Abstract
The critically ill are exposed to many drugs, including sedatives, inotropes, analgesics and antibiotics [1]. Drug prescription in the critically ill is usually based on dose regimens extrapolated from data obtained from healthy volunteers or animals [2,3]. They form a heterogenous group with varying severity of disease, chronicity and cause. Drug metabolism is altered significantly in these patients [2,4]. Little is known about the causes of these changes although many factors may participate (Fig. 1).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Burns AM, Shelly MP, Park GR (1992) The use of sedative agents in critically ill patients. Drugs 43: 507–515
Bodenham A, Shelly MP, Park GR (1988) The altered pharmacokinetics and pharmacodynamics of drugs commoijly used in critically ill patients. Clin Pharmacokin 14: 347–373
Penfold NW, Park GR (1990) The effects of organ failure on drug metabolism. Curr Opinion Anaest 3: 235–240
Shelly MP, Park GR, Mendel L (1987) Failure of critically ill patients to metabolise midazolam. Anaesthesia 42: 619–626
Koch-Weser J (1972) Serum drug concentrations as therapeutic guides. N Engl J Med 287: 227–231
Perruca E, Grimaldi R, Crema A (1985) Interpretation of drug levels in acute and chronic disease states. Clin Pharmacokin 10: 498–513
Bodenham A, Brownlie G, Dixon JS, Park GR (1988) Reversal of sedation by prolonged infusion of flumazenil. Anaesthesia 43: 376–378
Bond AJ, Hailey DM, Lader MH (1977) Plasma concentrations of benzodiazepines. Brit J Clin Pharmacol 4: 51–56
Nebert DW, Nelson DR, Coon MJ, et al (1991) The P450 superfamily: Update on new sequences, gene mapping, and recommended nomenclature. DNA Cell Biol 10: 1–14
Moochhala SM (1991) Alteration of drug biotransformation by interferon and host defence me-chanism. Ann Acad Med 20: 13–18
Farrel GC (1987) Drug metabolism in extrahepatic disease. Pharmacol Ther 35: 375–404
Scott DB, Beamish D, Hudson IN, Josteil KG (1980) Prolonged infusion of ehlormethiazole in intensive care. Brit J Anaest 52: 541–545
Robson DJ, Blow C, Games P, Flanagan RJ, Henry JA (1984) Accumulation of chlormethiazole during intravenous infusion. Intensive Care Med 10: 315–316
Pentikainen PJ, Neuvonen PJ, Tarpila S, Sylvalahti E (1978) Effect of cirrhosis of the liver on the pharmacokinetics of chlormethiazole. B Med J 2: 861–863
Podkowik BI, Park GR (1992) Plasma concentrations of flumazenil during liver transplantation. Anaesthesia 47: 887–889
Jones DP (1981) Hypoxia and drug metabolism. Biochem Pharmacol 30: 1019–1023
Angus PW, Morgan DJ, Smallwood RA (1990) Hypoxia and hepatic drug metabolism: Clinical implications. Aliment Pharmacol Therap 4: 213–225
Hart P, Farrell GC, Cooksley WGE, Powell LW (1976) Enhanced drug metabolism in cigarette smokers. Br Med J 2: 147–149
Reidenberg MM (1977) The biotransformations of drugs in renal failure. Am J Med 62: 482–485
Lichter M, Black M, Arias IM (1973) The metabolism of antipyrine in patients with chronic renall failure. J Pharmacol Exp Ther 187: 612–619
Song CS, Gelb NA, Wolff SM (1972) The influence of pyrogen induced fever on salicylamide metabolism in man. J Clin Invest 51: 2959–2966
Elin RJ, Vesell ES, Wolff SM (1975) Effects of etiocholanolone induced fever on plasma anti-pyrine half lives and metabolic clearance. Clin Pharmacol Ther 17: 447–457
Trenholme GM, Williams RL, Rieckmann KH, Frischer H, Carson PE (1976) Quinine disposition during malaria and during induced fever. Clin Pharmacol Ther 19: 459–467
Egawa K, Yoshida M, Kasai N (1981) An endotoxin-induced serum factor that depresses hepatic δ-aminolevulinic acid synthetase activity and cytochrome P-450 levels in mice. Microbiol Immunol 25: 1091–1096
Beck FJ, Whitehouse MW (1974) Impaired drug metabolism in rats associated with acute inflammation: A possible assay for anti-injury agents. Proc Soc Exp Biol Med 145: 135–140
