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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Ame Sans Vie on August 29, 2004, at 7:46:55
Does anyone know if there is a therapeutic window for desipramine that can be determined by blood level? I've been taking 200mg daily for close to three weeks now and possibly experiencing some benefit... at the very least it's given my Adderall more of a punch! No side effects at this dose either, save a very mild orthostatic hypotension that I can easily put up with. I'd just like to decide at what point I'm going to consider my desipramine trial a wash and jump on the Cymbalta bandwagon (and/or give selegiline a try at an MAO-B selective dose, along with pharmaceutical beta-phenylethylamine).
~Michael
Posted by Larry Hoover on August 29, 2004, at 8:07:55
In reply to Blood levels for desipramine?, posted by Ame Sans Vie on August 29, 2004, at 7:46:55
> Does anyone know if there is a therapeutic window for desipramine that can be determined by blood level?
The lower bound of therapeutic response to desipramine is 116 ng/ml. The upper bound is not clearly established (i.e. that point at which toxicity effects become significant, vis a vis response).
Do you think you can get tested for desipramine concentration? Way cool, if you can.
> I've been taking 200mg daily for close to three weeks now and possibly experiencing some benefit... at the very least it's given my Adderall more of a punch! No side effects at this dose either, save a very mild orthostatic hypotension that I can easily put up with.
You're a tad impatient. Three weeks is not long enough to judge response. Three months is.
> I'd just like to decide at what point I'm going to consider my desipramine trial a wash and jump on the Cymbalta bandwagon (and/or give selegiline a try at an MAO-B selective dose, along with pharmaceutical beta-phenylethylamine).
>
> ~MichaelDo you have any idea what your 2D6 status is? Extensive metabolizers only sustain desipramine concentrations below 50 ng/ml.
Lar
Posted by Ame Sans Vie on August 29, 2004, at 8:50:10
In reply to Re: Blood levels for desipramine? » Ame Sans Vie, posted by Larry Hoover on August 29, 2004, at 8:07:55
> The lower bound of therapeutic response to desipramine is 116 ng/ml. The upper bound is not clearly established (i.e. that point at which toxicity effects become significant, vis a vis response).
>
> Do you think you can get tested for desipramine concentration? Way cool, if you can.Hopefully -- I plan on calling my pdoc about it tomorrow.
> > I've been taking 200mg daily for close to three weeks now and possibly experiencing some benefit... at the very least it's given my Adderall more of a punch! No side effects at this dose either, save a very mild orthostatic hypotension that I can easily put up with.
>
> You're a tad impatient. Three weeks is not long enough to judge response. Three months is.lol, not impatient so much as pessimistic. I don't expect this stuff to work out in the long run, and besides, I'm a bit concerned about the cardio effects. My blood pressure's definitely a bit higher than normal.
> Do you have any idea what your 2D6 status is? Extensive metabolizers only sustain desipramine concentrations below 50 ng/ml.
I'm definitely an extensive metabolizer... I dunno, guess I'll have to see how it goes.
~Michael
Posted by SLS on August 29, 2004, at 10:35:50
In reply to Re: Blood levels for desipramine?, posted by Ame Sans Vie on August 29, 2004, at 8:50:10
Hi Michael.
Since there is no efficacy window with desipramine as there is with nortriptyline, it is probably easiest just to continue titrating clinically to 300mg if you are tolerating the drug side effects. Roughly speaking, as listed in the PDR, 200mg is for outpatients and 300mg is for more severe inpatients. You can use blood levels as a guide to make sure you are not way underdosed or overdosed, but as Larry suggested, there is really no upper bounds established as a maximum beyond which there is no further therapeutic value. I am not you (in case you haven't noticed), but I don't glean maximum benefit (which isn't much) until I reach 300mg. I would just go for it. You'll reach a conclusion to your trial that much quicker. I would give 200mg no more than 3 weeks before moving up. After an additional 3 weeks, if you feel no improvement and have no intentions of augmenting with lithium, you can make the decision to terminate the trial. If you do respond at the 6 week mark, and are not convinced you need the full 300mg, you can try dropping back. You'll find out very quickly.
Just a suggestion. It is somewhat aggressive.
- Scott
Posted by King Vultan on August 29, 2004, at 12:22:05
In reply to Blood levels for desipramine?, posted by Ame Sans Vie on August 29, 2004, at 7:46:55
It may vary a little depending on the particular standard the lab doing the test uses, but typically, the therapeutic blood plasma range for desipramine is in the range of 125-300 ng/ml. This was the standard used by the lab that did my tests last year; it is also the level indicated in "Psychotropic Drugs" in the profile for desipramine.
Todd
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