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[Mexiletine in terminal renal failure and various dialysis procedures]
Abstract:
We monitored the plasma levels of mexiletine in 20 dialysis patients with severe cardiac arrhythmias after repeated oral administration and the elimination by various dialysis procedures. The levels of mexiletine in plasma and dialysate were assayed by high-pressure liquid chromatography. After repeated administration of mexiletine 400-600 mg/day trough levels were in the range from 500-2,000 ng/ml. Treatment controlled by Holter monitoring was effective in 13/20 patients. Doses of 600 mg/day and more often were not tolerated by patients with dialysis after some weeks. There was no important removal of mexiletine from plasma during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis. In conclusion, we recommend a slightly reduced dosage of 400-600 mg mexiletine/day (usually 600-800 mg) for patients with end-stage renal insufficiency, irrespective of dialysis.
Insights
Mexiletine effectively treated cardiac arrhythmias in dialysis patients, but higher doses were poorly tolerated. Reduced mexiletine dosage is recommended for patients with end-stage renal insufficiency, regardless of dialysis type.
Area of Science:
- Pharmacology
- Nephrology
- Cardiology
Background:
- Severe cardiac arrhythmias pose a significant challenge in patients with end-stage renal disease.
- Mexiletine is an antiarrhythmic drug, but its use in dialysis patients requires careful consideration due to altered drug metabolism and elimination.
- Understanding mexiletine's pharmacokinetics and efficacy in dialysis patients is crucial for optimizing treatment.
Purpose of the Study:
- To monitor plasma mexiletine levels in dialysis patients with cardiac arrhythmias.
- To evaluate the elimination of mexiletine during various dialysis procedures.
- To determine optimal mexiletine dosing for patients with end-stage renal insufficiency.
Main Methods:
- Plasma and dialysate mexiletine levels were measured using high-performance liquid chromatography.
- Patients received repeated oral administration of mexiletine (400-600 mg/day).
- Cardiac arrhythmias were assessed using Holter monitoring.
Main Results:
- Therapeutic trough levels of mexiletine ranged from 500-2,000 ng/ml with 400-600 mg/day dosing.
- Mexiletine was effective in controlling arrhythmias in 13 out of 20 patients.
- No significant removal of mexiletine was observed during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis.
- Doses of 600 mg/day or higher were often not tolerated.
Conclusions:
- Mexiletine can be effective for cardiac arrhythmias in dialysis patients.
- Mexiletine is not significantly removed by common dialysis procedures.
- A reduced daily dosage of 400-600 mg mexiletine is recommended for patients with end-stage renal insufficiency, irrespective of dialysis treatment.