Abstract
One of the major goals of investigations of new drug therapy is the establishment of practical guidelines for patient management. Some drugs are found to have very wide margins between the dosages that produce desired effects and those causing adverse reactions. Developing guidelines for the use of such drugs is not likely to be a problem because interpatient pharmacologic variability is insignificant compared to the width of this therapeutic window. However, the therapeutic window is often very small for cardioactive drugs. Therefore, information on any factor which contributes to interindividual variability in response may be helpful in maximizing therapeutic effects while minimizing the risk of adverse reactions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
McDevitt, D.G., Nies, A.S., Wilkinson, G.R., Smith, R.F., Woosley, R.L., and Oates, J.A. Antiarrhythmic effects of a lidocaine congener, tocainide, 2– amino–2’,6’–propionoxylidide, in man. Clin. Pharmacol. Ther. 19: 396–402, 1976.
Roden, D.M., Reele, S.B., Higgins, S.B., Mayol, R.F., Gammans, R.E., Oates, J.A., and Woosley, R.L. Total suppression of ventricular arrhythmias by encainide. New Engl. 3. Med. 302: 877–882, 1980.
Roden, D.M., Reele, S.B., Higgins, S.B., Wilkinson, G.R., Smith, R.F., Oates, J.A., and Woosley, R.L. Antiarrhythmic efficacy, pharmacokinetics and safety of N–acetylprocainamide in human subjects: comparison with procainamide. Amer. 3. Cardiol. 46: 463–468, 1980.
Winkle, R.A., Mason, J.W., Griffin, 3.C., and Ross, D. Malignant ventricular tachyarrhythmias associated with the use of encainide. Amer. Heart 3. 102: 857–864, 1981.
Sheiner, L.B., Rosenberg, B., and Marathe, V.V. Estimation of population characteristics of pharmacokinetic parameters from routine clinical data. J. Pharmacokin. Biopharmac. 5: 445–479, 1977.
Drayer, D.E., Lowenthal, D.T., Woosley, R.L., Nies, A.S., Schwartz, A., and Reidenberg, M.M. Cumulation of N–acetylprocainamide, an active metabolite of procainamide, in patients with impaired renal function. Clin. Pharmacol. Ther. 22: 63–69, 1977.
Guentert, T.W., Upton, R.A., Holford, N.H.G., and Riegelman, S. Divergency in pharmacokinetic parameters of quinidine obtained by specific and nonspecific assay methods. J. Pharmacokin. Biopharmac. 7: 303–311, 1979.
Lindenbaum, J., Mellow, M.H., Blackstone, M.O., and Butler, Jr., V.P. Variation in biologic availability of digoxin from four preparations. New Engl. J. Med. 285: 1344–1347, 1971.
Anderson, J.L., Patterson, E., Wagner, J.G., Stewart, J.R., Behm, H.L., Lucchesi, B.R. Oral and intravenous bretylium disposition. Clin. Pharmacol. Ther. 28: 468–478, 1980.
Boyes, R.N, Scott, D.B., Jebson, P.J., Godman, M.J., and Julian, D.G. Pharmacokinetics of lidocaine in man. Clin. Pharmacol. Ther. 12: 105–116, 1971.
Wood, A.J.J., Carr, K., Vestal, R.E., Belcher, S., Wilkinson, G.R., and Shand, D.G. Direct measurement of propranolol bioavailability during accumulation to steady–state. Br. J. Clin. Pharmac. 6: 345–350, 1978.
Wang, T., Roden, D.M., Wolfenden, H.T., Woosley, R.L., Wilkinson, G.R., and Wood, A.J.J. Pharmacokinetics of encainide and its metabolites in man. Clin. Pharmacol. Ther. 31: 278, 1982 (abstract).
Narang, P.K., Crouthamel, W.G., Carliner, N.H., and Fisher, M.L. Lidocaine and its active metabolites. Clin. Pharmacol. Ther. 654–662, 1978.
Elharrar, V. and Zipes, D.P. Effects of encainide and metabolites (M314030 and M39444) on canine purkinje and ventricular fibers. J. Pharm. Exp. Ther. 220: 440–447, 1981.
Roden, D.M., Duff, H.J., Altenbern, D. and Woosley, R.L. Antiarrhythmic activity of the O–demethyl metabolite of encainide. J. Pharmacol. Exp. Ther. 221: 552–557, 1981.
De Boer, A.G., Breimer, D.D., Mattie, H., Pronk, J., and Gubbens–Stibbe, J.M. Rectal bioavailability of lidocaine in man: Partial avoidance of “first–pass”metabolism. Clin. Pharmacol. Ther. 26: 701–709, 1979.
Wood, A.J.J., Kornhauser, D.M., Wilkinson, G.R., Shand, D.G., and Branch, R.A. The influence of cirrhosis on steady–state blood concentrations of unbound propranolol after oral administration. Clin. Pharmacokin. 3:478–487, 1978.
Benowitz, N.L. and Meister, W. Clinical pharmacokinetics of lidocaine. Clin. Pharmacokin. 3:177–204, 1978.
Greenblatt, D.J., Bolognini, V., Koch–Weser, J., and Harmatz, J.S. Pharmacokinetic approach to the clinical use of lidocaine intravenously. 3AMA 236: 273–277, 1976.
