hat is known concerning amitriptyline and increased level of cholesterol?/nA 54-year-old man has be

Fråga: hat is known concerning amitriptyline and increased level of cholesterol?

A 54-year-old man has been treated with Tryptizol (amitriptyline) 100-150 mg for several years. Stepwise an increase of the cholesterol level, now 9 (reference value 2.6-7.8) has occurred. The patient is not overweight, lives otherwise a healthy life and no explanation could be found to the increased cholesterol level.

Sammanfattning: No conclusive data has been found in the literature stating a connection between hyperlipidemia and treatment with antidepressive agents. However, studies have indicated an increase of total cholesterol level during treatment with clomipramine and imipramine. In the present case a causal relationship between increase in cholesterol level and the use of amitriptyline cannot be verified, other causes to the cholesterol level must be investigated.

Svar: imilar questions have been investigated twice (1,2). No conclusive data could be found in the literature stating a relationship of increased serum cholesterol and the use of tricyclic antidepressive agents.

An updated search has been performed and no data could be found of increased values of cholesterol during treatment with amitriptyline.

However, other antidepressive agents such as clomipramine (3) and imipramine (4,5) have been discussed in connection to changes in cholesterol levels. The effect of clomipramine on plasma lipoproteins, including high density lipoprotein (HDL) was investigated in five healthy males. Clomipramine (50mg) was administered daily for two weeks. In four of the subjects, total plasma cholesterol and LDL-cholesterol decreased during week one and two of clomipramine treatment, and increased slightly in one patient. The net result of changes of LDL-cholesterol and HDL2- and HDL3-cholesterol was a small, but statistically insignificant increase in the concentration of total HDL-cholesterol during clomipramine treatment (3).

In a retrospective study of 24 patients with panic disorders receiving imipramine, mean dose 129 mg per day, it was found that serum cholesterol level was significantly higher than the baseline value (4). The same authors report in a prospective pilot study that in 20 patients with panic disorders treated with imipramine, mean dose of imipramine 148 mg per day, mean treatment period 19.5+/-17.8 weeks there was a significant increase in the ratio of total cholesterol/HDL cholesterol after treatment with imipramine. There was also a significant decrease of HDL cholesterol after tratment with imipramine (5).

The Swedish Adverse Drug Reactions Advisory Committee (SADRAC) has received a single report of hyperlipidemia in connection to antidepressive treatment. However, in that case paroxetine (Seroxat) was used and the connection between the drug and hyperlipidemia could not be classified.