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Biomedical subjects

H R Ochs

Publications and source records attributed to H R Ochs.

At least 73 records · Page 4Linked to original sources
PubMed1984

Clorazepate dipotassium and diazepam in renal insufficiency: serum concentrations and protein binding of diazepam and desmethyldiazepam.

5 patients with chronic renal failure on maintenance hemodialysis and 5 healthy matched controls received single 20-mg intravenous doses of clorazepate dipotassium. Clearance of pharmacologically active unbound desmethyldiazepam was reduced in renal failure patients as opposed to controls, and free fraction in serum was greater. Since desmethyldiazepam distribution was reduced in renal patients, elimination half-life was actually shorter than in controls (36 vs. 57 h). In 10 dialysis patients receiving chronic diazepam treatment (5-15 mg/day), steady-state concentrations of diazepam (56 ng/ml) and desmethyldiazepam (77 ng/ml) were significantly lower than in age- and weight-matched controls receiving similar doses (189 and 216 ng/ml, respectively). However after correction for the higher free fractions of both compounds in renal patients as opposed to controls, steady-state concentrations of unbound drug were found to be similar between groups. Interpretation of kinetic variables and steady-state serum concentrations of extensively protein-bound drugs requires consideration of alterations in protein binding that may occur in disease states.

Adult↗
PubMed1984

Benzodiazepine drug-drug interactions commonly occurring in clinical practice.

Pharmacokinetic drug-drug interactions which involve currently available benzodiazepines may be classified into two major categories: interactions which affect benzodiazepine rate of absorption, and interactions which affect clearance and, therefore, elimination half-life. Ethanol is the prototype for absorptive interactions. Concurrent ethanol use and oral ingestion of benzodiazepine derivatives uniformly slows the rate but does not change the extent of benzodiazepine absorption. Interactions which affect benzodiazepine clearance affect only those derivatives which are oxidatively metabolized or cleared as a function of hepatic blood flow (high first-pass clearance). Conjugated benzodiazepines are not implicated in such interactions. Rifampin and chronic ethanol use induce benzodiazepine oxidation, while cimetidine, oral contraceptives, ethanol (acute ingestion), disulfiram, isoniazid, and propranolol inhibit benzodiazepine oxidation. In addition, ethanol, cimetidine and isoniazid decrease first-pass hepatic extraction of triazolam, enhancing its systemic availability and decreasing oral clearance. The pharmacokinetic consequence of induction of benzodiazepine oxidation is higher clearance and decreased steady-state concentrations during chronic dosing. Conversely, inhibition of benzodiazepine oxidation decreases clearance and increases steady-state benzodiazepine concentrations during chronic dosing. Because a correlation of benzodiazepine plasma concentration and pharmacological effect is not established, the pharmacodynamic consequences of these interactions are not currently well characterized.

Anti-Anxiety Agents↗
PubMed1984

[Therapy control in cardiology: serum level monitoring].

Treatment of cardiac patients with drugs of low therapeutic ratio (i.e. cardiac glycosides, antiarrhythmics) must be individualized to avoid undertreatment or intoxication with their often deleterious consequences. However, in most cases the dose-response effect cannot be predicted, especially in those instances in which the desired effect is hard to measure (e.g. intermittent arrhythmias). Very often a potentially useful drug is not effective because the applied dose is either too low or administered at incorrect intervals. An effective medication can also be incorrectly assumed to be intolerable when the dose administered is too high relative to the patient's impaired renal or liver function. Fixed application schedules will not be successful in the majority of cases due to the following large interpatient variables: absorption, distribution, elimination, biotransformation, protein and tissue binding, and effect on the target organ. If drug efficacy cannot be proven by clinical observation the determination of blood levels of substances with a narrow therapeutic ratio cen be helpful. However, an interpretation should only be made by considering the clinical condition of the patient and the inherent kinetic variables of the drug.

Anti-Arrhythmia Agents↗
PubMed1983

Antipyretic analgesic drugs as models for studies of drug disposition in old age.

