Metabolism, hepatic

Chronic use of these irreversible MAO inhibitors has been associated with life-threatening toxicity, ie, hepatotoxicity and hypertensive crisis. Interactions with tyramine contained in food and other drugs have severely limited use of irreversible MAO inhibitors. These MAO inhibitors are also nonselective, inhibiting both MAO-A and MAO-B isoenzymes. Furthermore, they interfere with the hepatic metabolism of many dmgs. 

Mexifitene is well absorbed from the GI tract and less than 10% undergoes first-pass hepatic metabolism. In plasma, 60—70% of the dmg is protein bound and peak plasma concentrations are achieved in 2—3 h. Therapeutic plasma concentrations are 0.5—2.0 lg/mL. The plasma half-life of mexifitene is 10—12 h in patients having normal renal and hepatic function. Toxic effects are noted at plasma concentrations of 1.5—3.0 lg/mL, although side effects have been noted at therapeutic concentrations. The metabolite, /V-methy1mexi1itene, has some antiarrhythmic activity. About 85% of the dmg is metabolized to inactive metabolites. The kidneys excrete about 10% of the dmg unchanged, the rest as metabolites. Excretion can also occur in the bile and in breast milk (1,2). 

EoUowing po administration moricizine is completely absorbed from the GI tract. The dmg undergoes considerable first-pass hepatic metabolism so that only 30—40% of the dose is bioavailable. Moricizine is extensively (95%) bound to plasma protein, mainly albumin and a -acid glycoprotein. The time to peak plasma concentrations is 0.42—3.90 h. Therapeutic concentrations are 0.06—3.00 ]l/niL. Using radiolabeled moricizine, more than 30 metabolites have been noted but only 12 have been identified. Eight appear in urine. The sulfoxide metabolite is equipotent to the parent compound as an antiarrhythmic. Elimination half-life is 2—6 h for the unchanged dmg and known metabolites, and 84 h for total radioactivity of the labeled dmg (1,2). 

After po dosing, verapamil s absorption is rapid and almost complete (>90%). There is extensive first-pass hepatic metabolism and only 10—35% of the po dose is bioavahable. About 90% of the dmg is bound to plasma proteins. Peak plasma concentrations are achieved in 1—2 h, although effects on AV nodal conduction may be apparent in 30 min (1—2 min after iv adrninistration). Therapeutic plasma concentrations are 0.125—0.400 p.g/mL. Verapamil is metabolized in the liver and 12 metabolites have been identified. The principal metabolite, norverapamil, has about 20% of the antiarrhythmic activity of verapamil (3). The plasma half-life after iv infusion is 2—5 h whereas after repeated po doses it is 4.5—12 h. In patients with liver disease the elimination half-life may be increased to 13 h. Approximately 50% of a po dose is excreted as metabolites in the urine in 24 h and 70% within five days. About 16% is excreted in the feces and about 3—4% is excreted as unchanged dmg (1,2). 

Repaglinide and nateglinide are rapidly absorbed their binding durations to SUR-1 are much shorter than sulphonylurea binding, and their hepatic metabolism... 

A major obstacle to the use of naturally occurring estrogens for the purpose of contraception was extensive first-pass hepatic metabolism and hence inactivation of the compounds when given orally. The addition of an ethinyl group at the 17 position made estradiol orally active. Ethinyl estradiol is a potent oral estrogen and... 

Few submitted to metabolism variations, in particular to hepatic metabolism Submitted to metabolism variations, in particular via cytochroms... 

Sulfonamides may inhibit the (hepatic) metabolism of the oral hypoglycemic drugs tolbutamide (Orinase) and chloq ropamide (Diabinese). This would increase the possibility of a hypoglycemic reaction. 

Reports of Hepatic Metabolism and Drug Interaction Studies... 

Murphy SD. 1982. Toxicity of hepatic metabolism of organophosphate insecticides in developing rats. In Hunt VR, Smith MK, Worth D, eds. Banbury report, Vol. II. Environmental factors in hiunan growth and development symposium, November 1-4, 1981. Cold Spring Harbor, NY Cold Spring Harbor Laboratory, 125-136. 

Working with rats, Lntz et al. (1977) compared the rates of loss from blood of 4,-CB (rapidly metabolized) with that of 2,2, 4,4, 5 -HCB (slowly metabolized). Both showed biphasic elimination, with the former disappearing much more rapidly than the latter. Estimations were made of the rates of hepatic metabolism in vitro, which were then incorporated into toxicokinetic models to predict rates of loss. The predictions for HCB were very close to actual rates of loss for the entire period of... 

Machin, A.F. et al. (1975). Metabolic aspects of the toxicology of diazinonl Hepatic metabolism in the sheep, cow, guinea-pig, rat, turkey, chicken, and duck. Pesticide Science 6, 461 73. 

