A cimetidine-nortriptyline interaction in a 52-year-old black male is reported. After concomitant administration of cimetidine and nortriptyline for two weeks, steady-state nortriptyline concentrations fell 42 percent when cimetidine was discontinued. Later, during rechallenge with cimetidine, serum nortriptyline concentrations increased significantly, but subsequently fell again when cimetidine was discontinued. The possible clinical consequences of this interaction are discussed.
AsbergMCronholmBSjoquistF. Relationship between plasma level and therapeutic effect of nortriptyline. Br Med J1971; 3: 331–4.
2.
ZeiglerVEClaytonPJBiggsJT. A comparison study of amitriptyline and nortriptyline with plasma levels. Arch Gen Psychiatry1977; 34: 607–12.
3.
Kragh-SorensenPEffert-HansenCBaastrupPC. Self-inhibiting action of nortriptyline antidepressive effect at high plasma levels. Psychopharmacologia (Berlin)1976; 45: 305–12.
4.
GramLFOverKF. Drug interaction: inhibitory effect of neuroleptics on metabolism of tricyclic antidepressants in man. Br Med J1972; 1: 463–5.
5.
BurrowsGDDaviesB. Antidepressants and barbiturates. Br Med J1971; 4: 113.
6.
RendicSSunjicVTosoRKajfezF. Interaction of cimetidine with liver microsomes. Xenobiotica1979; 9: 555–64.
7.
WilliamsRLMamelakRD. Hepatic disease and drug pharmacokinetics. Clin Pharmacokinet1980; 5: 528–47.
8.
SomogyiAGuglerR. Drug interactions with cimetidine. Clin Pharmacokinet1982; 7: 23–41.
9.
MillerDDMacklinM. Cimetidine-imipramine interaction: a case report. Am J Psychiatry1983; 140: 351–2.
10.
GramLFOverKF. First-pass metabolism of nortriptyline in man. Clin Pharmacol Ther1975; 18: 305–14.
