Influence of concomitant medications on the total clearance and the risk for supra-therapeutic plasma concentrations of Citalopram. A population-based cohort study.

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RESEARCH PRODUCT

Influence of concomitant medications on the total clearance and the risk for supra-therapeutic plasma concentrations of Citalopram. A population-based cohort study.

K Wenzel-seifert C Hiemke E Haen R Brandl

subject

Drug Adult Male medicine.medical_specialty Metabolic Clearance Rate media_common.quotation_subject Population Pharmacology Citalopram Citalopram Logistic regression behavioral disciplines and activities Sex Factors Pharmacokinetics Risk Factors Internal medicine mental disorders medicine Cytochrome P-450 Enzyme Inhibitors Humans Pharmacology (medical)Body Weights and Measures Drug Interactions education media_common Aged Retrospective Studies Cytochrome P-450 Enzyme Inducers education.field_of_study medicine.diagnostic_test Dose-Response Relationship Drug business.industry Age Factors Retrospective cohort study General Medicine Middle Aged Psychiatry and Mental health Therapeutic drug monitoring Concomitant Antidepressive Agents Second-Generation Female Drug Monitoring business Selective Serotonin Reuptake Inhibitors medicine.drug

description

Introduction: The main objective of this study was to investigate the influence of the use of multiple medications and other risk factors on citalopram plasma concentrations. Methods: A retrospective cohort study with a naturalistic population of 957 patients for whom routine therapeutic drug monitoring (TDM) of citalopram had been requested between 2006 and 2013 was conducted. Results: Concomitant drugs inhibiting at least 2 different CYP subtypes involved in the metabolism of citalopram decreased statistically significantly the total clearance (Clt). Compared to younger patients over 64-year-old patients had on average a 4.5 times higher risk rate of supra-therapeutic plasma concentrations. However, binary logistic regression showed that age, sex and co-medication accounted only for 26% of the inter-individual variability of citalopram plasma concentrations. Discussion: Due to pharmacokinetic interactions, citalopram plasma concentrations are often higher than expected with a given dose. Especially in geriatric and often multimorbid patients who are usually prescribed high numbers of concomitant drugs and are at higher risk for adverse drug reactions (ADR), restriction of the maximal dose of citalopram is not sufficient to prevent supra-therapeutic plasma concentrations.

year	journal	country	edition	language
2014-11-05	Pharmacopsychiatry

10.1055/s-0034-1390477 https://pubmed.ncbi.nlm.nih.gov/25372890