A sensitive high-performance liquid chromatographic method with ultraviolet absorbance detection for the determination of olanzapine in human plasma is described. Clozapine was used as internal standard. Analytes were concentrated from alkaline plasma by liquid-liquid extraction with n-hexane-isoamyl alcohol (90:10, vol/vol). The organic phase was back-extracted with 150 muL phosphate buffer (KH2PO4 with 25% H3PO4) 0.1 mol/L pH 2.2. The chromatographic separation required 6 minutes at a flow-rate of 1.0 mL/min and was carried out on a Water Spherisorb S5 C6 analytical column (250 mm x 4.6 mm ID) with a mobile phase water-acetonitrile 55:45 vol/vol containing 0.009 moL/L eptansulfonic acid sodium salt and 0.06 mol/L potassium phosphate monobasic pH 2.7. The peaks were detected at 254 nm. Mean recoveries for olanzapine and internal standard were 89.4+/-3.3% and 90.4+/-1.0%, respectively. Coefficient of variation value for intraday was 5.0% at concentrations of 10, 50, and 100 ng/mL and for interday was 4.0% at concentrations of 5 and 25 ng/mL. Accuracy, expressed as percent error, ranged from -8.00% to 1.24%. Limit of detection and limit of quantification for olanzapine were 2 and 5 ng/mL, respectively. The method is suitable for pharmacokinetic studies and therapeutic drug monitoring.

The effect of lamotrigine on the steady-state plasma concentrations of the atypical antipsychotics clozapine, olanzapine, and risperidone was investigated in patients with schizophrenia or bipolar disorder stabilized on chronic treatment with clozapine (200-500 mg/day; n = 11), risperidone (3-6 mg/day; n = 10) or olanzapine (10-20 mg/day; n = 14)). Lamotrigine was titrated up to a final dosage of 200 mg/day over 8 weeks, and pharmacokinetic assessments were made at baseline and during treatment weeks 6 and 10, at lamotrigine dosages of 100 and 200 mg/day respectively. The plasma concentrations of clozapine, norclozapine, risperidone, and 9-hydroxy-risperidone did not change significantly during treatment with lamotrigine. The mean plasma concentrations of olanzapine were 31 +/- 7 ng/mL at baseline, 32 +/- 7 ng/mL at week 6, and 36 +/- 9 ng/mL at week 10, the difference between week 10 and baseline being statistically significant (P < 0.05). Adjunctive lamotrigine therapy was well tolerated in all groups. These findings indicate that lamotrigine, at the dosages recommended for use as a mood stabilizer, does not affect the plasma levels of clozapine, risperidone, and their active metabolites. The modest elevation in plasma olanzapine concentration, possibly due to inhibition of UGT1A4-mediated olanzapine glucuronidation, is unlikely to be of clinical significance.

No abstract

The effect of sertraline on the steady-state plasma concentrations of risperidone and its active metabolite 9-hydroxyrisperidone (9-OH-risperidone) was studied in 11 patients with schizophrenia or schizoaffective disorder. To treat concomitant depressive symptoms, additional sertraline, at the dose of 50 mg/d, was administered for 4 weeks to patients stabilized on risperidone (4-6 mg/d). Mean plasma concentrations of risperidone, 9-OH-risperidone, and the active moiety (sum of the concentrations of risperidone and 9-OH-risperidone) did not change significantly during combined treatment with sertraline. At the end of week 4, sertraline dosage was adjusted in some patients on the basis of the individual response and then maintained until the end of week 8. At final evaluation, mean plasma levels of risperidone active moiety were not modified in the 4 patients who were still receiving the initial sertraline dose, but concentrations were slightly but not significantly increased (by a mean 15% over pretreatment) in the subgroup of 5 subjects treated with a final dose of 100 mg/d. In the 2 patients receiving the highest dose of sertraline, 150 mg/d, at week 8 total plasma risperidone concentrations were increased by 36% and 52%, respectively, as compared with baseline values. Sertraline coadministration with risperidone was well tolerated, and no patient developed extrapyramidal symptoms. These findings indicate that sertraline at dosages up to 100 mg/d is not associated with clinically significant changes in plasma risperidone concentrations. However, higher doses of sertraline may elevate plasma risperidone levels, presumably as a result of a dose-dependent inhibitory effect of sertraline on CYP2D6-mediated 9-hydroxylation of risperidone.

These findings indicate that topiramate, at the dosages recommended for use as a mood stabilizer, does not affect the plasma levels of the new antipsychotics-clozapine, olanzapine, risperidone, and quetiapine.