[Experiences with propranolol (Obsidan25) in hypertension therapy in pregnancy]

The treatment of the mentioned forms of hypertension with propranolol during pregnancy either as monotherapy or in combination with dihydralazine and after careful exclusion of the contraindications described represents a further effective therapy. In the control examinations during pregnancy carried out in close cooperation between obstetrician and internist no detrimental side effects could be established for both mother and child. No significant changes of absorption, distribution and elimination of propranolol in pregnant women with hypertension in comparison with normotensive nonpregnant women were found as follows from the pharmacokinetic parameters shown.

[The pharmacokinetics of cephalothin following single and repeated administration in man]

The repeated administration of substances, which are mainly excreted by tubular secretion, can cause an increase of its own elimination. Because cephalothin is tubularly transported, it was of interest to prove, whether or not the repeated administration of therapeutic doses for 5 d produces an increases of renal elimination. Pharmacokinetic parameters show only small differences between the single and repeated dosing, caused by changes of volume of distribution. No stimulation of the carrier transport system was found. On the contrary, the renal elimination was reduced slightly after therapy for 5 d. Our results show that the present dosage recommendations are valid also for repeated administrations.

Pharmacokinetics and pharmacodynamic effects of furosemide in patients with liver cirrhosis

Ten patients with compensated cirrhosis of the liver, 7 patients with portal decompensated cirrhosis of the liver and 10 patients with intact liver function were investigated. After intravenous injection of 40 mg furosemide elimination half-life, total and excretory clearance were not significantly different in the 3 groups investigated, but renal clearance was enhanced in the 2 cirrhosis groups and nonrenal clearance diminished in patients with decompensated cirrhosis of the liver. In those patients distributional volumes were significantly higher than in the control group. According to the increased urinary excretion of unchanged furosemide in patients with cirrhosis of the liver, the pharmacodynamic effect of the drug is enhanced: In the first 4-h-collecting period the excretion of water, chloride and sodium is significantly more increased than in the control group. After a period of 24 h this effect is still noticeable. The effect of furosemide on the excretion of potassium, creatinine and urea nitrogen is not significantly influenced by liver disease. Doubling the dose from 40 to 80 mg furosemide did not enhance the diuretic effect of the drug despite the doubled urinary excretion of unchanged furosemide.

[The influence of galenic and biologic factors on the bioavailability of Berlocombin]

The analysis of the influence of galenical and biological factors on the biological availability of Berlocombin (sulfamerazin and trimethoprim combination) has been performed by a single Berlocombin juice administration compared to tablets and by a tablet administration combined with nourishment. In case of the juice administration, the biological availability of trimethoprim and sulfamerazin has been reduced. The tablet administration at an empty stomach and a subsequent 5-h waiting period revealed a more complete trimethoprim resorption, which compared to an administration immediately after the standard breakfast is expressed by a significantly greater area under the concentration-time curve (AUC) in serum. In tablet application subsequent to a fatty breakfast, the trimethoprim and sulfamerazin resorption is compared to the relative group some increased; the differences, however, were insignificant ones. The results of this study failed to be of practical consequences, because the dosage applied and recommended by the producer significantly exceeded the minimum inhibition concentrations in serum and urine 3 h after administration. The required therapeutic level in no case fell short of up to the 12. hour.

Pharmacokinetic and pharmacodynamic effects of furosemide in patients with impaired renal function

Three groups of patients with kidney diseases were investigated: I. creatinine in serum less than 100 mumol/l, II. creatinine in serum 100-250 mumol/l, III. creatinine in serum greater than 250 mumol/l. After intravenous injection of 40 mg and 80 mg furosemide, serum concentrations and urinary excretion of the unchanged drug were measured fluorometrically. Moreover, urinary excretion of water, electrolytes, creatinine and urea nitrogen were estimated in order to check the pharmacodynamic effect of the drug. The pharmacokinetic parameters calculated were similar in group I and II. In group III t 1/2 was prolonged, renal clearance of furosemide was diminished. The diuretic effect of furosemide was noticeable during the first 4 hours following the injection of 40 mg in all 3 groups. Doubling the dose did not enhance the effect. Creatinine and urea nitrogen excretion in urine were not influenced by furosemide.

[Urinary enzyme excretion in cephalothin therapy in adults and children]

A damage of the kidney, particularly of proximal tubular cells, can be indicated by an increased concentration of definite enzymes in urine. After gynecological operation the repeated application of 8 g cephalothin daily provokes an higher increase of enzyme concentrations in urine than the application of ampicillin under the same conditions. These results show that cephalothin produces a slight alteration of tubular cells, probably without practical importance. In contrast to this, in children a total dose of 1.5 up to 6 g cephalothin, administered after an operative correction of vesikoureterale reflux, provokes no marked changes in urinary enzyme excretion. Probably, in these children the determination of urinary enzyme excretion is not a suitable parameter to demonstrate a slight tubulotoxic damage.

