Odette Grech-Bélanger

Effect of cigarette smoking on mexiletine kinetics.

The effect of cigarette smoking on the kinetics of a single, 200 mg, oral dose of the antiarrhythmic drug mexiletine was investigated in healthy subjects. Cigarette smoking had no effect on absorption or distribution of the drug, but it significantly reduced the elimination t½ from 11.1 ± 3.4 to 7.2 ±1.8 hours; the effect on clearance was less significant. Determination of the urinary concentrations of the three major metabolites of mexiletine (mexiletine glucuronide conjugate, hydroxymethylmexiletine, and p‐hydroxymexiletine) indicated that cigarette smoking selectively induced conjugation of mexiletine with glucuronic acid as well as aliphatic hydroxylation to yield hydroxymethylmexiletine, but that it had no effect on the formation of p‐hydroxymexiletine.

Resolution and Electrophysiological Effects of Mexiletine Enantiomers

Abstract— Resolution of mexiletine enantiomers from the racemic mixture has been achieved by fractional crystallization through the formation of diastereoisomeric p‐toluoyl tartrate salts. Following three crystallization steps in methanol, R‐(–)‐ and S‐(+)‐mexiletine were resolved with an optical purity > 98 % (yield ∼ 30%) and their hydrochloride salts formed. Incremental doses of mexiletine enantiomers were administered to dogs with experimentally‐induced arrhythmias to investigate the stereoselective antiarrhythmic and electrophysiological effects of these compounds. Using up to three extrastimuli, programmed electrical stimulation was performed in conscious animals 7–30 days after coronary ligation. R‐(–)‐Mexiletine prevented ventricular tachycardia in 3/6 dogs (2 after 0·5 mg kg−1, 1 after 8 mg kg−1); two animals died after 1 and 8 mg kg−1, respectively; one remained unchanged even at the highest dosage (16 mg kg−1). S‐(+)‐Mexiletine prevented ventricular tachycardia in only one dog (after 1 mg kg−1); two died after 4 and 8 mg kg−1, respectively; 2/5 remained unchanged even after the administration of 16 mg kg−1. No significant changes in any electrocardiographic intervals (PR, QRS, QTc) or refractory periods were induced by mexiletine enantiomers at any doses used (0·5–16·0 mg kg−1). These results suggest that R‐(–)‐mexiletine possesses greater antiarrhythmic properties than the opposite enantiomer.

Colorimetric determination of N-hydroxylated metabolites in microsomal studies.

A colorimetric method is described which can be used for the routine determination of primary and secondary N-hydroxylamino compounds in drug metabolism studies using microsomal preparations. The assay is carried out on the supernatant obtained after protein precipitation of the incubation mixture. The method is based on the reduction of ferric ion by the hydroxylamino moiety with the resulting ferrous ion being quantitated by coupling with 2,4,6-tripyridyl-s-triazine to form a purple color with a maximum absorbance at 595 nm. The method is specific to primary and secondary hydroxylamino compounds and calibration curves can be obtained in the range of concentrations of 1 to 20 μg/ml. Hydroxamic acid, amido, amino, phenolic, nitro, nitroso, oxime, nitrone, aldehyde, and ketone compounds do not produce any color reaction when analyzed by the same method. The method is simple, rapid, and many samples can be analyzed in a short period of time.

Pharmacokinetics of Diltiazem in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

The disposition of a single oral dose of diltiazem hydrochloride was studied in six male patients treated by continuous ambulatory peritoneal dialysis. Peak concentrations were obtained 2 to 4 hours postdose. The mean absorption rate constant was 0.94 ± 0.21 (sd) hr‐1, and the mean elimination half‐life was 3.09 ± 1.16 hr. Serum levels of deacetyldiltiazem, a metabolite of diltiazem, were always below 10 ng/mL. The amounts of diltiazem and deacetyldiltiazem eliminated in dial ysate over 24 hours represent less than 0.1% of the administered dose. The pharmacokinetic parameters of diltiazem determined in these patients did not differ from those determined in healthy volunteers and in patients suffering from end‐stage renal disease.

