PRELIMINARY-OBSERVATIONS OF THE SIGNIFICANCE OF MONITORING TRICYCLIC ANTI-DEPRESSANT PLASMA-LEVELS IN THE PEDIATRIC-PATIENT

Abstract

Plasma concentrations of clomipramine and demethylclomipramine were monitored together with clinical effects over a period of 1-9 mo. in children and young adolescents (5-19 yr of age) receiving clomipramine because of depressive features of enuresis. In the child, clomipramine is apparently rapidly absorbed while its disposition rate is age dependent, as indicated by the significantly lower level:dose ratio (P < 0.01) observed in the younger groups (5-10; 10-15 yr). The incidence of side effects was clearly related to clomipramine plasma concentrations; no relationship could be observed for the demethyl metabolite. In the case of enuresis, a therapeutic effect was observed at clomipramine concentrations of 20-60 ng/ml, while lower or higher levels were associated with lack of therapeutic effect of adverse effects. No relationship was found between oral daily doses and clomipramine or demethylclomipramine plasma concentrations.