Pharmacokinetics and pharmacodynamics of ranitidine in renal impairment

Autor: Kevin M. Koch, I. M. Davis, S. Shaw, Y. Yin, M. Liu
Rok vydání: 1997
Předmět:
Zdroj: European Journal of Clinical Pharmacology. 52:229-234
ISSN: 1432-1041
0031-6970
DOI: 10.1007/s002280050279
Popis: The pharmacodynamics and pharmacokinetics of ranitidine were examined in subjects with varying degrees of renal function to determine the effect of this condition on acid-antisecretory activity.Subjects with creatinine clearances (Ccr) ranging from 0 to 213 m1.min-1 received single 50-mg and 25-mg i.v. doses of ranitidine. This was followed by determination of serum and urine ranitidine concentrations, and continuous gastric pH monitoring for 24 h.Serum ranitidine concentrations were described by a two-compartment model linked to a sigmoidal Emax model describing gastric pH. Ranitidine renal clearance, ranging from 0 to 1003 m1.min-1, correlated with CPAH (r2 = 0.707), while non-renal clearance was unaltered. Steady-state volume of distribution decreased by half in severe renal impairment. No changes in the effective concentration at half-maximal response (EC50), maximal response (Emax), or basal response (E0) were observed. Thus, renal elimination of ranitidine declined in parallel with renal function, while sensitivity to the pharmacologic effect (gastric pH elevation) was unaltered. Ranitidine was cell tolerated in these renally impaired subjects.These data indicate that the current recommendation for renal impairment dose reduction (by two-thirds when Ccr50 m1-min-1) might result in under-treating moderately impaired patients, and suggests a less conservative dose reduction (by half when Ccr10 m1.min-1) to avoid therapeutic failure while remaining within the wide margin of safety for this drug.
Databáze: OpenAIRE
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