Background Psychiatric patients are generally thought of as having low rates of treatment adherence. Simplification of treatment regimen often improves compliance.
Purpose To report a case of major depressive disorder in maintenance treatment with imipramine during a shortage of imipramine tablets.
Material and methods We report the case of an 82-year-old woman diagnosed with major depressive disorder with psychotic features since 2005. Current treatment: imipramine 150 mg/day, quetiapine 150 mg/day, clonazepam drops (0–5–10), valproic acid 200 mg/day, trazodone 100 mg/day, lorazepam 2 mg/day, candesartan/hydrochlorothiazide 32/12.5 mg/day, atorvastatin 20 mg/day.
In October 2013, the supplier of imipramine 50 mg tablets announced a shortage of the drug. Our national Drug Agency began to import tablets of Imipramine chlorhydrate 10 mg. Our patient was told to take 15 tablets a day.
Two months later the psychiatrist observed that the patient was suffering delusions again. The principal caregiver informed them that her mother had abandoned treatment 2 weeks ago because of the number of tablets.
The psychiatrist contacted the Pharmacy Service to evaluate another alternative. We suggested compounding an oral solution of imipramine 25 mg/ml to simplify the treatment regimen (6 ml/day).
Materials Imipramine chlorhydrate: 2.5 g; sodium methylparaben 99%: 100 mg; simple syrup: 30 ml; saccharin solution: 0.5 ml; orange oil: 0.05 ml; distilled water (DW) q.s 100 ml; Method of preparation: Dissolve the methylparaben with 70 ml of DW. Add the imipramine and mix well. Incorporate the saccharin and orange oil. Mix. Add the simple syrup and DW to final volume.
Results Ten days later, we measured plasma levels of imipramine to check the adherence. Results: Imipramine: 72 ng/ml, desipramine: 31 ng/ml, imipramine + desipramine: 103 ng/ml; (Therapeutic range: 150–250 ng/ml).
At the next consultation, 50 days later, the psychiatrist observed a significant clinical improvement in our patient.
Conclusion Drug shortages are an increasing problem that is forcing both physicians and pharmacists to seek therapeutic alternatives. Pharmaceutical compounding can be a valuable option when changes of drug or dosage form are not desirable.
References and/or Acknowledgements No conflict of interest.
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