Pharmacokinetics and pharmacodynamics of dichloroacetate in patients with cirrhosis.
OBJECTIVE
We tested the hypotheses that (1) plasma clearance of dichloroacetate is decreased in patients with end-stage cirrhosis, and (2) patients with cirrhosis are vulnerable to dichloroacetate-induced hypoglycemia caused by exaggerated inhibition of hepatic glucose production.


METHODS
Seven subjects with cirrhosis and six healthy volunteers received a 5-hour primed constant infusion of 6,6-2H2-glucose. After a 2-hour basal period, subjects received intravenous dichloroacetate, 35 mg/kg, over 30 minutes. Dichloroacetate pharmacokinetics were compared by the mixed-effects population-based technique. Glucose production was calculated by means of isotope dilution.


RESULTS
The optimal dichloroacetate pharmacokinetic model for both subjects with cirrhosis and control subjects had two compartments, with all parameters weight normalized. Peak plasma dichloroacetate concentration in subjects with cirrhosis did not differ from that in control subjects, but typical dichloroacetate clearance was only 36% of that in control subjects (P < .001). Dichloroacetate decreased plasma lactate concentration by approximately 50% (P < .001), glucose production by 7% to 9% (P < .05), and plasma glucose concentration by 9% to 14% (P < .05) in both subjects with cirrhosis and control subjects. Dichloroacetate-induced decreases in plasma lactate and glucose concentrations and in glucose production in subjects with cirrhosis did not differ from those in control subjects.


CONCLUSIONS
Plasma dichloroacetate clearance is markedly decreased in patients with cirrhosis, likely because of compromised hepatic function. Subjects with cirrhosis exhibit neither exaggerated inhibition of glucose production nor increased risk of hypoglycemia as a result of acute dichloroacetate-induced hypolactatemia.
Shangraw
R E
RE
Department of Anesthesiology, Oregon Health Sciences University and Veterans Affairs Medical Center, Portland 97201-3098, USA.
Fisher
D M
DM
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D003999:Dichloroacetic Acid / Q000493:pharmacokinetics* / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000378:metabolism; D019344:Lactic Acid / Q000097:blood; D008099:Liver / Q000187:drug effects / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D001786:Blood Glucose; D019344:Lactic Acid; D003999:Dichloroacetic Acid