Occupancy of norepinephrine transporter by duloxetine in human brains measured by positron emission tomography with (S,S)-[¹⁸F]FMeNER-D₂

Background: The norepinephrine transporter in the brain has been targeted in the treatment of psychiatric disorders. Duloxetine is a serotonin and norepinephrine reuptake inhibitor that has been widely used for the treatment of depression. However, the relationship between dose and plasma concentration of duloxetine and norepinephrine transporter occupancy in the human brain has not been determined. In this study, we examined norepinephrine transporter occupancy by different doses of duloxetine. Methods: We calculated norepinephrine transporter occupancies from 2 positron emission tomography scans using (S,S)-[¹⁸F] FMeNER-D₂ before and after a single oral dose of duloxetine (20 mg, n = 3; 40 mg, n = 3; 60 mg, n = 2). Positron emission tomography scans were performed from 120 to 180 minutes after an i.v. bolus injection of (S,S)-[¹⁸F]FMeNER-D₂. Venous blood samples were taken to measure the plasma concentration of duloxetine just before and after the second positron emission tomography scan. Results: Norepinephrine transporter occupancy by duloxetine was 29.7% at 20 mg, 30.5% at 40 mg, and 40.0% at 60 mg. The estimated dose of duloxetine inducing 50% norepinephrine transporter occupancy was 76.8 mg, and the estimated plasma drug concentration inducing 50% norepinephrine transporter occupancy was 58.0 ng/mL.