Pronounced inhibition of noradrenaline uptake by 10-hydroxymetabolites of nortriptyline

The potency of the tricyclic antidepressant nortriptyline (NT) relative to that of its major metabolite (E-10-hydroxynortriptyline; E-10-OH-NT) to inhibit the uptake of noradrenaline in rat brain slices incubated in human plasma was 1.75 ± S.D. 0.30. The E- and Z-isomers of 10-OH-NT were equipotent. Hydroxy-metabolites of NT or amitriptyline did not inhibited the neuronal uptake of serotonin.During treatment of 87 patients with NT or amitriptyline the mean ratio between the plasma levels of unconjugated 10-OH-NT and NT was 1.40 ± S.D. 0.86 with a range of 0.32 – 5.0. This ratio increased with age. There was a significant correlation between the plasma levels of the two compounds (r = 0.63; p < 0.001). In three patients treated with NT, the CSF levels of the parent drug and unconjugated 10-OH-NT were similar and about 5 % of the plasma levels.These results indicate that during treatment with NT (or amitriptyline) 10-OH-NT contributes to the effect of these drugs on central noradrenergic neurons. This seems to be of special significance in the elderly.