Chang KC, Laner BA, Bell JD, Chai H (1978) Altered theophylline pharmacokinetics during acute respiratory viral illness. Lancet 1: 1132–1133
Craig PI, Mehta I, Murray M, et al (1990) Interferon down regulates the male-specific cytochrome P450 IIIA2 in rat liver. Mol Pharmacol 38: 313–318
Ghezzi P, Saccardo B, Bianchi M (1986) Induction of xanthine oxidase and heme oxygenase and depression of liver drug metabolism by interferon: A study with different recombinant interferons. J Interferon Res 6: 251–256
Moochhala SM, Renton KW (1989) Effects of the interferon inducing agent, Poly rl.rC on the synthesis of hepatic cytochrome P450. Asia Pac J Pharmacol 4: 83–88
El Azhary R, Renton KW, Mannering GJ (1980) Effect of interferon inducing agents (Polyriboinosinic Acid, Polyribocytidylic Acid and Tilorone) on the heme turnover of hepatic cyto-chrome P450. 1 Iol Pharmacol 17: 395–399
Morgan ET, Norman CA (1990) Pretranslational suppression of cytochrome P450h (HCl 1) gene expression in rat liver after administration of interferon inducers. Drug Metab Disp 18: 649–653
Ghezzi P, Saccardo B, Villa P, Rossi V, Bianchi M, Dinarello CA (1986) Role of interleukin-1 in the depression of liver drug metabolism by endotoxin. Infect Immun 54: 837–840
Ramadori G, Sipe JD, Dinarello CA, Mizel SB, Colten HR (1985) Pretranslational modulation of acute phase hepatic protein synthesis by murine recombinant interleukin-1 (IL-1) and puri- fied human IL-1. J Exp Med 162: 930–942
Sujita K, Okuno F, Hirano Y, Inamoto Y, Eto S, Arai M (1990) Effect of interleukin-1 (IL-1) on the levels of cytochrome P450 involving IL-1 receptor on the isolated hepatocytes of rat. Biochem Biophys Res Commun 168: 1217–1222
Marinkovic S, Jahreis GP, Wong GG, Baumann H (1989) IL-6 modulates the synthesis of a specific set of acute phase plasma proteins in vivo. J Immunol 142: 808–812
Chen YL, Florentin I, Blatt AM, Ferrari L, Giroud JP, Chauvelot-Maochon L (1992) Effects of interleukin-6 on cytochrome P450-dependent mixed function oxidases in the rat. Biochem Pharmacol 44: 137–148
Rivier C, Vale W, Brown M (1989) In the rat, IL-1 alpha & beta stimulate adrenocorticotropin and catecholamine release. Endocrinology 125: 3096–3102
Pineau T, Daujat M, Pichard L, et al (1991) Developmental expression of rabbit cytochrome P450 CYP1A1, CYP1A2, and CYP3A6 genes. Effect of weaning and rifampicin. Eur J Biochem 197: 145–153
Miahin V, von Bahr C, Ingelman-Sundberg M (1991) Clomethiazole as a potent and selective inhibitor in vivo of CYP2E1 during food deprivation. First International Conference on Food Nutrition and Chemical Toxicity, Guildford, England (Abst )
Kanazawa Y, Kitada M, Mori T (1991) Ascorbic acid deficiency decreases specific forms of cytochrome P450 in liver microsomes of guinea pigs. Mol Pharmacol 39: 456–460
Burgess P, Hall RI, Bateman DN, Johnston IDA (1987) The effect of total parenteral nutrition on hepatic drug oxidation. J Paren Enteral Nut 11: 540–543
Yun Y, Casazza JP, Sohn DH, Veech RL, Song BJ (1992) Pretranslational activation of cytochrome P450IIE during ketosis induced by a high fat diet. Mol Pharmacol 41: 474–479
Pollack GM, Browne JL, Marton J, Haberer LJ (1991) Chronic stress impairs oxidative metabolism and hepatic excretion of model xenobiotic substrates in the rat. Drug Metab Disp 19: 130–134
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
O’Meara, M.E., Woodrooffe, A.J.M., Park, G.R. (1993). What Changes Drug Metabolism in the Critically Ill?. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1993. Yearbook of Intensive Care and Emergency Medicine 1993, vol 1993. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84904-6_31
Download citation
DOI: https://doi.org/10.1007/978-3-642-84904-6_31
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-56463-8
Online ISBN: 978-3-642-84904-6
eBook Packages: Springer Book Archive