The pharmacokinetics of the enantiomers of atenolol

A number of studies have demonstrated that lipophilic beta-adrenoceptor blocking agents, eliminated almost exclusively by hepatic metabolism, are stereoselectively metabolized in human beings. Previous studies in our laboratory have demonstrated that pindolol, a beta-adrenoceptor blocking agent of intermediate lipophilicity that is eliminated by both hepatic metabolism and renal excretion, is eliminated stereoselectively in the kidney. In the present study we examined the pharmacokinetics of the enantiomers of atenolol, a hydrophilic cardioselective beta-adrenoceptor blocking agent that is eliminated almost exclusively by the kidney. A single 100 mg oral dose of racemic atenolol was administered to six healthy adult men. Concentrations of d- and l-atenolol in plasma and urine were measured by a stereospecific HPLC analytic procedure. In each subject the peak concentration of d-atenolol was greater than the peak concentration of l-atenolol (mean +/- SD of 420 +/- 81 ng/ml vs 366 +/- 61 ng/ml; p less than 0.05). The peak concentration of both enantiomers was reached at the same time in each subject (between 2 and 3 hours). The renal clearances of d- and l-atenolol were not significantly different (109.7 +/- 33.5 ml/min vs 112.5 +/- 36.7 ml/min), probably because the major route of renal elimination is glomerular filtration. The half-lives of d- and l-atenolol were not significantly different (mean +/- SD of 4.6 +/- 1.1 hours vs 5.2 +/- 0.9 hours). However, both the AUC and the amount excreted unchanged in the urine in 24 hours Ae [0-24]) were significantly greater for d-atenolol than for l-atenolol (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of probenecid on the renal elimination of cimetidine

It is generally assumed that the systems involved in the transport of organic cations and organic anions in the renal proximal tubule are substrate selective (i.e., organic anions do not inhibit organic cation transport and vice versa). However, recent data obtained in vitro have suggested that the organic anion probenecid inhibits the renal transport of the organic cation cimetidine. We addressed the question of whether this interaction is biologically relevant in human beings. The study involved a two-treatment, randomized crossover design. Six healthy male subjects were given an intravenous infusion of 300 mg cimetidine alone as one treatment and, as the other treatment, received multiple oral doses of probenecid before receiving the cimetidine infusion. The renal clearance of cimetidine and inulin was determined in each period. There were no significant differences between treatments in cimetidine plasma concentrations, apparent volume of distribution, systemic clearance, half-life, amount of drug excreted unchanged in the urine, or nonrenal clearance. Probenecid significantly decreased the renal clearance of cimetidine by decreasing both the filtration clearance and the net secretory clearance. These effects were most evident in the first 1/2 to 1 hour after cimetidine administration, when probenecid levels in plasma and renal tissue would have been the highest. Because there was no effect of probenecid on cimetidine plasma concentrations, this interaction is not clinically relevant to the therapeutic use of these two compounds. However, the study demonstrates that renal interactions between organic cations and organic anions can occur in human beings. The mechanism of this interaction and the implications to other drug combinations are being explored.

Species differences in the negative inotropic response of 1,4-dihydropyridine calcium channel blockers in myocardium

To determine if species differences exist in myocardial response to 1,4-dihydropyridine (DHP) calcium channel blockers, the binding and pharmacologic responses of a series of DHP compounds were examined in both rat and rabbit myocardium. [3H]Nitrendipine was used to label specific binding sites in myocardial membrane particulates. The results of saturation binding experiments (n = 3) indicated no statistically significant difference in either Kd or Bmax between rat and rabbit myocardial membranes (0.19 +/- 0.02 nM and 157 +/- 29 fmol/mg protein in rat and 0.14 +/- 0.06 nM and 227 +/- 125 fmol/mg protein in rabbit). Furthermore, [3H]nitrendipine binding inhibition experiments using 12 unlabeled DHP analogues yielded Ki values for each compound that were almost identical in myocardium from rat and rabbit, resulting in an excellent 1:1 correlation when data for all of the compounds were compared (r = 0.997, p less than 0.001). The negative inotropic effect of five of these DHP compounds was studied in vitro in isolated right papillary muscles from rabbit and right ventricular strips from rat, and concentration required to displace 50% of ligand binding (IC50) values for inhibition of contraction were determined. The IC50 values were significantly greater in rat myocardium than in rabbit myocardium (p less than 0.003). Therefore, a significantly lower potency of DHP calcium channel blockers has been demonstrated in rat compared with rabbit myocardium, and this species difference cannot be explained by a difference in the DHP binding site. Rat myocardium differs from rabbit myocardium in a number of ways that may explain this lower potency.(ABSTRACT TRUNCATED AT 250 WORDS)

