Altered pharmacokinetics of beta-adrenoceptor blocking drugs in patients with renal insufficiency

Altered pharmacokinetics of beta-adrenoceptor blocking drugs in renal insufficiency are described in the light of available data in the literature and current knowledge based on recent investigations with a variety of commonly used drugs. Reduced excretion and retention of the active drug is not the only abnormality that may occur in renal insufficiency. Alterations in drug absorption, protein binding, volume of distribution, biotransformation and accumulation of pharmacologically active metabolite are important factors to consider--all may play an important role in determining altered pharmacologic or toxicologic response to a drug. Our own observations on altered disposition kinetics of the three beta-adrenoceptor blocking drugs practolol, sotalol and acebutolol in patients with renal insufficiency are also included in this paper.