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Steady-state serum concentrations of venlafaxine in patients with late-life depression. Impact of age, sex and BMI

  • Psychiatry and Preclinical Psychiatric Studies - Original Article
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Abstract

Diagnosis of late-life depression is given when depressive symptoms emerge in persons older than 65 years. Great care is needed when elderly patients receive psychopharmacotherapy due to altered pharmacokinetic status. As a consequence, age is considered to have a significant effect on serum concentrations of antidepressant drugs. The magnitudes of age-dependent changes, however, are uncertain. By utilizing a large therapeutic drug monitoring (TDM) database, this cross-sectional study aimed to retrospectively assess pharmacotherapy in elderly patients in comparison with their younger counterparts, when treated with venlafaxine, which is widely used to treat late-life depression. In addition, the influence of sex and body mass index (BMI) was evaluated. Serum concentrations of venlafaxine and its active metabolite O-desmethylvenlafaxine requested during routine TDM in two University Medical Centers in Germany were analyzed. Patients with concomitant CYP2D6 inhibiting drugs as co-medication were excluded. In total, 1,417 samples were available for the analysis. Elderly patients had by average 42 % higher dose-adjusted serum concentrations (ng/mL/mg) of the active moiety (venlafaxine plus O-desmethylvenlafaxine) than younger patients. In addition, our study demonstrated that the difference between age groups is independent of sex and BMI. However, age groups only explain 4.5 % of the total dose-adjusted serum concentration variation of the venlafaxine active moiety. Dose adjustments for venlafaxine are recommended in patients aged 65 years or older, particularly in elderly female patients who are exceptionally vulnerable to high serum concentrations of venlafaxine. TDM is recommended during venlafaxine pharmacotherapy.

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Conflict of interest

Authors report no conflict of interest. The design, analysis and interpretation of the data, writing of the report and decision to submit the paper for publication were entirely responsible by the author and co-authors. H. Sigurdsson conducted an internship at the University Medical Center in Mainz, Germany, supervised by Prof. C. Hiemke, as a part of an MSc degree from Maastricht University, The Netherlands.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany

    H. P. Sigurdsson & C. Hiemke

  2. Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany

    N. Ben-Omar, A. Köstlbacher, K. Wenzel-Seifert & E. Haen

  3. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre Mainz, Mainz, Germany

    G. Hefner

Authors
  1. H. P. Sigurdsson
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  2. G. Hefner
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  3. N. Ben-Omar
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  4. A. Köstlbacher
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  5. K. Wenzel-Seifert
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  6. C. Hiemke
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  7. E. Haen
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Correspondence to H. P. Sigurdsson.

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Sigurdsson, H.P., Hefner, G., Ben-Omar, N. et al. Steady-state serum concentrations of venlafaxine in patients with late-life depression. Impact of age, sex and BMI. J Neural Transm 122, 721–729 (2015). https://doi.org/10.1007/s00702-014-1317-9

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  • DOI: https://doi.org/10.1007/s00702-014-1317-9

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