[Comparison of the pharmacokinetic behavior of Turivital, Acesal and Micristin]

The 3 acetylsalicylic acid preparations showed at normal patients at the same elimination phase no significant differences concerning the bioavailability (comparison of the area under the concentration-time-curve). The absorption kinetics of the preparations were different: the time up to the maximum serum concentration was at Turivital with 1,3 +/- 0,7 h and Micristin (2,1 +/- 0,8 h) the shortest, because the resorption delay was at Turivital the smallest. Absorption constant, fictive initial concentration and maximum concentration in serum are nearly the same in all 3 preparations.

[Furosemide effects in patients with chronic renal insufficiency]

In 8 patients with a slight restriction of the renal function (serum creatinine 150-300 mumol/l), 10 patients with a severe restriction of the renal function (serum creatinine greater than 300-1,200 mumol/l) and in 10 control persons with intact renal function on 2 subsequent days after 40 and 80 mg furosemide the pharmacokinetic data were calculated intravenously from the course of the serum concentration and the renale excretion as well as pharmacodynamic parameters. In comparison to the control persons in patients with creatinine values of more than 200 mumol/l still 4 hours after intravenous injection furosemide could be proved in the serum. According to this the excretion of the unchanged furosemide was clearly decreased in the 24-hour-urine. In decreased renal clearance of furosemide the elimination half-life period was prolonged. In all three groups of patients the diuretic effect of furosemide was very distinctly marked in the first four hours after injection of 40 mg, a doubling of the dose did not increase this effect. Only in the first four hours also an increased excretion of sodium, chloride and calcium occurred; in the 24-hour-collection period no differences between the three groups were the result. The excretion of creatinine and urea-N in the urine was not influenced by furosemide. Thus also in the chronic renal insufficiency there is the indication of the furosemide therapy only then, when the extracellular space or the intravasal volume are enlarged. As individual dose 40 mg are recommended intravenously.

[Pharmacokinetics and electrolyte balance following administration of furosemide in pregnant women with E gestosis]

In pregnant women with E-gestosis distribution and elimination of furosemid are significantly different to a non-pregnant control group. Furosemid guarantees a rapid and safe excretion of edemas. The efficiency of furosemid concerning electrolyte excretion is stronger in pregnant women with E-gestosis than in nonpregnant women. Therefore furosemide should be administered to pregnant women under intensive electrolyte control only.

[Pharmacokinetics of the sulfonamide-trimethoprim combinations Berlocombin and Sulprim in patients with various degrees of kidney dysfunction]

Patients with normal and decreased kidney function were treated with an initial dose of 4 tablets Berlocombin and following with a dose of 2 tablets for 10 d in a 12 h period. The dialysis patients got only once the initial dose. The kinetic parameters were calculated by means of a one compartment model. Independend on the kidney function the minimum therapeutic serum concentrations of 1 microgram/ml at trimethoprime and of 20 micrograms/ml at the sulphonamides were reached during the first hours after medicament application. At all patients the urine concentration of trimethoprime were some times over the minimum therapeutic concentration. The individually found maintenance doses fluctuate between 2 tablets each 12 h and 1 tablet each 24 h. At patients with serum creatinine levels greater than 3 mg/100 ml (greater than 265 mumol/l) 1 tablet each 12 h is sufficient as maintenance dose. At a higher degree of kidney function decreasing (serum creatinine greater than 6 mg/100 ml (greater than 530 mumol/l] cumulating of the sulphonamide metabolites in the serum is found. The evaluated elimination velocity of the investigated sulphonamides during the hemodialysis was higher than that at patients with normal kidney function. The elimination rate of trimethoprime during the dialysis is in the same region as at patients without any kidney diseases.

[Placental passage of nalidixic acid (Negram) and pharmacokinetic studies in the newborn infant]

Nalidixic acid and hydroxynalidixic acid penetrate the placenta during labour. During the first 24 h of life the serum concentrations of nalidixic acid and nalidixic acid plus hydroxynalidixic acid decline slowly and show individual differences. The changed kinetic parameter in the newborn, especially the delayed elimination of nalidixic acid as well as nalidixic acid plus hydroxynalidixic acid lead to the consequence of recommendation of a very strong therapeutic indication in the peripartal period.

Prevention of recurrent uric acid and calcium oxalate stones by administration of the xanthine oxidase inhibitors Milurit 100 and Milurit 300

Disturbances in purine metabolism with hyperuricaemia and/or hyperuricosuria are a risk factor in uric acid and Ca oxalate stone formation. By way of a competitive xanthine oxidase inhibition, the formation of uric acid is reduced by allopurinol. In investigations on two groups of patients, Milurit could be demonstrated to decrease the uric acid levels in serum and urine. No differences could be seen in the dosages of 3 x 100 mg or 1 x 300 mg Milurit. Therefore, in stone recurrence prevention, the administration of Milurit 300 is recommended.

