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Pharmacokinetics and pharmacodynamics of furosemide in protein-calorie malnutrition

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Abstract

The influence of dietary protein deficiency on pharmacokinetics and pharmacodynamics of furosemide was investigated after iv bolus (1 mg/100 g) and oral (2 mg/100 g) administration of furosemide to male Sprague-Dawley rats fed on a 23% (control) or a 5% (protein-calorie malnutrition: PCM) protein diet ad lib.for 4 weeks. After iv administration, the mean values of CL R , V ss, and the percentages of dose excreted in 8-hr urine as furosemide were increased 81, 31, and 61%, respectively, in PCM rats when compared with those in control rats, however, CL NR was 54% decreased in PCM rats. The decreased CLNR in PCM rats suggested the significantly decreased nonrenal metabolism of furosemide. The urine volume per g kidney after iv administration was not significantly different between the two groups of rats although the amount of furosemide excreted in 8-hr urine per g kidney increased significantly in PCM rats. The diuretic, natriuretic, kaluretic, and chloruretic efficiencies reduced significantly in PCM rats after iv administration. After oral administration, the extent of bioavailability increased considerably from 27.6% in control rats to 47.0% in PCM rats, probably as a result of decreased gastrointestinal and hepatic first-pass metabolism. This was supported by a tissue homogenate study; the amount of furosemide remaining per g tissue after 30-min incubation of 50 μg of furosemide with the 9000 × gsupernatant fraction of stomach (42.4 vs. 47.9 μg) and liver (41.4 vs. 45.9 μg) homogenates increased significantly in PCM rats. No significant differences in CLR and t1/2 were found between the control and the PCM rats after oral administration. The 24-hr urine volume and the amount of sodium excreted in 24-hr urine per g kidney increased significantly in PCM rats, and this might be due to a significantly increased amount of furosemide reaching the kidney excreted in urine per g kidney.

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References

  1. K. Krishnaswamy. Drug metabolism and pharmacokinetics in malnutrition.Clin. Pharm-acokin. 3:216–240(1978).

    Article  CAS  Google Scholar 

  2. N. Buchanan. Drug kinetics in protein energy malnutrition.S. Afr. Med. J. 53:327–330 (1978).

    CAS  PubMed  Google Scholar 

  3. D. Jung. Pharmacokinetics of theophylline in protein-calorie malnutrition.Biopharm. Drug Dispos. 6:291–299 (1985).

    Article  CAS  PubMed  Google Scholar 

  4. D. Jung. Disposition of acetaminophen in protein-calorie malnutrition.J. Pharmacol. Exp. Ther. 232:178–182 (1985).

    CAS  PubMed  Google Scholar 

  5. M. G. Lee and W. L. Chiou. Evaluation of potential causes for the incomplete bioavailability of furosemide: Gastric first-pass metabolism.J. Pharmacokin. Biopharm. 11:623–640 (1983).

    Article  CAS  Google Scholar 

  6. D. E. Smith, E. T. Lin, and L. Z. Benet. Absorption and disposition of furosemide in healthy volunteers, measured with a metabolite-specific assay.Drug Metab. Dispos. 8:337–342 (1980).

    CAS  PubMed  Google Scholar 

  7. D. C. Brater, R. Seiwell, S. Andreasen, A. Burdette, G. J. Dekmer, and P. Chennavasin. Absorption and disposition of furosemide in congestive heart failure.Kidney Int. 22:171–176 (1982).

    Article  CAS  PubMed  Google Scholar 

  8. T. P. Green and B. L. Mirkin. Furosemide disposition in normal and proteinuric rats: Urinary drug-protein binding as a determinant of drug effect.J. Pharmacol. Exp. Ther. 218:122–127 (1981).

    CAS  PubMed  Google Scholar 

  9. B. Beermann, E. Dalén, B. Lindström, and A. Rosén. On the fate of furosemide in man.Em. J. Clin. Pharmacol. 9:57–61 (1975).

    Article  CAS  Google Scholar 

  10. L. Z. Benet. Pharmacokinetics/pharmacodynamics of furosemide in man: A review.J. Pharmacokin. Biopharm. 7:1–27 (1979).

    Article  CAS  Google Scholar 

  11. M. Hammarlund-Udenaes and L. Z. Benet. Furosemide pharmacokinetics and pharmaco-dynamics in health and disease—An update.J. Pharmacokin. Biopharm. 17:1–46 (1989).

    Article  CAS  Google Scholar 

  12. J. Patrick. Death during recovery from severe malnutrition and its possible relationship to sodium pump activity in the leucocyte.Br. Med. J. 23:1051–1054 (1977).

    Article  Google Scholar 

  13. A. Young and R. J. Levin. Diarrhoea of famine and malnutrition-investigations using a rat model, 2-ileal hypersecretion induced by starvation.Gut 31:162–169 (1990).

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. M. G. Lee, M. L. Chen, and W. L. Chiou. Pharmacokinetics of drugs in blood II: Unusual distribution and storage effect of furosemide.Res. Commun. Chem. Pathol. Pharmacol. 34:17–23 (1981).

    CAS  PubMed  Google Scholar 

  15. W. G. Shin, M. G. Lee, M. H. Lee, and N. D. Kim. Factors influencing the protein binding of vancomycin.Biopharm. Drug Dispos. 12:637–646 (1991).

    Article  CAS  PubMed  Google Scholar 

  16. S. Øie and T. W. Guentert. Comparison of equilibrium times in dialysis experiments using spiked plasma or spiked buffer.J. Pharm. Sci. 71:127–128 (1982).