Alterations in drug metabolizing capacity associated with the aging process can be elucidated using analgesic-antipyretic agents as model compounds. Antipyrine serves to profile drug oxidizing capacity. Drug oxidation is significantly impaired in old age, but age-related changes are far greater in men than in women. Acetaminophen analogously serves to profile conjugating capacity, which is minimally influenced by age both in men and in women. Changes in the capacity to biotransform these model compounds are reasonably well predictive of parallel changes in the same person's ability to metabolize other drugs transformed by the same pathway.

Acetaminophen↗
PubMed1983

Potentially toxic serum lidocaine concentrations following spray anesthesia for bronchoscopy.

Serum lidocaine concentrations were measured in a series of ten patients during and after topical lidocaine spray anesthesia used for diagnostic fiberoptic bronchoscopy. Mean total dose of lidocaine ranged from 480-720 mg. Peak serum lidocaine concentrations averaged 3.6 micrograms/ml (range: 1.9 to 7.4 micrograms/ml), and were attained shortly after the start of the procedure. Repeated topical administration of lidocaine spray therefore may lead to large cumulative doses and serum concentrations which are in the therapeutic or potentially toxic range.

Adult↗
PubMed1983

[Benzodiazepines: significance of kinetics for therapy].

The onset and duration of action of benzodiazepines after single oral doses depend largely on absorption rate and the rate and extent of distribution. The rate and extent of accumulation during multiple dosage depend on elimination half-life and clearance. A framework is proposed for classification of benzodiazepines according to elimination half-life. Long acting benzodiazepines have half-life values usually exceeding 24 h. Drugs in this category have long-acting pharmacologically active metabolites, often desmethyldiazepam, accumulate extensively during multiple dosage, and may have impaired clearance in the elderly and those with liver disease. Intermediate and short-acting benzodiazepines have half-life values from 5-24 h and active metabolites are uncommon. Accumulation during multiple dosage is less extensive than with the long-acting group and diminishes as the half-life becomes shorter. Age and liver disease have a small influence on metabolic clearance. The half-life of ultrashort-acting benzodiazepines is less than 5 h. These drugs are essentially nonaccumulating. Pharmacokinetic classification may assist in understanding differences among benzodiazepines, but does not explain all of their clinical actions.

Age Factors↗
PubMed1983

Cimetidine impairs nitrazepam clearance.

The effect of cimetidine on hepatic clearance of the benzodiazepine derivative nitrazepam was evaluated in healthy subjects. Six received a single 5- or 10-mg oral nitrazepam dose in the drug-free state and again with therapeutic cimetidine doses. Nitrazepam kinetics were determined from multiple serum concentrations measured during the 72 hr after each dose. Cimetidine had no effect on nitrazepam absorption kinetics, since peak serum nitrazepam concentration and time of peak concentration were not altered. Cimetidine did not alter nitrazepam volume of distribution, but cimetidine consistently reduced nitrazepam clearance, from a mean of 1.41 ml/min/kg in the control state to 1.17 ml/min/kg during cimetidine treatment. This resulted in prolongation of nitrazepam elimination t1/2 from 22.2 to 27.8 hr. Thus the ability of cimetidine to impair drug oxidation in man extends to the capacity for clearance of nitrazepam, a compound biotransformed mainly by nitroreduction.

Adolescent↗
PubMed1983

Repeated diazepam dosing in cirrhotic patients: cumulation and sedation.

Five medically stable male patients with cirrhosis and four healthy age- and sex-matched controls received single 5-mg oral doses of diazepam (DZ) daily for 22 consecutive days. Plasma concentrations of DZ and its major metabolite desmethyldiazepam (DMDZ) were measured daily during the period of dosing and in the 7-day washout period that followed. Clinical self-ratings of sedation, fatigue, mood state, and sleep patterns were obtained daily during the period of dosage with the use of visual analogue scales. Steady-state plasma DZ concentrations were higher (165 and 98 ng/ml), and DMDZ concentrations tended to be higher (399 and 206 ng/ml), in cirrhotics than in controls. Increases in self-rated daytime sedation also were greater in cirrhotics than in controls and correlated strongly with total DZ and DMDZ plasma concentration during the first 2 wk of diazepam dosing. Thus, reduced clearance of DZ in cirrhotics leads to increased cumulation during long-term dosing. This in turn is associated with increased clinical sedation. Sedative effects are partly offset as treatment proceeds because of adaptation or tolerance. Based on kinetic findings, diazepam can be given safely to cirrhotic patients provided daily dosage is reduced by approximately 50%.

