Document Detail

Prolonged toxicity after amitriptyline overdose in a patient deficient in CYP2D6 activity.
MedLine Citation:
PMID:  21614669     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Amitriptyline and its metabolite, nortriptyline, are metabolized, in part, by CYP2D6, a polymorphic enzyme. About 8% of Caucasians are deficient in CYP2D6 activity.
CASE REPORT: We present the case of a comatose woman who intentionally overdosed on amitriptyline and displayed rising serum total tricyclic antidepressant concentrations for at least 6 days after admission. Serial immunoassay total tricyclic antidepressant concentrations in our patient showed gradual decline beginning day 7, although the patient did not regain normal mental status until day 12. Genotyping revealed the patient to be homozygous for the CYP2D6*4 allele, the most common explanation of CYP2D6 enzymatic deficiency among Caucasians. Patients taking tricyclic antidepressants who are homozygous for CYP2D6*4 demonstrate >3 times concentration-time curve (AUCs) and prolonged elimination half-lives, especially of secondary amines such as nortriptyline.
DISCUSSION: We believe this is the first report describing toxicokinetics after tricyclic antidepressant overdose in a CYP2D6-deficient patient.
Jennifer Cohen Smith; Steven C Curry
Related Documents :
17013209 - Oxygen delivery and outcome.
2921259 - Smoke inhalation and airway management at a regional burn unit: 1974-1983. part i: diag...
3601489 - Impaired sensitivity of a single early leukocyte count in screening for neonatal sepsis.
8914569 - Accuracy of pulse oximetry in pigmented patients.
18695609 - Thigh burn associated with laptop computer use.
104679 - Outpatient oxygen therapy in chronic obstructive pulmonary disease. a review of 13 year...
290029 - Localization of hormone-producing gastrointestinal tumours by ultrasonic scanning.
9502849 - Noninvasive mechanical body contouring: (endermologie) a one-year clinical outcome stud...
637719 - Proximal hepatic duct reconstruction. repair using sutureless mucosal graft hepaticojej...
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of medical toxicology : official journal of the American College of Medical Toxicology     Volume:  7     ISSN:  1937-6995     ISO Abbreviation:  J Med Toxicol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-08     Completed Date:  2011-11-30     Revised Date:  2013-07-31    
Medline Journal Info:
Nlm Unique ID:  101284598     Medline TA:  J Med Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  220-3     Citation Subset:  IM    
Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Alprazolam / poisoning
Amitriptyline / blood,  poisoning*
Antidepressive Agents, Tricyclic / blood,  poisoning*
Body Temperature / drug effects
Brain / pathology
Coma / chemically induced
Cytochrome P-450 CYP2D6 / deficiency*,  genetics
Drug Overdose
Gas Chromatography-Mass Spectrometry
Hemodynamics / physiology
Hypnotics and Sedatives / poisoning
Magnetic Resonance Imaging
Middle Aged
Respiration, Artificial
Suicide, Attempted
Reg. No./Substance:
0/Antidepressive Agents, Tricyclic; 0/Hypnotics and Sedatives; 28981-97-7/Alprazolam; 50-48-6/Amitriptyline; EC P-450 CYP2D6

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Robotic-assisted Roux-en-Y gastric bypass performed in a community hospital setting: the future of b...
Next Document:  Decisions for lung cancer chemotherapy: the influence of physician and patient factors.