Olanzapine: Interaction Study with Imipramine

Authors

  • Dr. John T. Callaghan MD, PhD,

    Corresponding author
    1. Lilly Laboratory for Clinical Research, Wishard Memorial Hospital and Indiana University Medical School, Department of Medicine and Pharmacology, Indianapolis, Indiana.
      Lilly Laboratory for Clinical Research, Wishard Memorial Hospital, 1001 West 10th Street, Indianapolis, IN 46202.
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  • Benito J. Cerimele PhD,

    1. Lilly Laboratory for Clinical Research, Wishard Memorial Hospital and Indiana University Medical School, Department of Medicine and Pharmacology, Indianapolis, Indiana.
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  • Kelem J. Kassahun PhD,

    1. Lilly Laboratory for Clinical Research, Wishard Memorial Hospital and Indiana University Medical School, Department of Medicine and Pharmacology, Indianapolis, Indiana.
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  • Eldon H. Nyhart Jr. PhD,

    1. Lilly Laboratory for Clinical Research, Wishard Memorial Hospital and Indiana University Medical School, Department of Medicine and Pharmacology, Indianapolis, Indiana.
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  • Dr. Pamela J. Hoyes-Beehler PhD,

    1. University of Texas at Arlington, Human Performance Institute.
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  • Dr. George V. Kondraske PhD

    1. University of Texas at Arlington, Human Performance Institute.
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Lilly Laboratory for Clinical Research, Wishard Memorial Hospital, 1001 West 10th Street, Indianapolis, IN 46202.

Abstract

Olanzapine is an “atypical” antipsychotic agent with a high affinity for serotonin 5HT2A/C, 5HT3, 5HT6, and dopamine D1, D2, D3, D4 receptors. Depressed patients with psychotic disorders frequently require treatment with concomitant antipsychotic and antidepressant medications. Imipramine pharmacokinetics serve as a marker for hepatic CYP2D6, CYP1A2, CYP3A activity. An open-label, three-way randomized crossover study was done to determine the safety, pharmacokinetics, and potential for a drug interaction between olanzapine (5 mg) and imipramine (75 mg). Each drug was administered alone and in combination. Nine healthy men, ages 32 to 54 years, enrolled in the study. Psychomotor performance capacities, plasma olanzapine, imipramine, desipramine concentrations, and clinical laboratory tests were measured. Pharmacokinetic variables, vital signs, subjective tests for liveliness, and psychomotor outcomes were analyzed using a two-way ANOVA. Olanzapine was safe. Sedation, postural hypotension, and minor vital sign alterations occurred during all treatments. On the liveliness questionnaire, patients generally reported poorer (less lively) scores with olanzapine alone or coadministered with imipramine versus baseline scores. These effects disappeared within 24 hours after administration. Olanzapine alone and in combination decreased motor-speed tasks (finger tapping and visual-arm random reach) compared with baseline or imipramine treatment. Peak 6-hour changes were statistically significant but clinical importance was only marginal. Olanzapine concentrations were <19% greater than with imipramine. But olanzapine did not affect the kinetics of imipramine or desipramine and, therefore, did not show a metabolic drug interaction involving CYP2D6. J Clin Pharmacol 1997;37:971–978.

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