Pharmacology of rising oral doses of 5-hydroxytryptophan with carbidopa

J Psychopharmacol. 2008 Jun;22(4):426-33. doi: 10.1177/0269881107082025. Epub 2008 Feb 28.

Abstract

5-hydroxytryptophan (5-HTP) is a direct 5-hydroxytryptamine (5-HT) precursor used to assess central serotonergic function. Its use has been limited by a narrow window between neuroendocrine changes and side effects, and variable kinetics related to inconsistent administration modes. By combining 5-HTP with carbidopa (CBD), increased bioavailability for brain penetration and decreased peripheral side effects would be expected, due to reduced peripheral decarboxylation of 5-HTP to 5-HT. A double-blind, placebo-controlled, single rising dose, four-way crossover trial with placebo randomisation was performed in 15 healthy male volunteers to investigate the neuroendocrine dose-response relationship at various 5-HTP levels; the tolerability and subjective effects of oral 5-HTP at 100, 200 and 300 mg combined with CBD and the pharmacokinetic properties of the 5-HTP/CBD-challenge. Dose-dependent increases in average cortisol concentrations were observed. Mean response (area-under-the-curve) over the first 4 hours (SD): 172.0 nmol/L (22.3) for placebo, 258.3 nmol/L (72.6) for 100 mg, 328.47 nmol/L (84.6) for 200 mg and 387.3 nmol/L (82.4) for 300 mg 5-HTP. Similar dose-dependent increases for prolactin were seen while adreno-corticotrophic hormone response was more variable. 5-HTP kinetics were adequately described using a one-compartment model with first-order absorption and a lag time (mean oral clearance 28 L/h interindividual coefficient of variation 31%). Nausea and vomiting occurred dose-dependently as most frequent side effects, resulting in dose-related dropout of 6.6% at 100 mg and 45.5% at 300 mg 5-HTP. Orally administered 5-HTP combined with CBD is an effective serotonergic challenge test, exhibiting dose-related plasma concentrations and neuroendocrine responsiveness. Frequent occurrence of nausea and vomiting limits the applicability of this challenge at 5-HTP doses above 100 mg.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • 5-Hydroxytryptophan / administration & dosage*
  • 5-Hydroxytryptophan / adverse effects
  • 5-Hydroxytryptophan / pharmacokinetics
  • Administration, Oral
  • Adrenocorticotropic Hormone / blood
  • Adult
  • Affect / drug effects
  • Antidepressive Agents, Second-Generation / administration & dosage*
  • Antidepressive Agents, Second-Generation / adverse effects
  • Antidepressive Agents, Second-Generation / pharmacokinetics
  • Biological Availability
  • Brain / drug effects
  • Brain / metabolism
  • Carbidopa / administration & dosage*
  • Carbidopa / pharmacokinetics
  • Cross-Over Studies
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Synergism
  • Enzyme Inhibitors / administration & dosage*
  • Enzyme Inhibitors / adverse effects
  • Enzyme Inhibitors / pharmacokinetics
  • Half-Life
  • Humans
  • Hydrocortisone / blood
  • Male
  • Metabolic Clearance Rate / drug effects
  • Nausea / chemically induced
  • Patient Dropouts / statistics & numerical data
  • Prolactin / blood
  • Vomiting / chemically induced
  • Young Adult

Substances

  • Antidepressive Agents, Second-Generation
  • Enzyme Inhibitors
  • Adrenocorticotropic Hormone
  • Prolactin
  • 5-Hydroxytryptophan
  • Carbidopa
  • Hydrocortisone