Adult↗
PubMed1983

Lorazepam and oxazepam kinetics in women on low-dose oral contraceptives.

Women on low-dose estrogen oral contraceptives (OC) and drug-free control women matched for age, weight, and cigarette smoking habits, received single 2-mg IV doses of lorazepam or single 30-mg oral doses of oxazepam, two benzodiazepines metabolized by glucuronide conjugation. Kinetics were determined from multiple plasma concentrations measured during 48 hr after dosing. Mean kinetic variables for lorazepam in control and OC groups (n = 15 in each group) were: volume of distribution (Vd), 1.33 and 1.45 l/kg; elimination t1/2, 13.1 and 12.2 hr; total clearance, 1.25 and 1.50 ml/min/kg; free fraction in plasma, 10.3% and 10.3% unbound. For oxazepam, kinetic variables in the two groups (n = 14 and 17) were: Vd, 1.05 and 1.19 l/kg; t1/2, 7.6 and 7.2 hr; total clearance, 1.60 and 2.03 ml/min/kg; free fraction, 4.6% and 4.9% unbound. None of these differences were significant. Thus, metabolic clearance by glucuronidation of lorazepam and oxazepam is not significantly affected by OC, in contrast with the highly significant reduction in clearance of the oxidized benzodiazepine diazepam.

Adult↗
PubMed1983

Differential effect of isoniazid on triazolam oxidation and oxazepam conjugation.

Healthy volunteers received a single dose of triazolam (0.5 mg) or oxazepam (30 mg) on two occasions, once in the control state and again during coadministration of isoniazid (INH) base, 180 mg day. INH coadministration prolonged triazolam half-life (3.3 vs 2.5 h, P less than 0.05) and increased total area under the curve (38.6 vs 26.5 ng ml-1 h, P less than 0.01) consistent with a reduction of apparent oral clearance (3.9 vs 6.8 ml min-1 kg-1, 0.05 less than P less than 0.1). INH coadministration had no influence on the kinetics of oxazepam. INH impairs hepatic microsomal oxidation of triazolam, leading to reduced first-pass hepatic extraction as well as prolonged half-life. However INH had no influence on oxazepam conjugation.

Adult↗
PubMed1983

Pharmacokinetic model of diltiazem.

The pharmacokinetic profile of D-3-acetoxy-cis-2,3-dihydro-5-(2-dimethylamino-ethyl)-2-(p-methoxy-phenyl)-1, 5-benzothiazepin-4(5H)-one hydrochloride (diltiazem . HCl) following i.v. and p.o. administration has been studied in six healthy subjects using a new sensitive GLC method. The volunteers received an i.v. infusion of 20 mg in 20 min, a peroral solution of 120 mg and two 60-mg tablets (Dilzem) in a randomized sequence. The plasma level time courses of the unchanged compound following infusion and peroral solution were simultaneously evaluated by nonlinear regression analysis. The best model was chosen by means of statistical criteria. In all subjects the experimental data could be adequately described by an open three-compartment model with zero order input following infusion and first order absorption following p.o. solution. Using this procedure the following common disposition parameters were obtained for both routes of administration: t1/2 alpha = 0.1 h, t1/2 beta = 2.1 h, t1/2 gamma = 9.8 h (harmonic means derived from individualized fits), Vc = 0.9 +/- 0.4 l/kg, Vss = 5.2 +/- 2.4 l/kg, Cltot = 11.5 +/- 1.8 ml/min/kg. Compared to the beta-phase the terminal gamma phase represents a smaller contribution to the total AUC. The blood/plasma distribution ratio was found to be 1.00 +/- 0.08 (N = 4), the mean hepatic extraction ratio was 0.54. Peak levels appeared 0.6 +/- 0.3 h after the p.o. solution. The mean absolute bioavailability of diltazem based on the individual AUC infinity 0 of the p.o. solution and the infusion was 0.44 +/- 0.10. Following tablet administration, delayed maximum levels were found after 2.8 +/- 0.9 h. Comparing the AUC infinity 0 of tablets and p.o. solution, there was no significant difference between both dosage forms.

Adult↗