[Studies on the pharmacokinetics of the compound preparation sulfamerazine/trimethoprim (Berlocombin-200) in pregnancy]

Pharmacokinetics of the sulphamerazine/trimethoprim-combination Berlocombin-200 was calculated by an one-compartment-model following therapeutic administration in pregnant women and compared with a control group. Distribution parameters are significantly changed, but elimination half-lifes of both the sulphonamide and trimethoprim are not influenced by repeated administration during pregnancy. There are no consequences concerning the dosage of Berlocombin in bacterial infections during pregnancy.

Dialysability of benzodiazepines by haemodialysis and controlled sequential ultrafiltration (CSU) in vitro

The efficacy of haemodialysis and controlled sequential ultrafiltration (CSU) for the elimination of three hypnotic and 6 benzodiazepine drugs was compared in vitro. In comparison to haemodialysis the efficacy of ultrafiltration by CSU was poor, as the mean per cent of CSU/haemodialysis (mg/hr) for 5 benzodiazepines was only 0.6-4.0% and for three hypnotics, phenobarbital 3.4%, pyrithyldione 8.2% and glutethimide 2.5% of the haemodialysis values. In haemodialysis in vitro phenobarbital, pyrithyldione, glutethimide and chlordiazepoxide were significantly and markedly more dialysable than 5 other benzodiazepines. The mean clearance of six benzodiazepine derivatives was about 2 to 3 times higher at blood flow rates of 200 ml/min. than 100 ml/min. In CSU experiments in vitro it was possible to remove approximately (as the mean percent of the initial dose) only the amount of five benzodiazepines corresponding to the per cent of the protein unbound fraction in the plasma (correlation r = 0.975, P less than 0.01). Only low amounts of three hypnotics, especially glutethimide, were removed by CSU in vitro.

Excretion of nalidixic acid via mother's milk

Following the oral administration of 2.0 g nalidixic acid (NA) to lactating women only 0.003% of the dose was excreted chemotherapeutically active in the total 24 h milk. In milk, minimal inhibitory concentrations of nalidixic acid were never reached. 6-8 h after medication the milk/serum quotient was 0.061 +/- 0.003.

Comparative in vitro investigations on the dialysability of hypnotic and psychotropic drugs by hemodialysis and controlled sequential ultradiffusion

The efficiency of hemodialysis and controlled sequential ultradiffusion (CSU) for the elimination of toxic drug concentrations was tested by in vitro-investigations. In the 6 benzodiazepin derivatives tested, the clearance is markedly higher at a blood flow of 200 ml/min than at 100 ml/min. Pyrithyldione, glutethimide and phenobarbital are better dialysed than the benzodiazepines with exception of chlordiazepoxide. In comparison with hemodialysis, hemofiltration by means of CSU was less effective because of the small amount of ultrafiltrate obtained.

[Studies on the pharmacokinetics of Sulfaclomid, Mebacid, Nevigramon and Metindol in patients with reduced kidney function]

In patients with restriction of the renal function the pharmacokinetics of Sulfaclomid, Mebacid, Nevigramon and Metindol was investigated. According to the different elimination mechanisms of the drugs investigated the kinetics was infleunced in different way by the restriction of the renal elimination of these drugs: The half-life periods for the elimination of Metindol, Nevigramon and Mebacid remained unchanged in patients with renal diseases; the half-value period for the elimination of Sulfaclomid was prolonged.

[Pharmacokinetics of indomethacin and indomethacin metabolites administered continuously to patients with healthy or damaged kidneys]

After oral administration of 75 mg Indomethacin dlimination half-life of the unchanged drug is not altered in patients with severely impaired renal function. In patients with renal insufficiency half-life of Indomethacin plus metabolites is twice that of the normal value. Repeated daily administration of 75 mg for 8 days does not influence Indomethacin kinetics. In the control group and in patients with moderate by impaired renal function Indomethacin half-life does not change during chronic administration.

Pharmacokinetics of sulfaclomide and sulfamerazine in patients with impaired renal function after first and after repeated application

At the beginning of the therapy with sulfaclomide resp. sulfamerazine elimination half-life of sulfaclomide was prolonged significantly in patients with impaired renal function (creatinine in serum greater than 2 mg/100 ml) on 119.6+/-6.9 h in comparison to control group (83.6+/-14.5 h). Half-life of sulfamerazine (23.6+/-4.1 h) did not differ from that of the control group (20.3+/-2.8 h). Renal excretion of both sulfonamides was sharply diminished. After treatment for 11 days with sulfaclomide resp. sulfamerazine in patients with impaired renal function, half-lives were prolonged to 117.3+/-6.1% resp. 119.3+/-3.9% of the initial value. In patients with impaired renal function elimination half-life of PAH as a measure of tubular function is three times that of control group. It is not statistically significantly influenced by repeated administration of the sulfonamides. In the control group there is a shortening of the PAH-half-life under the same conditions.