Table 4.
Some drugs used during hypothermia and interaction states (16)
| Class | Drug | Metabolism | Effect of hypothermia | Recommended dose |
|---|---|---|---|---|
| Anticonvulsants | Phenobarbital | CYP2C19 | Half-life increases 2-fold | Loading two times maximally, no need for change maintenance |
| Phenytoin | CYP2C9, CYP2C19, renal, bile, UGT glucuronidation | Clearance reduces to 67% The drug’s stay time in the body is prolonged by 180% | Check the level before loading a second dose | |
| Midazolam | CYP3A | Clearance reduces by 11% for each 1°C | Be careful with repeated doses and infusion | |
| Sedatives | Fentanyl | CYP3A | Increase in plasma levels by 25% | Accumulation occurs with repeated doses and infusions, one should be careful |
| Antibiotics | Gentamycin | Renal | Watch for renal failure | |
| Ampicillin | Renal | It is thought that there is no effect | Watch for renal failure | |
| Inotropic agents | Dobutamine | COMT | Adjust the dose by clinical need | |
| Dopamine | COMT/MAO | Accumulation may occur | Hypothermia may decrease response to inotropes | |
| Noradrenaline | COMT/MAO | α adrenergic action is in the forefront throughout hypothermia |
COMT: catechol-o-methyl transferase; MAO: monoamine oxidase