Dorey and GS Jerkovich
Department of Psychiatry, University of Kansas School of Medicine, Wichita 67214.

The traditional dose-response method of medication adjustment depends on several assumptions that are not met in the case of tricyclic antidepressants (TCAs), which makes therapeutic drug monitoring (TDM) particularly useful with these drugs. TDM can facilitate treatment by providing objective guidelines for dose adjustment. It provides a means of assessing compliance, ensuring an effective concentration, and avoiding toxicity. The latter is an often-overlooked benefit of therapeutic monitoring of TCAs and yet is just as important as improving response. The cardiac and central nervous system toxicity of TCAs is concentration-dependent and potentially life-threatening. Such toxicity will predictably occur in up to 5% of patients on standard antidepressant doses of TCAs when TDM is not used to rationally adjust the dose. Without TDM, such toxicity is difficult to detect early. A cost/benefit analysis supports the cost effectiveness of TDM as a standard part of TCA chemotherapy when doses in the 100-300 ng/day range are used.


The following articles in journals at HighWire Press have cited this article:


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 Clin. Chem.Home page
M. W. Linder and P. E. Keck Jr.
Standards of laboratory practice: antidepressant drug monitoring
Clin. Chem., May 1, 1998; 44(5): 1073 - 1084.
[Abstract] [Full Text] [PDF]

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 Clin. Chem.Home page
P. D. Walson
Therapeutic drug monitoring in special populations
Clin. Chem., February 1, 1998; 44(2): 415 - 419.
[Abstract] [Full Text] [PDF]


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