Effects of drugs on the oxygen dissociation curve-a scoping review

The shape and position of the hemoglobin-oxygen dissociation curve (ODC) is of critical importance in medicine, as it determines the uptake of O₂ in the lungs and the delivery of O₂ to the tissues. Numerous reports have identified affinity-modulating effects of drugs in humans. Such effects may be relevant to conditions such as pulmonary diffusion disorders, peripheral vascular disease, or coronary artery disease. The aim of this scoping review was to assess and summarize the current evidence on these effects.

The review was based on the PRISMA-ScR guidelines. We searched PubMed and the Cochrane Library and only included papers with free full-text access. The search covers all papers published before September 2024 and used the following keywords: "Oxygen affinity" or "oxygen dissociation curve" in combination with > 100 substance classes that should cover most drugs in clinical use.

The search returned 2447 hits of which 80 were selected for further full text review. In terms of discipline, cardiology accounted for the largest proportion, and in terms of effect quality, a right-ward shift resulting in improved tissue oxygenation was most common. For example, quantitative data show an increase in P₅₀ of 6.1-12.4% and 25-53% for propranolol and RSR13, respectively.

Despite a substantial body of data, the effects of the vast majority of drugs on the ODC have not been studied or have not been studied in sufficient detail. The undeniable potential for medical interventions to alter the ODC calls for revival of this area of research.