Bromfenac disposition in patients with impaired kidney function

Area of Science:

• Pharmacology
• Nephrology
• Drug Metabolism

Background:

• Bromfenac is a nonsteroidal anti-inflammatory drug (NSAID).
• Renal impairment can affect drug pharmacokinetics.
• Understanding bromfenac's behavior in kidney disease is crucial for safe prescribing.

Purpose of the Study:

• To compare the pharmacokinetics of bromfenac in healthy individuals versus patients with impaired kidney function and end-stage renal disease.
• To assess the impact of renal compromise on bromfenac's absorption, distribution, metabolism, and excretion.

Main Methods:

• A single 50 mg oral dose of bromfenac was administered to three groups: normal kidney function (18 subjects), decreased kidney function (12 subjects), and dialysis-dependent (10 subjects).
• Pharmacokinetic parameters including peak concentration, area under the curve, clearance, volume of distribution, and half-life were analyzed.
• Protein binding was evaluated using equilibrium dialysis.

Main Results:

• Bromfenac half-life nearly doubled in patients with impaired kidney function and those on dialysis.
• The mean unbound fraction of bromfenac was approximately twice as high in dialysis patients compared to those with normal kidney function.
• No significant differences were observed in clearance or volume of distribution between the groups, even after correcting for the free fraction.

Conclusions:

• No dosage adjustment for bromfenac is necessary in patients with impaired kidney function.
• Despite altered pharmacokinetics, bromfenac appears safe for use in renal impairment.
• Clinical monitoring tailored to the individual patient's condition is recommended.