Table 15.2 (continued)

Antidepressant

Clinical study

Clinical observations

Escitalopram

Rao (2007)

Adolescents, elderly individuals, and patients with

hepatic impairment do not have clinically relevant

differences in PK compared with healthy young adults,

implying that adjustment of escitalopram dosage is not

necessary in these patient groups. Escitalopram is

metabolized by CYP isoenzymes like CYP2C19,

CYP2D6, and CYP3A4. However, ritonavir, a potent

inhibitor of CYP3A4, does not affect the PK values of

escitalopram

Chung et al. (2017)

The (S)-enantiomer of citalopram has a potential QT

prolonging effect. In a clinical study, 12 healthy elderly

individuals received a single oral dose of escitalopram

(20 mg), and their pharmacokinetics and QT effect data

were compared with data from 33 younger adults

obtained in a previous study. Serial blood samples for

PK analysis were collected and ECG was performed up

to 48 h post-dose. The elderly and younger adults

showed similar PK profiles. The mean baseline-

adjusted QT (dQT) time profiles were similar and the

mean values of maximum dQT were not significantly

different between the elderly and the younger adults

Venlafaxine

Hansen et al.

(2017)

The median dose-corrected serum level for venlafaxine

was 1.49 nmol/L/mg, while the dose-corrected serum

level of men and women were 1.21 nmol/L/mg and

1.60 nmol/L/mg, respectively, after a median daily dose

of 225 mg. The dose-corrected sum of venlafaxine and

o-desmethyl-venlafaxine (ODV) was 8.91 nmol/L/mg

versus 5.52 nmol/L/mg for patients above 64 years and

below the age of 65 years, respectively. Dose-corrected

plasma concentrations of venlafaxine and ODV are

increased to a clinically significant degree in patients

above the age of 64, and initiation of venlafaxine

therapy in the elderly should be made cautiously and

supported by drug measurements

Allard et al. (2004)

Benefits of venlafaxine treatment in elderly patients

with major depression were similar to those observed in

younger adults as were reported adverse events or side

effects

Hefner et al. (2019)

In elderly inpatients aged 65 years, amitriptyline and

venlafaxine induce significant QT prolongation

depending on drug concentrations in blood

Duloxetine

Knadler et al.

(2011)

Duloxetine achieves a maximum plasma concentration

(Cmax) of approx. 47 ng/mL (40 mg twice-daily dosing)

to 110 ng/mL (80 mg twice-daily dosing) around 6 h

after dosing. The elimination half-life of duloxetine is

approximately 10–12 h and the volume of distribution

is about 1640 ng/L. Patient demographic characteristics

found to influence the PK of duloxetine include gender,

smoking status, age, ethnicity, CYP450 2D6 genotype,

hepatic function, and renal function. Of these, only

(continued)

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The Importance of Drug Dose Adjustment in Elderly Patients with Special. . .

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