Cimetidine elimination from the cerebrospinal fluid of the rat

The major goal of this study was to develop a small animal model that could be used to assess quantitatively the clearance of cimetidine from the cerebrospinal fluid (CSF) under relatively physiologic conditions. In addition, we addressed questions related to the pathways involved in the elimination of cimetidine from the CSF. We administered high and low bolus doses of cimetidine together with inulin, as a marker of bulk flow, into the lateral ventricle of anesthetized rats and sampled CSF from the cisterna magna. Principles of linear pharmacokinetic systems were applied to the data to obtain clearances from the CSF. The clearance of inulin was 2.02 +/- 0.22 microliters/min, which is in excellent agreement with the CSF production rate of 2.2 microliters/min in anesthetized rats. The clearance of cimetidine from the CSF following the administration of a low dose was 11.8 +/- 3.1 microliters/min, which is in good agreement with the cimetidine CSF clearance in the rat obtained previously in studies using the technique of ventriculocisternal perfusion. A 32% decrease in the CSF clearance of cimetidine (P less than 0.05) was observed when the high dose was administered, suggesting that CSF elimination is saturable. The clearance of inulin was unaffected by the high dose of cimetidine. This study demonstrates that the technique of lateral ventricle injection and sampling from the cisterna magna is useful in quantitatively assessing the elimination of compounds from the CSF in the rat under relatively physiologic conditions.

Renal transport of drugs: an overview of methodology with application to cimetidine

The development of new methods to study transport processes in renal epithelia has greatly enhanced our knowledge of the mechanisms involved in the transport of a number of endogenous compounds. More recently, these methods have been applied to study mechanisms of specific drug transport. This article is intended to provide an overview of the various methods used to study renal elimination of compounds. References to more detailed reviews of the individual methods are provided. Studies of the renal transport of cimetidine, a histamine H2-receptor antagonist, are presented to illustrate the application of these methods to the study of specific drugs. Methods such as clearance techniques and the Sperber chicken preparation used to study renal elimination of compounds in whole animals are briefly described. Techniques to identify the site of renal transport including stop flow, isolated perfused tubules, and micropuncture methods are discussed and references to more technical reviews are cited. The more recently developed methods of isolated membrane vesicles for studying transport across the individual polar membranes of the proximal tubule are discussed along with the relevant studies of the use of these membranes in elucidating the mechanisms involved in the renal transport of cimetidine. Finally, the use of cultured renal epithelial cell lines in studying renal transport is described. Knowledge of drug transport mechanisms in the kidney is important both in drug targeting to the kidney and in understanding the pharmacokinetics of renally eliminated drugs. As exemplified by the studies with cimetidine, only by combining the data from experiments using diverse methodology can the mechanisms involved in the renal excretion of compounds be delineated.(ABSTRACT TRUNCATED AT 250 WORDS)

Interactions of organic anions with the organic cation transporter in renal BBMV

It is generally assumed that the organic cation transport system in the renal proximal tubule is specific for organic cations and the transport of organic cations is not affected by organic anions. However, there are also data in the literature demonstrating that probenecid, a classical inhibitor of organic anion transport systems, inhibits the transport of an organic cation, cimetidine, in the renal proximal tubule. In this study we investigated the effects of probenecid and furosemide on the transport of N'-methylnicotinamide (NMN) the classical substrate of the organic cation transporter, in brush-border membrane vesicles prepared from rabbit renal cortex. In the presence of a pH gradient, both probenecid (10 mM) and furosemide reduced the initial uptake of NMN. Probenecid reduced the initial uptake of NMN to 12.1% of the control values (1.19 +/- 0.26 pmol/mg) and furosemide reduced the initial uptake of NMN to 39.2%. Probenecid (10 mM) also decreased the initial transport of NMN in the absence of a pH gradient. Inhibition of the transport of NMN by probenecid was concentration dependent, with the concentration of probenecid resulting in 50% inhibition of the transport of NMN equal to 2.31 +/- 1.18 mM in the presence of a pH gradient. Probenecid appeared to be a competitive inhibitor of NMN transport. The apparent Km (mean +/- SE) of NMN transport (2.01 +/- 0.78 mM) was increased to 18.7 +/- 10 mM (P less than 0.05) by probenecid (10 mM), whereas the Vmax was not changed (125 +/- 19.2 pmol.s-1.mg-1 vs. 186 +/- 94 pmol.s-1.mg-1, P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of binding affinities and negative inotropic potencies of the 1,4-dihydropyridine calcium channel blockers in rabbit myocardium

The binding and pharmacologic response of a series of 1,4-dihydropyridine analogs were examined in rabbit myocardium. [3H]Nitrendipine was used to label specific binding sites in myocardial membrane particulates and displacement experiments were carried out with the unlabeled analogs to determine their IC50 values. Binding of [3H]nitrendipine could be characterized by a Kd of 0.15 +/- 0.06 nM and a maximum number of binding sites of 247 +/- 150 fmol/mg of protein. Saturation binding experiments performed with higher concentrations of [3H]nitrendipine did not reveal the presence of a lower affinity site. Binding IC50 values of 12 unlabeled 1,4-dihydropyridine analogs ranged from 4.3 X 10(-10) M to 1.32 X 10(-6) M. The negative inotropic effect of the same compounds was studied in vitro in isolated papillary muscles and the IC50 values for inhibition of contraction determined. There was a statistically significant correlation between the IC50 values for binding and response (r = 0.79, P less than .005; rs = 0.78, P less than .005). Consistent with previous studies with several of these compounds, the response IC50 value for each compound was greater than the binding IC50 value. For most of the compounds, this difference was from one to two orders of magnitude. For three compounds, nitrendipine, nimodipine and nicardipine, this difference reached three orders of magnitude. These three dihydropyridine analogs share structural features that may determine their low myocardial potency and, at the same time, their high vascular smooth muscle potency. Elucidation of these structural features may be useful in determining which analogs will have the highest vascular smooth muscle selectivity.

Cimetidine transport in isolated luminal membrane vesicles from rabbit kidney

Experiments were conducted to study the transport of the histamine H2-receptor antagonist, cimetidine, in luminal membrane vesicles prepared from rabbit renal cortex. Cimetidine accumulated in the vesicles with time. Cimetidine uptake was sensitive to changes in vesicle size, suggesting that the compound is transported into an osmotically reactive intravesicular space. Its rate of uptake could be described by both a saturable and a nonsaturable process. The Km was 4.6 +/- 4.0 microM and the Vmax was 6.8 +/- 2.3 pmol X s-1 X mg protein-1 (mean +/- SD, n = 4). N1-methylnicotinamide (NMN), cimetidine, cimetidine sulfoxide, and ranitidine inhibited the uptake of cimetidine. Cimetidine uptake in the presence of an outwardly directed proton gradient was enhanced in vesicles preloaded with a higher concentration of unlabeled cimetidine (2.4 X 10(-4) M). An outwardly directed proton gradient enhanced the uptake of cimetidine to values exceeding its equilibrium accumulation. Uptake stimulated in this way could be inhibited by the cation, NMN, the bases, ranitidine, and cimetidine sulfoxide, and interestingly, by the anion, probenecid. The effect of probenecid did not appear to be due to nonspecific effects on membrane binding, membrane potential, or vesicle size. These data are consistent with data obtained in isolated perfused proximal tubules, demonstrating that probenecid inhibits cimetidine transport. The data in this study suggest that the effect of probenecid on cimetidine transport specifically involves the transporter in the luminal membrane.

Essential tyrosine residues in transport of organic cations in renal BBMV

The effects of tyrosine modifying agents on organic cation transport in brush-border membrane vesicles prepared from rabbit renal cortex were investigated. Treatment of membranes with 7-chloro-4-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl) and N-acetylimidazole reduced the initial rate of transport of N'-methylnicotinamide (NMN) significantly. The inactivation of NMN transport by NBD-Cl was concentration and time dependent. The maximal transport rate (Tmax) of NMN transport (18.4 +/- 4.3 pmol X s-1 X mg protein-1) in vesicles treated with NBD-Cl (0.15 mM) was reduced to 56% of the Tmax in the control vesicles (32.6 +/- 8.4 pmol X s-1 X mg protein-1, P less than 0.05); whereas the Km was not changed. Treatment with 2-mercaptoethanol reversed the reaction of NBD-Cl with sulfhydryl groups but did not significantly change the transport of NMN in the control or the treated membranes, suggesting that tyrosine but not sulfhydryl residues are involved. The overshoot of NMN uptake in the presence of a proton gradient was 3.38 +/- 0.67 pmol/mg protein in the untreated membranes and was reduced to 2.05 +/- 0.71 pmol/mg protein in the NBD-Cl-treated membranes (P less than 0.05). Studies with the pH-sensitive dye, acridine orange, demonstrated that NBD-Cl-treated vesicles were not leakier with respect to protons, suggesting that NBD-Cl may have specifically affected the organic cation-proton transporter.(ABSTRACT TRUNCATED AT 250 WORDS)

The pH gradient-dependent transport of organic cations in the renal brush border membrane. Studies with acridine orange

Recent studies have suggested that there is an organic cation-proton exchange mechanism in the renal brush border membrane which may be responsible for the active secretion of organic cations by the kidney. In all of these studies, the movement of organic cations was specifically monitored in the presence of a proton gradient. In this study, the organic cation-proton exchange mechanism in renal brush border membrane vesicles was examined by studying the movement of protons in the presence of favorable gradients of the organic cation, tetraethylammonium (TEA). Using acridine orange, a pH-sensitive fluorescent probe, we demonstrated that in isolated brush border membrane vesicles prepared from rabbit renal cortex, the rate of proton efflux increased with increasing inwardly directed gradients of TEA, although the efflux was saturable. An outwardly directed TEA gradient could also accelerate the influx of protons. The rate of exchange of protons for TEA was slower than that for Na+. This slower rate appears to be due to a lower Vmax of the exchange of organic cations with protons. These data provide more direct evidence for an exchange of organic cations with protons or a cotransport of organic cations and hydroxyl ions in the renal brush border membrane.

Studies on Ca2+ channel antagonists. 5-[(3,4-Dimethoxyphenethyl)methylamino]-2-(3,4-dimethoxyphenyl)-2- isopropylpentyl isothiocyanate, a chemoaffinity ligand derived from verapamil

Reduction of 1 (verapamil) afforded amine 2, which was converted with thiophosgene to isothiocyanate 3, a chemoaffinity ligand for Ca2+ channels. Compound 3 showed concentration-dependent negative inotropic effects in rat right myocardial ventricular strips, EC50 = (4.56 +/- 3.40) X 10(-6) M (mean +/- SD), being slightly less potent than 4 (gallopamil), EC50 = (1.95 +/- 1.22) X 10(-6) M. It displaced [3H]gallopamil in rat myocardial membranes, IC50 = (3.42 +/- 2.51) X 10(-7) M, approximately equipotent with 1. It showed irreversible antagonism of [3H]gallopamil binding when preincubated at 10(-5) M; only 25% of [3H]gallopamil binding vs. control was observed. This agent may be a useful chemoaffinity ligand to aid in characterization of Ca2+ channels.

The interaction of phenylalkylamine calcium channel blockers with the 1,4-dihydropyridine binding site

The interaction of verapamil and other phenylalkylamine calcium channel blockers with the 1,4-dihydropyridine receptor was examined. Studies characterizing the interaction and relationship between calcium channel blocking potency and binding affinity were performed in rat myocardium. The 1,4-dihydropyridines, nifedipine and nitrendipine, interacted competitively. The apparent Kd and Bmax of nitrendipine were 270 +/- 140 pM and 390 +/- 76 fmol/mg protein, respectively. In contrast, the interaction of the phenylalkylamines with the 1,4-dihydropyridine receptor was not competitive. At a 3H-nitrendipine concentration of 0.12 nM, verapamil displaced only 60% of specifically bound radioactivity and progressively less as the concentration of 3H-nitrendipine increased. Kinetic data indicated that the interaction of both D600 and verapamil with the 1,4-dihydropyridine receptor was not cooperative. At infinite dilution the dissociation rate constant (k-1) was not altered in the presence of 10(-5) M D600. We examined the hypothesis that 3H-nitrendipine interacts at several sites with similar affinities and that the phenylalkylamines interact at one of these sites. Although D600 could not further displace 3H-nitrendipine in the presence of a maximally displacing concentration of nifedipine (10(-6) M), nifedipine could further displace 3H-nitrendipine in the presence of a maximally displacing concentration of D600 (10(-5) M). These results are consistent with competitive interactions at multiple sites but do not explain the diminished ability of the phenylalkylamines to displace progressively less radioactivity at increasing 3H-nitrendipine concentrations. No relationship between binding affinity and pharmacologic potency of the phenylalkylamines was found suggesting that the interaction of the phenylalkylamines with the 1,4-dihydropyridine receptor is not responsible for their calcium channel blocking effects.

In vivo interaction of the enantiomers of disopyramide in human subjects

Disopyramide, an antiarrhythmic agent, is marketed as a racemic mixture of two enantiomers. The racemic drug has unusual pharmacokinetic properties because of its concentration-dependent binding to plasma proteins in the therapeutic plasma concentration range. This study examined, in healthy subjects, the individual pharmacokinetic properties of both total and unbound d- and 1-disopyramide in plasma after intravenous administration of each enantiomer separately (1.5 mg/kg). Also investigated is the pharmacokinetics of total d- and 1-disopyramide in plasma after intravenous administration of a pseudoracemate. Both d- and 1-disopyramide are found to exhibit concentration-dependent binding to plasma proteins, with d-disopyramide being more avidly bound at lower concentrations. The stereoselective, concentration-dependent binding to plasma proteins resulted in distinct pharmacokinetic properties when the enantiomers were given together as the pseudoracemate. d-Disopyramide had a lower plasma clearance and renal clearance, a longer half-life, and a smaller apparent volume of distribution than 1-disopyramide. However, when the enantiomers were administered separately, there were no differences in the clearance, renal clearance, and volume of distribution between enantiomers calculated from either total or unbound drug concentrations. The results reveal an important pharmacokinetic interaction between the enantiomers of disopyramide when given as a racemic mixture, which may be dose-dependent and is not apparent upon administration of the enantiomers separately.

High performance liquid chromatographic determination of the enantiomers of beta-adrenoceptor blocking agents in biological fluids. I: Studies with pindolol

This paper describes a high-performance liquid chromatographic procedure for the analysis of (+)- and (-)-pindolol in biological fluids. Racemic pindolol is extracted from alkalinized plasma or urine into ether, then purified by two steps of back extraction. The final extract is reacted with (S)-(-)-alpha-methylbenzyl isocyanate at room temperature, forming urea diastereoisomers as suggested by mass spectral analysis. Separation of the two diastereoisomers is accomplished by high-performance liquid chromatography with fluorescence detection. The assay is reproducible and precise for both (+)- and (-)-pindolol in human plasma and urine, as judged by a coefficient of variation of less than 10% at most concentrations. The standard curves for (+)- and (-)-pindolol in plasma are linear between 10-100 ng/mL, and between 100-2500 ng/mL in urine. The lower limit of detection is approximately 2 ng/mL for each enantiomer in plasma. This procedure can be readily adapted for the stereospecific assay of other beta-adrenoceptor blocking agents as demonstrated by the base-line separation of atenolol and acebutolol.

Stereoselective renal clearance of pindolol in humans

In this study, pindolol, a beta-adrenoceptor blocking agent marketed as a racemic mixture, was used as a model compound to investigate stereoselective renal clearance of organic cations in human beings. Six normal subjects received an oral dose of 20 mg racemic pindolol. Heart rate and blood pressure were measured throughout the study. A stereospecific high performance liquid chromatographic procedure was used to quantitate the concentrations of d- and l-pindolol in plasma and urine. Renal clearance and other pharmacokinetic parameters of both enantiomers were calculated and compared. The renal clearance of l-pindolol was greater than that of d-pindolol in all subjects. The renal clearance (mean +/- SD) was 240 +/- 55 ml/min for l-pindolol and 200 +/- 51 ml/min for d-pindolol (P less than 0.01). Since stereoselective binding to plasma proteins was not observed, differences in renal clearance between d- and l-pindolol were caused by either stereoselective renal transport, or stereoselective renal metabolism. The area under the plasma concentration-time curve, the amount of drug excreted, and the half-life of l-pindolol were greater than those of d-pindolol, which suggests that pindolol was also eliminated stereoselectively by nonrenal routes. The slopes of the resting heart rate vs. the plasma concentration of l-pindolol were significantly less than zero and were significantly correlated to the pretreatment heart rate, which supports the hypothesis that intrinsic sympathetic tone largely determines the effect of pindolol on the resting heart rate. The observation that pindolol is eliminated stereoselectively by the kidney may have clinical implications for other racemic drugs that are renally eliminated.

Decreased binding of verapamil to plasma proteins in patients with liver disease

The binding of verapamil to proteins in plasma of patients with liver disease was studied using equilibrium dialysis. Compared with an age- and sex-matched control group, the fraction unbound of verapamil was significantly greater in patients with liver disease (p less than 0.01). The mean +/- SD fraction unbound in the patients was 0.16 +/- 0.05 compared with 0.099 +/- 0.015 in the control group (p less than 0.01). The higher fraction unbound in the liver disease patients appeared to be largely due to lower concentrations of binding proteins in plasma. A substantial effect of pH on the binding of verapamil to plasma proteins was observed. The increase in fraction unbound is consistent with previous findings of an increased apparent volume of distribution in patients with liver disease. Because of the pharmacokinetic characteristics of verapamil, the observed altered binding to plasma proteins would be expected to result in higher steady-state plasma concentrations of unbound drug after intravenous but not oral administration. For clinical monitoring, at any given total concentration, the unbound concentration would be approximately 60% higher in patients with liver disease. This study, together with previous studies in the literature, suggests that caution should be exercised in the administration of verapamil to patients with liver disease.

Effect of concentration-dependent binding to plasma proteins on the pharmacokinetics and pharmacodynamics of disopyramide

Disopyramide exhibits concentration-dependent binding to plasma proteins at therapeutic plasma concentrations. This paper reviews the effect of this type of binding on both the pharmacokinetic and pharmacodynamic properties of the drug. For a drug with capacity-limited, binding-sensitive elimination like disopyramide, concentration-dependent binding to plasma proteins produces a non-linear relationship between dosing rate and total plasma concentrations of the drug. However, when dosing rate is related to unbound concentrations of drug, the relationship is linear. Renal clearance of total disopyramide has been found to depend on the unbound fraction whereas renal clearance of unbound drug may be dependent upon time after drug administration as well as route of drug administration. However, due to some potential methodological problems, these data need verification. The concentration-dependent binding of disopyramide to plasma proteins, with its resultant effects on clearance and distribution, produces a concave curvature in the log unbound concentration versus time curves and a log-linear decline in total plasma concentration versus time after intravenous administration of the drug. Several pharmacological studies suggest that the unbound drug is active in terms of producing both desirable and undesirable effects. Hence, monitoring unbound concentrations of disopyramide seems more rational for clinical purposes. The few studies that have been carried out examining the optical isomers of disopyramide have suggested that both the pharmacokinetic and pharmacodynamic properties of the drug are stereoselective. Recent data reveal stereoselective binding to plasma proteins in humans.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of low doses of heparin on the plasma binding of phenytoin and prazosin in normal man

The effect of low doses of heparin on the binding of phenytoin and prazosin to plasma proteins was evaluated in four normal subjects. Heparin activates the hydrolysis of triglycerides in plasma. The ensuing increase in non-esterified fatty acids (NEFA) was more marked in vitro than in vivo and increased the free fraction (FF) of phenytoin and prazosin in plasma. The higher FF caused a change in the plasma to whole blood ratio (P/B ratio) of both drugs. The changes in FF and P/B ratio after heparin were small, but could be of significance in pharmacokinetic studies.