Drugs online research references
J Am Acad Child Adolesc Psychiatry. 1993 Mar;32(2):343-9.
Nortriptyline in the treatment of ADHD: a chart review of 58 cases.
Wilens TE, Biederman J, Geist DE, Steingard R, Spencer T.
Consolidated Department of Psychiatry, Massachusetts General Hospital, Boston 02114.
OBJECTIVE: The potential benefit of the tricyclic antidepressant medication, nortriptyline (NT), in the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD) was evaluated. METHOD: A systematic search was conducted from a computerized data base of all clinic patients in an outpatient pediatric psychopharmacology unit treated with NT for ADHD. The records of the 58 subjects identified (37 children and 21 adolescents) were reviewed for overall response, dose, serum levels, and adverse effects. RESULTS: Ninety-seven percent of the identified subjects had failed to respond to an average of four previous medication trials, 84% had at least one comorbid diagnosis with ADHD, and 47% were receiving at least one concurrent medication. NT doses ranged from 0.4 to 4.5 mg/kg (X +/- SD = 2.0 +/- 1.0 mg/kg) and subjects received NT from 0.4 to 57.9 months (11.9 +/- 14.0 months). Overall, 76% of subjects were considered to have a moderate to marked improvement by an independent rater, which was corroborated by their clinicians. There was no association between response and age, rate of comorbidity, number of previous medication trials, or concurrent pharmacotherapy (all p NS). Although there were no overall differences in serum NT levels between responders and nonresponders, significantly more patients within the suggested therapeutic range in adults of 50 to 150 ng/ml were classified as "markedly improved" than those outside this range (68% versus 35%, p < 0.03). Mild adverse effects were reported in 20 subjects (34%). CONCLUSIONS: These findings suggest that NT may be an effective well-tolerated agent for ADHD children and adolescents. Additional controlled investigations utilizing NT for ADHD should be undertaken.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8444763&dopt=Abstract
J Pharmacol Exp Ther. 1982 Jul;222(1):215-9.
Effects of tricyclic antidepressant and anticholinergic drugs on fixed-interval responding in the squirrel monkey.
McKearney JW.
Squirrel monkeys responded under fixed-interval schedules in which the first response after a fixed time period resulted either in the delivery of a food pellet or in the termination of stimuli associated with impending electric shock delivery. tricyclic antidepressant drugs markedly increased responding in 3 of 10 monkeys studied; less marked but reliable increases in responding were seen with 3 others, whereas the remaining 4 monkeys showed no increases in responding. Increases in responding were observed with amitriptyline HCl (0.1-17 mg/kg), imipramine HCl (0.3-17 mg/kg), chlorimipramine HCl (0.3-17 mg/kg), nortriptyline HCl (1-17 mg/kg) and desmethylimipramine HCl (1-17 mg/kg). Amitriptyline was most potent and desmethylimipramine least potent. The pattern of individual differences in the effects of the antidepressants was matched by a similar pattern of differences in the effects of atropine sulfate (0.03-1.7 mg/kg) and scopolamine HBr (0.003-0.3 mg/kg). That is, atropine and scopolamine increased responding only in those monkey showing increases in responding with the antidepressant drugs. In contrast, all monkeys showed increases in responding with the histamine H1 antagonist diphenhydramine HCl (0.3-17 mg/kg). The order of potency of the antidepressant drugs for producing response rate increases (i.e., amitriptyline greater than imipramine greater than desmethylimipramine) is the same as that reported by others for the affinity of these drugs for muscarinic binding sites in rat brain. This correspondence in relative potencies in addition to the similar pattern of individual differences produced by the antimuscarinic and antidepressant drugs suggests that the increases in responding observed were mediated by antimuscarinic properties of the antidepressant drugs.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7086700&dopt=Abstract
Eur J Clin Pharmacol. 1977 Jul 19;11(6):479-83.
Effect of simultaneous treatment with low doses of perphenazine on plasma and urine concentrations of nortriptyline and 10-hydroxynortriptyline.
Kragh-Sorensen P, Borga O, Garle M, Bolvig Hansen L, Hansen CE, Hvidberg EF, Larsen NE, Sjoqvist F.
Plasma levels of nortriptyline and perphenazine were measured in six patients on continuous nortriptyline treatment before, during and after oral administration of perphenazine 4 mg t.i.d. In four patients the plasma levels of the conjugated and unconjugated principal metabolite 10-hydroxynortriptyline were also measured. Urinary excretion of conjugated and unconjugated 10-hydroxynortriptyline and plasma levels of perphenazine were determined in all six patients. During treatment with perphenazine two patients showed a slight increase in the plasma level of nortriptyline. The changes in metabolite excretion rate were inconclusive. Thus, there did not appear to be any important pharmacokinetic interaction between the two drugs at the doses used, which were normal therapeutic doses. The previously reported inhibitory effect of perphenazine on the metabolism of nortriptyline probably depended therefore, either on administration of a higher dose of perphenazine, or on treatment in the reverse sequence--a single dose of nortriptyline was given to patients already receiving perphenazine.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=891595&dopt=Abstract
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