Assay of diltiazem and deacetyldiltiazem by capillary gas chromatography

A highly sensitive gas chromatographic method for the analysis of diltiazem and deacetyldiltiazem in plasma or serum is reported. After silylation with bis (trimethylsilyl) trifluoroacetamide, separation was obtained on a cross-linked fused-silica column and detection was by electron-capture. The minimum measurable concentrations were 3 and 1 ng/ml for diltiazem and deacetyldiltiazem, respectively. Intra- and inter-day coefficients of variation were less or equal to 6.0 and 8.0%, respectively, for both compounds. The method was used to study the kinetics of a single oral dose of 60 mg of diltiazem hydrochloride in a patient with renal failure.

Pharmacokinetics of Mexiletine in the Elderly

The effect of advancing age on the kinetics of the antiarrhythmic agent mexiletine was studied by comparing various kinetic parameters calculated after administration of a single oral dose of mexiletine hydrochloride to seven elderly and eight young healthy volunteers. The rate of absorption of the drug from the gastrointestinal tract was significantly slower in the elderly (1.37 ± 0.51 hr−1) than in the young group (2.25 ± 0.79 hr−1). The mean values for elimination half‐life and oral clearance were 12.3 ± 3.7 hr and 10.3 ± 5.4 mL/min/kg respectively in the young group and 14.4 ± 4.5 hr and 8.5 ± 2.9 mL/min/kg respectively in the elderly group. Neither of these parameters was significantly different between the two groups. The amount of mexiletine eliminated in urine up to 48 hours postdose was identical in both groups and represented less than 5% of the administered dose. It is concluded that the age‐related modifications in the kinetics of mexiletine are not clinically important during chronic administration of the drug.

Inhibitory effects of propafenone on the pharmacokinetics of caffeine in humans.

CYP1A2 is involved in the metabolism of both caffeine and propafenone, a class Ic antiarrhythmic agent. Despite the widespread consumption of caffeine, drug-drug interactions with this agent are often overlooked. This study investigated effects of propafenone on the pharmacokinetics of caffeine. Eight healthy volunteers were included in our study. A total of 300 mg of caffeine was given on 2 occasions, once alone and once during the coadministration of 300 mg propafenone. Serial blood samples were collected and pharmacokinetic parameters were estimated using a population pharmacokinetic approach. A one-compartment PK model with first-order absorption and elimination described plasma concentration profiles. Concomitant administration of propafenone decreased caffeine oral clearance from 8.3 ± 0.9 L/h to 5.4 ± 0.7 L/h (P < 0.05). Elimination half-life of caffeine was also increased 54% by propafenone. One of our volunteers was a poor metabolizer of CYP2D6. Concomitant administration of propafenone to this volunteer caused the greatest increase in caffeine plasma concentrations. These results support the concept of competitive inhibition between propafenone and caffeine. Our results suggest that propafenone causes significant inhibition of CYP1A2 activity leading to a decrease in the clearance of caffeine. Caffeine has intrinsic proarrhythmic effects; thus, its coadministration with an antiarrhythmic agent such as propafenone should be used with caution, especially in patients with poor CYP2D6 activity.

Inhibitory effect of isoniazid on antipyrine clearance in man

Abstract: The effect of both concomitant administration and pretreatment with isoniazid on the activity of the hepatic drug‐metabolizing enzymes of healthy young volunteers, as indicated by the antipyrine clearance test, is reported. Concomitant administration of isoniazid with antipyrine results in a significant decrease in the hepatic clearance of the latter compound. In contrast, pretreatment for 14 days with isoniazid had no effect on antipyrine elimination kinetics. It is concluded that isoniazid depresses hepatic drug metabolism only when present in significant amounts at the hepatic site of drug oxidation.