Diltiazem-induced Transient Complete Atrioventricular Block in an Elderly Patient with Acute on Chronic Renal Failure

Diltiazem is a calcium channel blocker commonly used in the treatment of various cardiovascular disorders such as hypertension, angina and supraventricular tachycardias. Metabolism occurs mainly in the liver, but a small percentage of unchanged drug and metabolites are excreted in the urine. Toxicity from this medication usually presents in the form of dysrrhytmias and heart block. Hence, we present a case of complete atrioventricular AV block in a patient receiving sustained- release diltiazem on a chronic basis. Risk factors such as advanced age and impaired renal function are dis-cussed.

Comparative Bioavailabilitv Studv of Two Brands of Terbutaline Sulphate Tablets in Healthy Human Volunteers

The purpose of this study was to evaluate the bioavailability of locally produced 2.5 mg terbutaline sulphate tablets (brand A ) relative to a reference product, Bricanyl 2.5 mg tablets (brand 6). The study was a single dose 5 mg randomized crossover one in 15 healthy volunteers in the fasting state. Urine was collected at intervals of 24 h. Total terbutaline excreted in urine as unchanged drug and as conjugates (sulphate and glucuronide) was determined by a developed and validated HPLC method. In-vitro characteristics of both brands were similar. Based on percent of the dose excreted in urine, the oral bioavailability ranged from 33.5% to 75.8% for both brands. Statistics were applied to judge bioequivalence according to USP 24 in-vivo bioequivalence guidance. Results indicated that brand A and B were bioequivalent and hence interchangeable in medical practice.

Prenatal and postpartum pharmacokinetics of stavudine (2',3'-didehydro-3'-deoxythymidine) and didanosine (dideoxyinosine) in pigtailed macaques (Macaca nemestrina).

Stavudine (5 mg/kg of body weight; n = 7) or didanosine (3.2 mg/kg; n = 4) was administered as an intravenous bolus to pregnant pigtailed macaques (Macaca nemestrina) near term and 4 to 5 weeks postpartum. No significant differences were found between the prenatal and postpartum total plasma drug clearance, steady-state volume of distribution, terminal plasma drug half-life, mean body residence time, or recovery of unchanged drug in urine. These data indicate that pregnancy does not affect the pharmacokinetics of stavudine or didanosine in M. nemestrina.

Pharmacokinetics of trovafloxacin (CP-99,219), a new quinolone, in rats, dogs, and monkeys.

The pharmacokinetics of trovafloxacin [CP-99,219; 7-(3-azabicyclo[3.1.0]hexyl)-naphthyridone] were studied in rats, dogs, and monkeys following oral and intravenous administration. After intravenous dosing, the systemic clearances of trovafloxacin in rats, dogs, and monkeys were 12.5, 11.1, and 7.2 ml/min/kg of body weight, respectively, and the respective volumes of distribution were 0.9, 1.7, and 4.3 liters/kg, with corresponding elimination half-lives of 0.7, 1.8, and 7.0 h. After the administration of oral doses of 50, 20, and 20 mg/kg to rats, dogs, and monkeys serum trovafloxacin concentrations reached a maximum at 0.6, 2.3, and 2.3 h, respectively, with respective maximum concentrations of trovafloxacin in serum of 11.5, 3.5, and 5.2 micrograms/ml; the corresponding elimination half-lives were 2.2, 2.5, and 7.5 h. The oral bioavailability of trovafloxacin was 68, 58, and 85% in rats, dogs, and monkeys, respectively. The binding of trovafloxacin to serum proteins was concentration independent, averaging 92, 75, and 66% for rats, dogs, and monkeys, respectively. Trovafloxacin penetrated well into tissues in dogs. The urinary recoveries of unchanged drug were less than 5% in dogs and monkeys, with or without incubation with alkali or Glusulase (beta-glucuronidase and sulfatase). In rats, 99.8% of the orally administered radioactivity was recovered in feces, while 20.6, 3.4, and 67.1% of the radioactive dose in bile duct-cannulated rats were recovered in feces, urine, and bile, respectively. These results suggest that the elimination of trovafloxacin from rats, and possibly from dogs and monkeys, is primarily through biliary excretion.

Correction: looking after the elderly diabetic (February 23, p.14)

Chlorpropamide is not as we stated ‘excreted mainly unchanged by the kidney’. About 80% is metabolised. The metabolites and unchanged drug are excreted in the urine and, as we stated, the drug should be avoided in renal failure.