Pharmacokinetic based adjustment of lidocaine antiarrhythmic schedule.
Administration of lidocaine, 200 mg/day i.m. or 275 mg orally, decreased sudden death after myocardial infarct (from 20.7% to 10.3%) although such schedules are not considered adequate to guarantee efficient plasma levels. Inclusion of lidocaine in a polyethylene matrix assured a slow release and complete disappearance of known side effects. Lidocaine was administered 200 mg intramuscularly to hospitalized patients every 6 h or 275 mg oral tablets to healthy volunteers every 8 h and plasma levels evaluated. Plasma levels after oral administration to healthy volunteers showed a great variability, so that it was not possible to draw a statistically significant conclusion about the accumulation of lidocaine in a period of 1 week. In coronary artery disease patients, plasma levels slowly increased with time, but clinical signs indicated, in some cases, a much more rapid accumulation. The therapeutic efficiency at low repeated doses was explained as a consequence of a slow accumulation on the one hand and of the addition of the action of MEGX, the major metabolite of lidocaine, on the other hand.
Voicu
V
V
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Mircioiu
C
C
Jinga
M
M
Ionescu
M
M
Burcea
X
X
Ionescu
D D
DD
Lupescu
G
G
D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy*; D002849:Chromatography, Gas; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D006801:Humans; D007273:Injections, Intramuscular; D008012:Lidocaine / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000517:prevention & control
D003692:Delayed-Action Preparations; D008012:Lidocaine