Skip to main content
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1991 Nov;32(5):591–597. doi: 10.1111/j.1365-2125.1991.tb03957.x

The effects of age on the pharmacokinetics, antihypertensive efficacy and general tolerability of dilevalol.

G J Macphee 1, C A Howie 1, P A Meredith 1, H L Elliott 1
PMCID: PMC1368636  PMID: 1954075

Abstract

1. This study investigated the influence of age on the pharmacokinetics, pharmacodynamics, general tolerability and concentration-effect relationships in 18 patients with essential hypertension (age range 23-73 years) during treatment with dilevalol, a non selective beta-adrenoceptor antagonist with vasodilator properties. 2. There were no significant age-related changes in pharmacokinetics for either acute or chronic treatment with dilevalol, although there were significant changes in elimination half-life from 7.8 to 11.7 h (P less than 0.05) and in AUC from 261 to 352 ng ml-1 h (P less than 0.005) following translation from acute to chronic dosing. 3. In absolute terms, dilevalol treatment (as compared with placebo) produced numerically larger falls in average blood pressure in the six oldest as compared with the six youngest patients: for example, supine blood pressure fell by, respectively, 29/15 and 10/7 mm Hg during chronic treatment. 4. Using an integrated kinetic-dynamic model, blood pressure responsiveness was characterised by relating the fall in blood pressure (mmHg) to the plasma drug concentrations in each individual patient. No independent age-related effect was demonstrated. There was a significant relationship between response and the height of initial blood pressure which tended to be higher in the elderly patients. 5. Patient tolerability was generally satisfactory and there was no differential age-related effect. 6. This study has shown that the antihypertensive efficacy of dilevalol is not attenuated in the elderly and that there are no significant age-related differences in pharmacokinetics or pharmacodynamics.

