PREDICTING DESIPRAMINE LEVELS IN CHILDREN AND ADOLESCENTS - A NATURALISTIC CLINICAL-STUDY

Objective: To determine the predictability and stability of desipramin e (DMI) concentrations in a clinically treated sample of children, est imating the risk of developing potentially toxic DMI levels at a highe r dose after a most recent level in a clinically acceptable range. Met hod: Subjects were 90 consecutive psychiatrically referred children an d adolescents treated with DMI with at least two assays of serum DMI c oncentrations (462 pairs). Assay data were analyzed after log transfor mation and linear regression. Results: Despite wide between-patient va riability in serum DMI levels at the same dose, future within-subject DMI blood levels were highly predictable from knowledge of current lev els, current dose, and the future dose. When the DMI serum level was 2 00 to 300 ng/mL, there was a 7.0% risk for subsequent levels at the sa me dose to exceed 300 ng/mL, but potentially toxic levels above 500 ng /mL were very infrequent (1.7%). Conclusions: Although the results of this naturalistic clinical study may not generalize to other situation s, the results indicate a reasonable stability, predictability, and sa fety of DMI levels in individual psychiatrically treated children that result from clinically chosen dose changes.