We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Fluoxetine Inhibits Desipramine Metabolism

TIMOTHY E. Wilens, MD; Joseph Biederman, MD; Ross J. Baldessarini, MD; Stephen P. McDermott, MD; James G. Flood, PhD
Arch Gen Psychiatry. 1992;49(9):752. doi:10.1001/archpsyc.1992.01820090080014.
Text Size: A A A
Published online


To the Editor.—  We read with interest the article by Nelson et al1 on the treatment of depression with fluoxetine and desipramine, particularly regarding effects of fluoxetine on serum levels of desipramine and its major active metabolite, 2-hydroxydesipramine. Fluoxetine can elevate blood concentrations and the risk of toxic effects of tricyclic antidepressants unless their dose is greatly restricted.2,3 This interaction probably reflects competition for enzymatic oxidation.4 Although ring-hydroxylation to 2-hydroxydesipramine is a major route of metabolism of desipramine, assessment of effects of fluoxetine on 2-hydroxydesipramine is very limited.2-4In a retrospective comparison of 14 adults with depression given desipramine and fluoxetine and 52 patients given desipramine alone, Nelson et al1 found serum desipramine levels to be similar in both groups despite an approximate reduction of 30% in desipramine dose with fluoxetine. In their data, we find (eg, at 4 weeks of fixed-dose treatment) lower mean


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.