Drug metabolism, pharmacokinetic heart failure

While essentially all ACE inhibitors have a similar mechanism of action and therefore exhibit similar efficacy in the treatment of hypertension and congestive heart failure, these drugs differ slightly in their pharmacokinetic profiles. Enalapril, lisinopril, and quinapril are excreted primarily by the kidney, with minimal liver metabolism, while the other prodrug compounds are metabolized by the liver and renally excreted. Thus, in patients with renal insufficiency, the half-life of renally excreted ACE inhibitors is prolonged. In addition, patients with impaired liver func-... 

Sotalol is well absorbed orally with bioavailability of approximately 100%. It is not metabolized in the liver and is not bound to plasma proteins. Excretion is predominantly by the kidneys in the unchanged form with a half-life of approximately 12 hours. Because of its relatively simple pharmacokinetics, solatol exhibits few direct drug interactions. Its most significant cardiac adverse effect is an extension of its pharmacologic action a dose-related incidence of torsade de pointes that approaches 6% at the highest recommended daily dose. Patients with overt heart failure may experience further depression of left ventricular function during treatment with sotalol. 

B. Pharmacokinetics. Absorption may be delayed with sustained-release preparations. The volume of distribution (Vd) is approximately 0.5 Ukg. The normal elimination half-life is 4-6 hours this may be doubled by illnesses or interacting drugs that slow hepatic metabolism, such as liver disease, congestive heart failure, influenza, erythromycin, or cimetidine, and may increase to as much as 20 hours after overdose. (See also Table 11-59, p 381.)... 

---