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What Changes Drug Metabolism in the Critically Ill?

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Yearbook of Intensive Care and Emergency Medicine 1993

Part of the book series: Yearbook of Intensive Care and Emergency Medicine 1993 ((YEARBOOK,volume 1993))

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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).

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References

  1. Burns AM, Shelly MP, Park GR (1992) The use of sedative agents in critically ill patients. Drugs 43: 507–515

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Article  CAS  Google Scholar 

  3. Penfold NW, Park GR (1990) The effects of organ failure on drug metabolism. Curr Opinion Anaest 3: 235–240

    Article  Google Scholar 

  4. Shelly MP, Park GR, Mendel L (1987) Failure of critically ill patients to metabolise midazolam. Anaesthesia 42: 619–626

    Article  PubMed  CAS  Google Scholar 

  5. Koch-Weser J (1972) Serum drug concentrations as therapeutic guides. N Engl J Med 287: 227–231

    Article  PubMed  CAS  Google Scholar 

  6. Perruca E, Grimaldi R, Crema A (1985) Interpretation of drug levels in acute and chronic disease states. Clin Pharmacokin 10: 498–513

    Article  Google Scholar 

  7. Bodenham A, Brownlie G, Dixon JS, Park GR (1988) Reversal of sedation by prolonged infusion of flumazenil. Anaesthesia 43: 376–378

    Article  PubMed  CAS  Google Scholar 

  8. Bond AJ, Hailey DM, Lader MH (1977) Plasma concentrations of benzodiazepines. Brit J Clin Pharmacol 4: 51–56

    CAS  Google Scholar 

  9. 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

    Article  PubMed  CAS  Google Scholar 

  10. Moochhala SM (1991) Alteration of drug biotransformation by interferon and host defence me-chanism. Ann Acad Med 20: 13–18

    CAS  Google Scholar 

  11. Farrel GC (1987) Drug metabolism in extrahepatic disease. Pharmacol Ther 35: 375–404

    Article  Google Scholar 

  12. Scott DB, Beamish D, Hudson IN, Josteil KG (1980) Prolonged infusion of ehlormethiazole in intensive care. Brit J Anaest 52: 541–545

    Article  CAS  Google Scholar 

  13. Robson DJ, Blow C, Games P, Flanagan RJ, Henry JA (1984) Accumulation of chlormethiazole during intravenous infusion. Intensive Care Med 10: 315–316

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  CAS  Google Scholar 

  15. Podkowik BI, Park GR (1992) Plasma concentrations of flumazenil during liver transplantation. Anaesthesia 47: 887–889

    Article  PubMed  Google Scholar 

  16. Jones DP (1981) Hypoxia and drug metabolism. Biochem Pharmacol 30: 1019–1023

    Article  PubMed  CAS  Google Scholar 

  17. Angus PW, Morgan DJ, Smallwood RA (1990) Hypoxia and hepatic drug metabolism: Clinical implications. Aliment Pharmacol Therap 4: 213–225

    Article  CAS  Google Scholar 

  18. Hart P, Farrell GC, Cooksley WGE, Powell LW (1976) Enhanced drug metabolism in cigarette smokers. Br Med J 2: 147–149

    Article  PubMed  CAS  Google Scholar 

  19. Reidenberg MM (1977) The biotransformations of drugs in renal failure. Am J Med 62: 482–485

    Article  PubMed  CAS  Google Scholar 

  20. Lichter M, Black M, Arias IM (1973) The metabolism of antipyrine in patients with chronic renall failure. J Pharmacol Exp Ther 187: 612–619

    PubMed  CAS  Google Scholar 

  21. Song CS, Gelb NA, Wolff SM (1972) The influence of pyrogen induced fever on salicylamide metabolism in man. J Clin Invest 51: 2959–2966

    Article  PubMed  CAS  Google Scholar 

  22. 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

    PubMed  CAS  Google Scholar 

  23. 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

    PubMed  CAS  Google Scholar 

  24. 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

    PubMed  CAS  Google Scholar 

  25. 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

    PubMed  CAS  Google Scholar 

  26. Chang KC, Laner BA, Bell JD, Chai H (1978) Altered theophylline pharmacokinetics during acute respiratory viral illness. Lancet 1: 1132–1133

    Article  PubMed  CAS  Google Scholar 

  27. 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

    PubMed  CAS  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. 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

    CAS  Google Scholar 

  30. 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

    Google Scholar 

  31. 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

    CAS  Google Scholar 

  32. 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

    PubMed  CAS  Google Scholar 

  33. 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

    Article  PubMed  CAS  Google Scholar 

  34. 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

    Article  PubMed  CAS  Google Scholar 

  35. 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

    PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  CAS  Google Scholar 

  37. Rivier C, Vale W, Brown M (1989) In the rat, IL-1 alpha & beta stimulate adrenocorticotropin and catecholamine release. Endocrinology 125: 3096–3102

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. 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 )

    Google Scholar 

  40. 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

    PubMed  CAS  Google Scholar 

  41. 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

    Article  CAS  Google Scholar 

  42. 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

    PubMed  CAS  Google Scholar 

  43. 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

    CAS  Google Scholar 

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© 1993 Springer-Verlag Berlin Heidelberg

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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

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  • DOI: https://doi.org/10.1007/978-3-642-84904-6_31

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-56463-8

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