Skip to main content
British Medical Journal logoLink to British Medical Journal
. 1976 Apr 17;1(6015):939–941. doi: 10.1136/bmj.1.6015.939

Impaired Lignocaine metabolism in patients with myocardial infarction and cardiac failure.

L F Prescott, K K Adjepon-Yamoah, R G Talbot
PMCID: PMC1639291  PMID: 1268491

Abstract

Plasma concentrations of lignocaine were measured during and after infusion of lignocaine at 1.4 mg/min for 36-46 hours in 12 patients with myocardial infarction and one patient with cardiac failure due to uncontrolled ventricular tachycardia. In six patients without cardiac failure the plasma concentrations of lignocaine rose progressively during the infusion and the mean lignocaine half life was 4.3 hours compared with 1.4 hours in healthy subjects. Mean plasma lignocaine concentrations were significantly higher in seven patients with cardiac failure, and concentrations also rose during the infusion and the half life was considerably prolonged to 10.2 hours. Lignocaine concentrations rose rapidly to toxic levels when cardiogenic shock developed in one patient and did not fall when the infusion was stopped. The mean plasma antipyrine half life was moderately prolonged (19.4 hours) in a larger group of patients with myocardial infarction and cardiac failure but returned to normal during convalescence (13.2 hours). The metabolism of lignocaine is grossly abnormal in patients with cardiac failure and cardiogenic shock after myocardial infarction.

Full text

PDF
939

Selected References

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

  1. Adjepon-Yamoah K. K., Nimmo J., Prescott L. F. Gross impairment of hepatic drug metabolism in a patient with chronic liver disease. Br Med J. 1974 Nov 16;4(5941):387–388. doi: 10.1136/bmj.4.5941.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Adjepon-Yamoah K. K., Prescott L. F. Gas-liquid chromatographic estimation of lignocaine, ethylglycylxylidide, glycylxylidide and 4-hydroxyxylidine in plasma and urine. J Pharm Pharmacol. 1974 Nov;26(11):889–893. doi: 10.1111/j.2042-7158.1974.tb09198.x. [DOI] [PubMed] [Google Scholar]
  3. Boyes R. N., Scott D. B., Jebson P. J., Godman M. J., Julian D. G. Pharmacokinetics of lidocaine in man. Clin Pharmacol Ther. 1971 Jan-Feb;12(1):105–116. doi: 10.1002/cpt1971121105. [DOI] [PubMed] [Google Scholar]
  4. Halkin H., Meffin P., Melmon K. L., Rowland M. Influence of congestive heart failure on blood vessels of lidocaine and its active monodeethylated metabolite. Clin Pharmacol Ther. 1975 Jun;17(6):669–676. doi: 10.1002/cpt1975176669. [DOI] [PubMed] [Google Scholar]
  5. Prescott L. F., Adjepon-Yamoah K. K., Roberts E. Rapid gas-liquid chromatographic estimation of antipyrine in plasma. J Pharm Pharmacol. 1973 Mar;25(3):205–207. doi: 10.1111/j.2042-7158.1973.tb10625.x. [DOI] [PubMed] [Google Scholar]
  6. Rydén L., Waldenström A., Winsnes Y., Ortengren B. Blood levels of lidocaine after various infusion rates in patients with acute myocardial infarction. Am Heart J. 1975 Apr;89(4):470–473. doi: 10.1016/0002-8703(75)90153-2. [DOI] [PubMed] [Google Scholar]
  7. Sadée W., Schröder R., von Leitner E., Dagcioglu M. Multiple dose kinetics of spironolactone and canrenoate-potassium in cardiac and hepatic failure. Eur J Clin Pharmacol. 1974;7(3):195–200. doi: 10.1007/BF00560381. [DOI] [PubMed] [Google Scholar]
  8. Stenson R. E., Constantino R. T., Harrison D. C. Interrelationships of hepatic blood flow, cardiac output, and blood levels of lidocaine in man. Circulation. 1971 Feb;43(2):205–211. doi: 10.1161/01.cir.43.2.205. [DOI] [PubMed] [Google Scholar]
  9. Strong J. M., Mayfield D. E., Atkinson A. J., Jr, Burris B. C., Raymon F., Webster L. T., Jr Pharmacological activity, metabolism, and pharmacokinetics of glycinexylidide. Clin Pharmacol Ther. 1975 Feb;17(2):184–194. doi: 10.1002/cpt1975172184. [DOI] [PubMed] [Google Scholar]
  10. Strong J. M., Parker M., Atkinson A. J., Jr Identification of glycinexylidide in patients treated with intravenous lidocaine. Clin Pharmacol Ther. 1973 Jan-Feb;14(1):67–72. doi: 10.1002/cpt197314167. [DOI] [PubMed] [Google Scholar]
  11. Talbot R. G., Nimmo J., Julian D. G., Clark R. A., Neilson J. M., Prescott L. F. Treatment of ventricular arrhythmias with mexiletine (Kö 1173). Lancet. 1973 Aug 25;2(7826):399–404. doi: 10.1016/s0140-6736(73)92270-8. [DOI] [PubMed] [Google Scholar]
  12. Thomson P. D., Melmon K. L., Richardson J. A., Cohn K., Steinbrunn W., Cudihee R., Rowland M. Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann Intern Med. 1973 Apr;78(4):499–508. doi: 10.7326/0003-4819-78-4-499. [DOI] [PubMed] [Google Scholar]
  13. Tokola O., Pelkonen O., Karki N. T., Luoma P. Hepatic drug-oxidizing enzyme systems and urinary D-glucaric acid excretion in patients with congestive heart failure. Br J Clin Pharmacol. 1975 Oct;2(5):429–436. doi: 10.1111/j.1365-2125.1975.tb00552.x. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES