Electrophysiologic effects and pharmacokinetics of intravenous penticainide (CM 7857)

Influence of food and body weight on the pharmacokinetics of penticainide

The pharmacokinetics of penticainide, a class Ic antiarrhythmic drug, was studied in 16 healthy adults (eight males and eight females) after a single 300-mg oral dose in fasting conditions and with a standard meal. Penticainide concentrations in plasma and urine were measured by hplc. The pharmacokinetic parameters of penticainide including Cmax, tmax, AUC and t1/2 were not significantly altered in the presence of food. AUC values (mean +/- sd) were 50.68 +/- 10.8 mg.h.l-1 and 49.52 +/- 9.87 mg.h.l-1 in the absence and presence of food, respectively. However, a significant difference was observed between males and females in both fasting and fed conditions with a higher value of the apparent oral clearance in the second group. The values of apparent oral clearance, expressed in weight-normalized units were 1.33 +/- 0.35 ml.mn-1.kg-1 (male) and 1.93 +/- 0.34 ml.mn-1.kg-1 (female) in fast conditions (P < 0.01) and 1.38 +/- 0.28 ml.mn-1.kg-1 (male) and 1.93 +/- 0.49 ml.mn-1.kg-1 (female) in fed conditions (P < 0.02), respectively. The pharmacokinetics of penticainide is not modified by the presence of food, but an influence of body weight may be considered.

High-performance liquid chromatographic method for the simultaneous determination of pentisomide and its major metabolite N-desisopropylpentisomide in plasma, urine and tissues using solid-phase extraction

A rapid, sensitive and selective high-performance liquid chromatographic method for the simultaneous determination of pentisomide and its major metabolite desisopropylpentisomide in plasma, urine and tissues has been developed. The method for plasma samples, urine samples and tissue samples, after homogenizing with 50% ethanol, involves extraction of samples via activated Bond-Elut C8 disposable columns with methanol at pH 10 after addition of internal standard, and initially on column washing of samples at pH 10 with water and acetonitrile. The obtained methanolic extract is evaporated to dryness under nitrogen at 25 degrees C; the sample residue is then reconstituted in mobile phase and an aliquot of this solution is injected into the liquid chromatograph. Separation is performed using a Nova-Pak C18 4 microns particle size column operating in combination with radial compression separation unit and a methanol-water-di-sec.-butylamine-phosphoric acid (40:60:0.5:0.2, v/v) pH 3.5 mobile phase with ultraviolet detection at 258 nm. Endogenous substances or a variety of drugs concomitantly used in pentisomide therapy, with the exception of disopyramide, do not interfere with the assay. The mean recovery of pentisomide and desisopropylpentisomide from plasma and urine and from tissues is more than 91 and 86%, respectively. The limit of detection of the assay is 10 ng/ml for both drugs. The intra- and inter-day coefficient of variation for replicate analyses of spiked plasma samples is less than 7 and 8%, respectively. Mean steady-state plasma levels of pentisomide and desisopropylpentisomide in patients on chronic oral therapy are reported.

Acute and chronic electrophysiological effects of pentisomide on the sinus and AV nodal function, noninvasive evaluation by a pacemaker with temporary pacing inhibition

The acute and chronic electrophysiological effects on sinus function and AV nodal conduction of pentisomide (Pen), a new antiarrhythmic agent, were studied in ten patients with sick sinus syndrome (SSS) (group I) and in ten patients with normal sinus function (group II) using a permanent pacemaker with temporary pacing inhibition (Symbios 7005 Medtronic, Inc.). We measured noninvasively the corrected sinus node recovery time (CSNRT), the sino-atrial conduction time (SACT), according to Narula's method and the Wenckebach point before and after Pen administration, acutely and orally for 10 days. In group I intravenous injection (4 mg/kg) and oral administration (450 mg bid) of Pen significantly prolonged the CSNRT (+217% and +149%, respectively) and the SACT (+63% and +49%, respectively). In group II only the intravenous injection of Pen provoked a significant modification of CSNRT (+12%) and SACT (+14%). No modification in AV nodal conduction was noted in any patient. These results suggest that Pen must be used with caution in patients with sinus nodal dysfunction.

Electrophysiology and long-term efficacy of pentisomide in patients with supraventricular tachycardia

The electrophysiologic effects of pentisomide were investigated after intravenous (5 mg/kg) and oral (900-1200 mg three times a day) application in 9 patients with drug refractory atrioventricular nodal tachycardia and 6 patients with orthodromic atrioventricular re-entrant tachycardia. Pentisomide did not change sinus cycle length, effective refractory period of the right ventricle and the atrioventricular node. AH, HV interval, effective refractory period of the right atrium, QRS duration and QTc duration were (p less than or equal to 0.01) increased. Tachycardia cycle length was only increased after intravenous application of pentisomide, antegrade effective refractory periods of the accessory pathways and shortest fully pre-excited R-R intervals during atrial fibrillation were increased after the oral treatment phase (p = 0.054). Intravenous pentisomide prevented tachycardia in 6/9 patients with atrioventricular nodal tachycardia and in 2/6 patients with atrioventricular re-entrant tachycardia. If intravenous pentisomide did not prevent induction of the tachycardia, oral pentisomide was not effective either. During long-term follow-up 2/7 patients with atrioventricular nodal tachycardia and 1/4 patient with atrioventricular re-entrant tachycardia had a recurrence. Long-term treatment with pentisomide had to be discontinued because of possible side effects in 2 patients. It is concluded, that the electrophysiological effects of pentisomide are similar to those of flecainide and propafenone.