Full text

PDF
591

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alton K. B., Petruzzi R. F., Patrick J. E. High-performance liquid chromatographic assay for dilevalol in human plasma and urine using a PRP-1 column and fluorimetric detection. J Chromatogr. 1988 Mar 18;425(2):363–372. doi: 10.1016/0378-4347(88)80040-9. [DOI] [PubMed] [Google Scholar]
  2. Andersen G. S. Atenolol versus bendroflumethiazide in middle-aged and elderly hypertensives. Acta Med Scand. 1985;218(2):165–172. doi: 10.1111/j.0954-6820.1985.tb08843.x. [DOI] [PubMed] [Google Scholar]
  3. Bühler F. R., Burkart F., Lütold B. E., Küng M., Marbet G., Pfisterer M. Antihypertensive beta blocking action as related to renin and age: a pharmacologic tool to identify pathogenetic mechanisms in essential hypertension. Am J Cardiol. 1975 Oct 31;36(5):653–669. doi: 10.1016/0002-9149(75)90168-x. [DOI] [PubMed] [Google Scholar]
  4. Castleden C. M., George C. F. The effect of ageing on the hepatic clearance of propranolol. Br J Clin Pharmacol. 1979 Jan;7(1):49–54. doi: 10.1111/j.1365-2125.1979.tb00896.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chrisp P., Goa K. L. Dilevalol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in hypertension. Drugs. 1990 Feb;39(2):234–263. doi: 10.2165/00003495-199039020-00007. [DOI] [PubMed] [Google Scholar]
  6. Daneshmend T. K., Roberts C. J. The effects of enzyme induction and enzyme inhibition on labetalol pharmacokinetics. Br J Clin Pharmacol. 1984 Sep;18(3):393–400. doi: 10.1111/j.1365-2125.1984.tb02481.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dillon N., Chung S., Kelly J., O'Malley K. Age and beta adrenoceptor-mediated function. Clin Pharmacol Ther. 1980 Jun;27(6):769–772. doi: 10.1038/clpt.1980.108. [DOI] [PubMed] [Google Scholar]
  8. Donnelly R., Elliott H. L., Meredith P. A., Kelman A. W., Reid J. L. Nifedipine: individual responses and concentration-effect relationships. Hypertension. 1988 Oct;12(4):443–449. doi: 10.1161/01.hyp.12.4.443. [DOI] [PubMed] [Google Scholar]
  9. Fitzgerald J. D. Age-related effects of beta-blockers and hypertension. J Cardiovasc Pharmacol. 1988;12 (Suppl 8):S83–S92. [PubMed] [Google Scholar]
  10. Fujimura A., Ohashi K., Tsuru M., Ebihara A., Kondo K. Clinical pharmacology of dilevalol (II). The pharmacokinetic, pharmacodynamic, and tolerance studies of dilevalol during repeated administration in healthy subjects. J Clin Pharmacol. 1989 Jul;29(7):643–649. doi: 10.1002/j.1552-4604.1989.tb03393.x. [DOI] [PubMed] [Google Scholar]
  11. Goa K. L., Benfield P., Sorkin E. M. Labetalol. A reappraisal of its pharmacology, pharmacokinetics and therapeutic use in hypertension and ischaemic heart disease. Drugs. 1989 May;37(5):583–627. doi: 10.2165/00003495-198937050-00002. [DOI] [PubMed] [Google Scholar]
  12. Holford N. H., Sheiner L. B. Understanding the dose-effect relationship: clinical application of pharmacokinetic-pharmacodynamic models. Clin Pharmacokinet. 1981 Nov-Dec;6(6):429–453. doi: 10.2165/00003088-198106060-00002. [DOI] [PubMed] [Google Scholar]
  13. Kendall M. J., Brown D., Yates R. A. Plasma metoprolol concentrations in young, old and hypertensive subjects. Br J Clin Pharmacol. 1977 Aug;4(4):497–499. [PMC free article] [PubMed] [Google Scholar]
  14. Kramer W. G., Nagabhushan N., Affrime M. B., Perentesis G. P., Symchowicz S., Patrick J. E. Pharmacokinetics and bioavailability of dilevalol in normotensive volunteers. J Clin Pharmacol. 1988 Jul;28(7):644–648. doi: 10.1002/j.1552-4604.1988.tb03189.x. [DOI] [PubMed] [Google Scholar]
  15. Kramer W. G., Perentesis G., Affrime M. B., Patrick J. E. Pharmacokinetics of dilevalol in normotensive and hypertensive volunteers. Am J Cardiol. 1989 Jun 5;63(19):7I–11I. doi: 10.1016/0002-9149(89)90121-5. [DOI] [PubMed] [Google Scholar]
  16. Lund-Johansen P. Hemodynamic effects of beta-blocking compounds possessing vasodilating activity: a review of labetalol, prizidilol, and dilevalol. J Cardiovasc Pharmacol. 1988;11 (Suppl 2):S12–S17. doi: 10.1097/00005344-198800000-00004. [DOI] [PubMed] [Google Scholar]
  17. Rowe J. W., Andres R., Tobin J. D., Norris A. H., Shock N. W. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol. 1976 Mar;31(2):155–163. doi: 10.1093/geronj/31.2.155. [DOI] [PubMed] [Google Scholar]
  18. Sumner D. J., Meredith P. A., Howie C. A., Elliott H. L. Initial blood pressure as a predictor of the response to antihypertensive therapy. Br J Clin Pharmacol. 1988 Dec;26(6):715–720. doi: 10.1111/j.1365-2125.1988.tb05310.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Tenero D. M., Bottorff M. B., Given B. D., Kramer W. G., Affrime M. B., Patrick J. E., Lalonde R. L. Pharmacokinetics and pharmacodynamics of dilevalol. Clin Pharmacol Ther. 1989 Dec;46(6):648–656. doi: 10.1038/clpt.1989.201. [DOI] [PubMed] [Google Scholar]
  20. Vestal R. E., Wood A. J., Shand D. G. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol Ther. 1979 Aug;26(2):181–186. doi: 10.1002/cpt1979262181. [DOI] [PubMed] [Google Scholar]
  21. Wikstrand J., Westergren G., Berglund G., Bracchetti D., Van Couter A., Feldstein C. A., Ming K. S., Kuramoto K., Landahl S., Meaney E. Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study. JAMA. 1986 Mar 14;255(10):1304–1310. [PubMed] [Google Scholar]
  22. Woodhouse K. W., Wynne H. A. Age-related changes in liver size and hepatic blood flow. The influence on drug metabolism in the elderly. Clin Pharmacokinet. 1988 Nov;15(5):287–294. doi: 10.2165/00003088-198815050-00002. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES