Stereoselective serum protein binding of mexiletine enantiomers in man

The binding of mexiletine enantiomers to human serum proteins was studied in vitro using serum samples collected from five healthy male subjects. Racemic mexiletine was added to an aliquot of each subject's serum to cover the concentration range 0.2 to 2.0 micrograms/mL. Following ultrafiltration of the serum samples containing racemic mexiletine, the individual enantiomers were determined using a stereoselective high-performance liquid chromatographic method developed in our laboratory. The assay data thus obtained for the free levels of the enantiomers showed that the free fraction of S(+) mexiletine was 28.32 +/- 1.45% and that of the R(-) enantiomer was 19.80 +/- 1.49%. The binding was shown to be significantly greater (p less than 0.001) for R(-) mexiletine than its antipode. There was no evidence of concentration dependence in binding over the concentration range studied, which covered the normal therapeutic range. However, significant inter-individual variability in the free fractions was observed. The total binding of the enantiomers was 76%.