Posted by Brainbeard on August 6, 2010, at 4:28:03
In reply to Re: 'Bloody' Clomipramine » Brainbeard, posted by ed_uk2010 on August 5, 2010, at 18:00:18
> Perhaps you could post a link to a study which demonstrates that measuring clomipramine blood levels improves clinical outcome.
Sure, no problem.
"Clinical significance of plasma levels of clomipramine, its hydroxylated and desmethylated metabolites: prediction of clinical outcome in mood disorders using discriminant analysis of therapeutic drug monitoring data": http://www.ncbi.nlm.nih.gov/pubmed/8126313:
"(...) the overall correlations between drug concentrations and daily doses of clomipramine were highly significant. (...) Discriminant analysis of the data from drug concentrations and scores of Global Assessment of Functioning revealed that it is useful to monitor the concentrations of both desmethylated and hydroxylated metabolites in order to predict the clinical effects of clomipramine."
From a testing lab:
http://www.childrensmn.org/Manuals/Lab/Chemistry/028768.asp:
"Studies investigating the relationship between serum concentrations of clomipramine and norclomipramine and therapeutic response have yielded conflicting results. However, the probability of therapeutic failure seems to increase if the sum of the clomipramine and norclomipramine serum concentrations is <150 ng/mL. Summed serum concentrations of clomipramine and norclomipramine which exceed 450 ng/mL seem to result in no additional enhancement in therapeutic response and may predispose the patient to greater risk of adverse side affects."
For OCD, there has been more research concerning plasma levels and clinical outcome:
'The relationship of plasma clomipramine and N-desmethylclomipramine to response in obsessive-compulsive disorder':
http://www.ncbi.nlm.nih.gov/pubmed/2371366:
"A significant degree of correlation was also obtained between plasma levels of clomipramine, but not N-desmethylclomipramine, and post-treatment outcome measures."
'Clomipramine: plasma levels, side effects and outcome in obsessive-compulsive neurosis':
http://www.ncbi.nlm.nih.gov/pubmed/7393824:
"In general the response was best in the middle range of plasma concentrations, showing the inverted U curve well recognized with nortriptyline. However, the results of this study suggest that the response of compulsive rituals correlates with levels of plasma clomipramine, while depression appears to correlate with plasma levels of desmethylclomipramine."
'High blood concentrations of imipramine or clomipramine and therapeutic failure: a case report study using drug monitoring data':
http://www.ncbi.nlm.nih.gov/pubmed/2741190
>
> >blood work is imperative for any responsible doctor prescribing TCAs
>
> In that case, I can only assume that the majority of doctors are irresponsible.In the UK, perhaps, yes. As you may have noticed from the other reactions, outside the UK, it is common procedure to do blood work when prescribing TCA's, especially for the more toxic tertiary amine TCA's.
>
> >Clomipramine doesn't have numerous active metabolites; it has only one active metabolite (just like the other tertiaty amine TCA's), which is desmethylclomipramine, a potent NRI.
>
> Thank you Brainbeard, I am well aware that desmethylclomipramine is a potent NRI. Clomipramine does, however, have numerous metabolites. I would not like to presume that desmethylclomipramine is its only active metabolite. Not enough research has been done in this area.As the articles mentioned above already make clear, I indeed found out that clomipramine has a whole bunch of metabolites, which may be active. I stand corrected!
>
> Thank you for your comments.
>Most welcome, thank YOU.
Current meds: clomipramine 75mg, fluvoxamine 25mg.
poster:Brainbeard
thread:956845
URL: http://www.dr-bob.org/babble/20100731/msgs/957454.html