    Article  PubMed  Google Scholar 

  17. C. L. Litterst, E. G. Mimnaugh, R. I. Reagan, and T. E. Gram. Comparison of in vitro drug metabolism by lung, liver and kidney of several common laboratory species.Drug Metab. Dispos. 3:259–265 (1975).

    CAS  PubMed  Google Scholar 

  18. O. H. Lowry, N. J. Rosebrough, A. L. Farr, and R. J. Randall. Protein measurement with the folin phenol reagent.J. Biol. Chem. 173:265–275 (1951).

    Google Scholar 

  19. T. Omura and R. Sato. The carbon monoxide-binding pigment of liver microsomes I. Evidence for its hemoprotein nature.J. Biol. Chem. 239:2370–2378 (1964).

    CAS  PubMed  Google Scholar 

  20. M. L. Chen, G. Lam, M. G. Lee, and W. L. Chiou. Arterial and venous blood sampling in pharmacokinetic study: Griseofulvin.J. Pharm. Sci. 71:1386–1389 (1982).

    Article  CAS  PubMed  Google Scholar 

  21. W. L. Chiou. Critical evaluation of potential error in pharmacokinetic studies using the linear trapezoidal rule method for the calculation of the area under the plasma level-time curve.J. Pharmacokin. Biopharm. 6:539–546 (1978).

    Article  CAS  Google Scholar 

  22. M. Gibaldi and D. Perrier.Pharmacokinetics, 2nd ed., Marcel Dekker, New York, 1982.

    Google Scholar 

  23. W. L. Chiou, C. Y. Lui, and G. Lam. Plasma area method in relative bioavailability evaluation of drugs with changing biological half-lives.J. Pharm. Sci. 70:109–112 (1981).

    Article  CAS  PubMed  Google Scholar 

  24. S. Øie and D. Jung. Bioavailability under variable renal clearance conditions.J. Pharm. Sci. 68:127–128 (1979).

    Article  Google Scholar 

  25. W. L. Chiou. New calculation method for mean apparent drug volume of distribution and application to rationale dosage regimens.J. Pharm. Sci. 68:1067–1069 (1979).

    Article  CAS  PubMed  Google Scholar 

  26. D. Varma. Influence of dietary protein on the anti-inflammatory and ulcerogenic effects and on the pharmacokinetics of phenylbutazone in rats.J. Pharmacol. Exp. Ther. 211:338–344 (1979).

    CAS  PubMed  Google Scholar 

  27. J. C. Merrill and T. M. Bray. The effect of dietary protein quantity on the activity of UDP-glucuronyltransferase and its physiological significance in drug metabolism.Can. J. Physiol. Pharmacol. 60:1556–1561 (1982).

    Article  CAS  PubMed  Google Scholar 

  28. M. M. Hammarlund and L. K. Paalzow. Dose-dependent pharmacokinetics of furose-mide in the rat.Biopharm. Drug Dispos. 3:345–359 (1982).

    Article  CAS  PubMed  Google Scholar 

  29. D. E. Smith and L. Z. Benet. Relationship between urinary excretion rate, steady-state plasma levels and diuretic response of furosemide in the rat.Pharmacology 19:301–306 (1979).

    Article  CAS  PubMed  Google Scholar 

  30. W. L. Chiou. A new simple approach to study the effect of changes in urine flow and/ or urine pH on renal clearance and its applications.Int. J. Clin. Pharmacol. Ther. Toxicol. 24:519–527 (1986).

    CAS  PubMed  Google Scholar 

  31. M. G. Lee. Absorption and disposition of furosemide. Ph.D. thesis, University of Illinois at Chicago, 1982.

  32. D. E. Smith and L. Z. Benet. Plasma protein binding of furosemide in kidney transplant patients.J. Pharmacokin. Biopharm. 10:663–674 (1982).

    Article  CAS  Google Scholar 

  33. L. L. Boles Ponto and R. D. Schoenwald. Furosemide (Frusemide). A pharmacokinetic/ pharmacodynamic review (Part I and II).Clin. Pharmacokin. 18:381–408, 460–471 (1990).

    Article  Google Scholar 

  34. Y. M. Choi, S. H. Kim, and M. G. Lee. Effects of phenobarbital and 3-methylchol-anthrene pretreatment on the pharmacokinetics and pharmacodynamics of furosemide in rats.J. Pharm. Sci. 80:638–642 (1991).

    Article  CAS  PubMed  Google Scholar 

  35. S. Inui, M. Yamamoto, H. Nakae, and S. Asada. Dose dependency of loop diuretics, furosemide and piretanide in the rat.Yakugaku Zasshi 102:1053–1060 (1982).

    CAS  PubMed  Google Scholar 

  36. S. Seno, S. M. Shaw, and J. E. Christian. Distribution and urinary excretion of furosemide in rat.J. Pharm. Sci. 58:935–938 (1969).

    Article  CAS  PubMed  Google Scholar 

  37. V. S. Chungi, L. W. Dittert, and R. B. Smith. Gastrointestinal sites of furosemide absorption in rats.Int. J. Pharm. 4:27–38 (1979).

    Article  CAS  Google Scholar 

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This work was supported in part by a research grant from the Korea Science and Engineering Foundation, 1990–1992.

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Kim, S.H., Choi, Y.M. & Lee, M.G. Pharmacokinetics and pharmacodynamics of furosemide in protein-calorie malnutrition. Journal of Pharmacokinetics and Biopharmaceutics 21, 1–17 (1993). https://doi.org/10.1007/BF01061772

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