Methods of detection, metabolism, and pathophysiology of the brevetoxins, PbTx-2 and PbTx-3, are summarized. Infrared spectroscopy and innovative chromatographic techniques were examined as methods for detection and structural analysis. Toxicokinetic and metabolic studies for in vivo and in vitro systems demonstrated hepatic metabolism and biliary excretion. An in vivo model of brevetoxin intoxication was developed in conscious tethered rats. Intravenous administration of toxin resulted in a precipitous decrease in body temperature and respiratory rate, as well as signs suggesting central nervous system involvement. A polyclonal antiserum against the brevetoxin polyether backbone was prepared a radioimmunoassay was developed with a sub-nanogram detection limit. This antiserum, when administered prophylactically, protected rats against the toxic effects of brevetoxin. 

Metabolic alkalosis (citrate hepatically metabolized to bicarbonate)... 

Medication use must be monitored carefully for potential hepatotoxicity. Hepatically metabolized medications have the potential to accumulate in patients with liver disease. Little guidance is available on drug dosing in hepatic impairment because these patients are often excluded from drug trials. Daily acetaminophen use should not exceed 2 g. Dietary supplements have not been well studied in hepatic impairment and cannot be recommended. 

Because p-blockers decrease blood pressure and heart rate, they should be started at low doses to increase tolerability. Propranolol is hepatically metabolized, and its half-life and pharmacologic effects are prolonged in portal hypertension. A reasonable starting dose of propranolol is 10 mg two to three times daily. 

Diuretics are often required in addition to the sodium restriction described previously. Spironolactone and jurosemide form the basis of pharmacologic therapy for ascites. Spironolactone is an aldosterone antagonist and counteracts the effects of activation of the renin-angiotensin-aldosterone system. In hepatic disease not only is aldosterone production increased, but its half-life is prolonged because it is hepatically metabolized. Spironolactone acts to conserve the potassium that would be otherwise excreted because of elevated aldosterone levels. 

Hepatic metabolism No Yes oxidation and hydroxylation induces liver enzymes to increase its metabolism and other drugs Yes oxidation and conjugation Yes oxidation and glucuronide conjugation Yes glucuronic acid conjugation Induces its own metabolism in normal volunteers... 

Drug Interactions Carbamazepine induces the hepatic metabolism of many drugs, including other antiepileptic drugs, antipsychotics, some antidepressants, oral contraceptives, and... 

Anastrozole is a selective nonsteroidal aromatase inhibitor that lowers estrogen levels. The pharmacokinetics of anastrozole demonstrate good absorption, with hepatic metabolism the primary route of elimination and only 10% excreted unchanged by the kidney. The elimination half-life is approximately 50 hours. Anastrozole is used for the adjuvant treatment of postmenopausal women with hormone-positive breast cancer and in breast cancer patients who have had disease progression following tamoxifen. Side effects include hot flashes, arthralgias, osteoporosis/bone fractures, and thrombophlebitis. 

ABVD Doxorubicin Anthracycline Hepatic metabolism Cardiomyopathy... 

Dacarbazine Alkylating agent Hepatic metabolism constipation Myelosuppression... 

As amisulpride has no hepatic metabolism, low protein binding, and is directly excreted in urine, there is little reason to suspect pharmacokinetic ethnic differences. Of course body mass and pharmacodynamic differences might occur, but to date have received little investigative attention. 

Biliary Excretion. The effects of significant hepatic extraction as a result of biliary secretion, with or without metabolism, would be expected to follow the same principles just outlined for hepatic metabolism. In fact, a whole class of compounds that serve as biliary contrast agents for radiological examination depend on significant first-pass biliary secretion to be effective. 

Hepatic metabolism of ethanol involves a nonlinear saturable pathway. Young children have a limited ability to metabolize and thereby detoxify ethanol. Ethanol intoxication has been recorded in children with blood levels as low as 25 mg/dL. Alcohol has a volume of distribution of approximately 0.65 L/kg. Ingestion of 20 mL of a 10% alcohol solution will produce a blood level of 25 mg/dL in a 30 pound child. The American Academy of Pediatrics (AAP) Committee on Drugs recommends that pharmaceutical formulations intended for use in children should not produce ethanol blood levels of >25 mg/dL after a single dose. 

Diana GD, Rudewicz P, Pevear DC, et al. Picornavirus inhibitors trifluo-romethyl substitution provides a global protective effect against hepatic metabolism. J Med Chem 1995 38 1355-1371. 

Lave, T., Coassolo, P., Reigner, B., Prediction of hepatic metabolic clearance based on interspecies allometric scaling techniques and in vitro-in vivo correlations, Clin. Pharmacokinet. 1999, 36, 211-321 and references cited therein. 

H. K., Eichelbaum, M., Differential induction of prehepatic and hepatic metabolism of verapamil by rifampin, Hepatology 1996, 24, 796-801. 

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