Anderson, J.L., Patterson, E., Conlon, M., Pasyk, S., Pitt, B., and Lucchesi, B.R. Kinetics of antifibrillatory effects of bretylium: Correlation with myocardial drug concentrations. Amer. J. Cardiol. 46: 583–589, 1980.
Lima, J.J., Boudoulas, H., and Blanford, M. Concentration–dependence of disopyramide binding to plasma protein and its influence on kinetics and dynamics. J. Pharmacol. Exp. Ther. 219: 741–747, 1981.
Gugler, R., Shoeman, D.W., Huffman, D.H., Cohlmia, 3.B., and Azarnoff, D.L. Pharmacokinetics of drugs in patients with the nephrotic syndrome. J. Clin. Invest. 55: 1182–89, 1975.
Schenck–Gustafsson, K., Jogestrand, T., Nordlander, R., and Dahlqvist, R. Effect of quinidine on digoxin concentration in skeletal muscle and serum in patients with atrial fibrillation. New Engl. J. Med. 305: 209–212, 1981.
Woosley, R.L., and Shand, D.G. Pharmacokinetics of antiarrhythmic drugs. Amer. J. Cardiol. 41: 986–995, 1978.
Thomson, P.D., Melmon, K.L., Richardson, J.A., Cohn, K., Steinbrunn, W., Cudihee, R., Rowland, M. Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann. Int. Med. 78:499–508, 1973
Richens, A. Clinical pharmacokinetics of phenytoin. Clin. Pharmacokin. 4: 153–169, 1979.
Hager, W.D., Fenster, P., Mayersohn, M., Perrier, D., Graves, P., Marcus, F.I., and Goldman, S. Digoxin–quinidine interaction. New Engl. J. Med. 300: 1238–1241, 1979.
Kluger, J., Leech, S., Reidenberg, M.M., Lloyd, V., and Drayer, D.E. Long– term antiarrhythmic therapy with acetylprocainamide. Amer. J. Cardiol. 48: 1124–1130, 1981.
Jaillon, P., Rubenson, D., Peters, F., Mason, J.W., and Winkle, R.A. Electrophysiologic effects of N–acetylprocainamide in human beings. Amer. J. Cardiol. 47: 1134–1140, 1981.
Meinertz, T., Kasper, W., Kersting, F., Just, H., Bechtold, H., Jahnchen, E. Locainide II. Plasma concentration–effect relationship. Clin. Pharmacol. Ther. 26: 187–195, 1979.
Jackman, W.M., Zipes, D.P., Naccarelli, G.V., Rinkenberger, R.L., Heger, J.J., and Prystowsky, E.N. Electrophysiology of oral encainide. Amer. J. Cardiol. 49: 1270–1278, 1982.
Drayer, D.E., Lowenthal, D.T., Restivo, K.M., Schwartz, A., Cook, C.E., and Reidenberg, M.M. Steady–state serum levels of quinidine and active metabolites in cardiac patients with varying degrees of renal function. Clin. Pharm. Ther. 24: 31–39, 1978.
Grant, A.M., Marshall, R.J., Ankier, S.I. Some effects of disopyramide and its N–dealkylated metabolite on isolated nerve and cardiac muscle. Eur. J. Pharmacol. 49: 389–394, 1978.
Murphy, P.J. Metabolic pathways of aprindine. Acta Cardiol. (Brux) S18:1176
Meffin, P.J., Winkle, R.A., Blaschke, T.F., Fitzgerald, J., Harrison, D.C. Response optimization of drug dosage: antiarrhythmic studies with tocainide. Clin. Pharmacol. Ther. 22: 42–56, 1977.
Roden, D.M., Reele, S.B., Higgins, S.B., Carr, R.K., Smith, R.F., Oates, J.A., and Woosley, R.L. Tocainide therapy for refractory ventricular arrhythmias. Amer. Heart J. 100: 15–22, 1980.
Alderman, E.L., Kerber, R.E., and Harrison, D.C. Evaluation of lidocaine resistance in man using intermittent large–dose infusion techniques. Amer. J. Cardiol. 34: 342–347, 1974.
Feely, J., Wilkinson, G.R., and Wood, AJJ. Reduction of liver blood flow and propranolol metabolism by cimetidine. New Engl. J. Med. 304: 692–695, 1981.
Shand, D.G., Desjardins, R.E., and Bjornsson, T.D. The method of separate exponentials: a simple aid to devising drug loading regimens. Clin. Pharm. Ther. 29: 542–549, 1981.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1983 Martinus Nijhoff Publishers, Boston
About this chapter
Cite this chapter
Roden, D.M., Woosley, R.L. (1983). Application of Pharmacologic Principles in the Evaluation of New Antiarrhythmic Agents. In: Morganroth, J., Moore, E.N. (eds) Sudden Cardiac Death and Congestive Heart Failure: Diagnosis and Treatment. Developments in Cardiovascular Medicine, vol 25. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3876-5_2
Download citation
DOI: https://doi.org/10.1007/978-1-4613-3876-5_2
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4613-3878-9
Online ISBN: 978-1-4613-3876-5
eBook Packages: Springer Book Archive