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[Severe nortriptyline poisoning in poor metabolizers of the sparteine type]. 1991

P Petersen, and K Brøsen
Odense Sygehus, Psykigtrisk afdeling P.

Approximately 7% of the Danish population are so called poor metabolizers (PM) as regards the model compound sparteine. These individuals lack the P450 isozyme which is mainly responsible for elimination of at least 20 different medicaments including nortriptyline. A woman aged 42 years suffering from depression was treated with 100 mg nortriptyline daily and, during the course of treatment, she developed a toxic serum nortriptyline level (approximately 2,100 nM). Treatment was withdrawn temporarily on account of severe side-effects. The depression recurred. During the medicine-free period, a sparteine test was performed and this demonstrated that the patient was a poor metabolizer. Scarcely two months after hospitalization, treatment was recommenced with 25 mg nortriptyline daily after which the patient's depression disappeared completely without any side-effects of note.

UI MeSH Term Description Entries
D007527 Isoenzymes Structurally related forms of an enzyme. Each isoenzyme has the same mechanism and classification, but differs in its chemical, physical, or immunological characteristics. Alloenzyme,Allozyme,Isoenzyme,Isozyme,Isozymes,Alloenzymes,Allozymes
D009661 Nortriptyline A metabolite of AMITRIPTYLINE that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions. Desitriptyline,Desmethylamitriptylin,Allegron,Apo-Nortriptyline,Aventyl,Gen-Nortriptyline,Norfenazin,Nortrilen,Nortriptyline Hydrochloride,Novo-Nortriptyline,Nu-Nortriptyline,PMS-Nortriptyline,Pamelor,Paxtibi,ratio-Nortriptyline,Apo Nortriptyline,Gen Nortriptyline,Hydrochloride, Nortriptyline,Novo Nortriptyline,Nu Nortriptyline,PMS Nortriptyline,ratio Nortriptyline
D003577 Cytochrome P-450 Enzyme System A superfamily of hundreds of closely related HEMEPROTEINS found throughout the phylogenetic spectrum, from animals, plants, fungi, to bacteria. They include numerous complex monooxygenases (MIXED FUNCTION OXYGENASES). In animals, these P-450 enzymes serve two major functions: (1) biosynthesis of steroids, fatty acids, and bile acids; (2) metabolism of endogenous and a wide variety of exogenous substrates, such as toxins and drugs (BIOTRANSFORMATION). They are classified, according to their sequence similarities rather than functions, into CYP gene families (>40% homology) and subfamilies (>59% homology). For example, enzymes from the CYP1, CYP2, and CYP3 gene families are responsible for most drug metabolism. Cytochrome P-450,Cytochrome P-450 Enzyme,Cytochrome P-450-Dependent Monooxygenase,P-450 Enzyme,P450 Enzyme,CYP450 Family,CYP450 Superfamily,Cytochrome P-450 Enzymes,Cytochrome P-450 Families,Cytochrome P-450 Monooxygenase,Cytochrome P-450 Oxygenase,Cytochrome P-450 Superfamily,Cytochrome P450,Cytochrome P450 Superfamily,Cytochrome p450 Families,P-450 Enzymes,P450 Enzymes,Cytochrome P 450,Cytochrome P 450 Dependent Monooxygenase,Cytochrome P 450 Enzyme,Cytochrome P 450 Enzyme System,Cytochrome P 450 Enzymes,Cytochrome P 450 Families,Cytochrome P 450 Monooxygenase,Cytochrome P 450 Oxygenase,Cytochrome P 450 Superfamily,Enzyme, Cytochrome P-450,Enzyme, P-450,Enzyme, P450,Enzymes, Cytochrome P-450,Enzymes, P-450,Enzymes, P450,Monooxygenase, Cytochrome P-450,Monooxygenase, Cytochrome P-450-Dependent,P 450 Enzyme,P 450 Enzymes,P-450 Enzyme, Cytochrome,P-450 Enzymes, Cytochrome,Superfamily, CYP450,Superfamily, Cytochrome P-450,Superfamily, Cytochrome P450
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013034 Sparteine A quinolizidine alkaloid isolated from several FABACEAE including LUPINUS; SPARTIUM; and CYTISUS. It has been used as an oxytocic and an anti-arrhythmia agent. It has also been of interest as an indicator of CYP2D6 genotype. 7,14-Methano-2H,6H-dipyrido(1,2-a:1',2'-e)(1,5)diazocine, dodecahydro-, (7S-(7alpha,7aalpha,14alpha,14abeta))-,Lupinidin,Lupinidine,Pachycarpine,D-sparteine,Depasan Retard,Genisteine Alkaloid,L-Sparteine,Pachycarpine Sulfate (1:1), Pentahydrate, (7S-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Hydrochloride, (7R-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Hydrochloride, (7S-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Hydroiodide, (7R-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Monohydrochloride, (7R-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Monohydroiodide, (7R-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Sulfate,Sparteine Sulfate (1:1), (7S-(7alpha,7aalpha,14alpha,14aalpha))-Isomer,Sparteine Sulfate (1:1), (7S-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine Sulfate Anhydrous,Sparteine, (+)-Isomer,Sparteine, (-)-Isomer,Sparteine, (7R-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine, (7R-(7alpha,7abeta,14alpha,14abeta))-Isomer,Sparteine, (7S-(7alpha,7aalpha,14alpha,14aalpha))-Isomer,Sparteine, (7S-(7alpha,7aalpha,14alpha,14abeta))-Isomer,Sparteine, (7S-(7alpha,7abeta,14alpha,14abeta))-Isomer,alpha-Isosparteine,beta-Isosparteine,Anhydrous, Sparteine Sulfate,Sulfate Anhydrous, Sparteine,alpha Isosparteine,beta Isosparteine

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