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Pharmacopsychiatry 1996; 29(3): 108-110
DOI: 10.1055/s-2007-979554
Case Report

© Georg Thieme Verlag Stuttgart · New York

Pharmacokinetic Fluvoxamine - Clomipramine Interaction with Favorable Therapeutic Consequences in Therapy-resistant Depressive Patient

P. Conus1 , G. Bondolfi1 , C. B. Eap1 , F. Macciardi2 , P. Baumann1
  • 1Département universitaire de psychiatrie adulte, Site de Cery, Prilly-Lausanne, Switzerland
  • 2University of Milano, San Raffaele Hospital, Department of Neurosciences, Milano, Italy
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Publication Date:
23 April 2007 (online)

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Abstract

We describe the case of a depressive patient who was a rapid metabolizer of CYP2D6 substrates and a heavy smoker, and who did not respond to several courses of treament with antidepressants, as a result of unusually low drug-plasma levels. During hospitalization, he did not improve after treatment with clomipramine (150 - 225 mg/day during three weeks), but showed a response within four days after addition of fluvoxamine (100 mg/day). Plasma levels of clomipramine and desmethylclomipramine changed from 58 ng/ml and 87 ng/ml to 223 ng/ml and 49 ng/ml respectively one week after addition of fluvoxamine. Present knowledge of the role of cytochrome P-450 isozymes, such as CYP1A2, CYP2C19, CYP2D6, and CYP3A4, in the metabolism of psychotropic drugs as well as therapeutic drug-plasma level monitoring may thus help to determine individual treatment.

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