title: Decreased dromotropic response to verapamil despite pronounced increased drug concentration in rheumatoid arthritis.
abstract: OBJECTIVE
  Inflammation reduces hepatic clearance of many drugs with unknown therapeutic consequences. This study was carried out to examine the effect of rheumatoid arthritis (RA) on the pharmacokinetics and pharmacodynamics of verapamil.
  
  
  METHODS
  Eight RA patients were age- and sex-matched with eight healthy volunteers. The disease severity was assessed, and ECG, blood pressure and verapamil enantiomers concentrations were measured for 12 h post 80 mg oral verapamil. Serum interleukin-6 (IL-6) and nitrite (NO2-) were measured in predose samples.
  
  
  RESULTS
  IL-6 and NO2- concentrations were significantly increased in parallel with disease severity. Oral clearance of both S- and R-verapamil was significantly decreased by RA. While the unbound fraction of S- and R-verapamil decreased by 5 and 7-fold, respectively, the unbound AUC remained unchanged for the more potent enantiomer, S-verapamil. AUC of norverapamil enantiomers was increased 2-3-fold. Despite elevated serum drug concentrations in RA, the potential to prolong the PR-interval was significantly reduced by one fold and the effect on the heart rate and blood pressure did not increase.
  
  
  CONCLUSIONS
  RA results in increased verapamil concentrations due likely to changes in protein binding, decreased clearance and/or altered hepatic blood flow. A significant decrease in dromotropic effect, despite increased serum drug concentrations, may be attributed to receptor down regulation caused by pro-inflammatory cytokines and/or NO.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, and Division of Rheumatology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: P R
authors.initials: PR
authors.lastname: Mayo
authors.forename: K
authors.initials: K
authors.lastname: Skeith
authors.forename: A S
authors.initials: AS
authors.lastname: Russell
authors.forename: F
authors.initials: F
authors.lastname: Jamali
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001172:Arthritis, Rheumatoid / Q000097:blood*; D002121:Calcium Channel Blockers / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008657:Metabolic Clearance Rate; D009573:Nitrites / Q000097:blood; D014700:Verapamil / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology
chemical_list: D002121:Calcium Channel Blockers; D015850:Interleukin-6; D009573:Nitrites; D014700:Verapamil