This study determined the total clearance of propranolol and the partial clearances through each of its three primary metabolic pathways after administration of an 80 mg single oral dose in 28 young, white subjects (13 women; 15 men). The oral clearance of propranolol was significantly higher (63%, p less than 0.02) in the men (65.7 +/- 7.7 ml/min/kg; mean +/- SE) than in the women (40.2 +/- 6.2 ml/min/kg). This sex difference was mainly attributable to a 137% higher clearance through the P-450-mediated side-chain oxidation in the men (p less than 0.001). There was also a 52% higher clearance through glucuronidation in the men (p less than 0.02). In contrast, the clearance through the P-450-mediated ring oxidation was not different between men and women. After administration of simultaneous intravenous doses of hexadeuterium-labeled drug (0.1 mg/kg) to 11 of the subjects, there were no differences between men and women in volume of distribution or half-life. Moreover, there were no sex differences in plasma and blood binding of propranolol. This study thus demonstrates that higher plasma levels of propranolol occur in women than in men after oral doses and suggests that some drug metabolizing enzymes, but not others, are regulated by sex hormones in human beings.

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The influence of a high-protein meal as compared to fasting on the disposition of simultaneous intravenous and oral doses of propranolol, as well as on indocyanine green clearance, was examined in six normal subjects. The intravenous dose (0.1 mg/kg) was unlabeled propranolol and the oral dose (80 mg) was a stereospecifically deuterium-labeled pseudoracemate of propranolol. Systemic clearance of propranolol increased 38%, from 1005 +/- 57 to 1384 +/- 115 ml/min (mean +/- SE; P less than 0.05) as a result of the meal, with no change in t1/2 or apparent volume of distribution. A 12% decrease in oral clearance occurred with the meal but was not statistically significant (3717 +/- 185 ml/min, fasting; 3245 +/- 498 after meal), whereas bioavailability increased 67% (27.2% +/- 1.7% fasting; 45.5% +/- 4.3% after meal; P less than 0.01). Estimated hepatic blood flow, as measured by indocyanine green clearance, rose 34% 60 minutes after the meal (1719 +/- 155 ml/min fasting; 2304 +/- 218 ml/min after meal; P less than 0.02). A difference was observed in the oral clearance of the propranolol enantiomers in the fasting state, but this difference was unaffected by the meal. These alterations in propranolol disposition, as the result of a high-protein meal, are consistent with a transient increase in hepatic blood flow.

The disposition of the pharmacologically active 4-hydroxypropranolol (HO-P), its glucuronic acid conjugate (HO-P-G), and propranolol were compared after single intravenous and oral doses of propranolol in 6 normal subjects and after long-term therapy in 32 patients with hypertension or coronary artery disease. The areas under the plasma concentration/time curves (AUCoo, ng . hr/ml) after 4-mg intravenous doses of propranolol were 6.6 +/- 2.2 (mean +/- SEM) for HO-P and 55 +/- 11 for propranolol. After 20- and 80-mg oral doses the AUCoo for HO-P were 59 +/- 9 and 162 +/- 21 and for propranolol were 72 +/- 9 and 306 +/- 46. Peak HO-P concentrations were reached at 1 to 1.5 hr after the oral doses. Although there was a rapid decline in plasma HO-P between 1.5 and 3 hr when HO-P-G was still rising to levels above HO-P levels 3.5- to 5-fold, the apparent half-lifes (t1/2s) after 3 hr were in the same range for HO-P, HO-P-G, and propranolol (3.0 to 4.2 hr). While during long-term therapy plasma HO-P rose over the whole dose range (40 to 960 mg daily) in an apparently linear fashion, the HO-P/propranol plasma level ratio fell from 1.07 +/- 0.13 at 40 mg daily to only 0.09 +/- 0.01 at 640 mg daily. Plasma HO-P-G rose exponentially with dose and demonstrated significant cumulation. HO-P and HO-P-G in urine accounted for about 9% of long-term propranolol doses. This study suggests a significant contribution of HO-P to pharmacologic effects, in particular at low single and long-term oral doses of propranolol and saturation of naphthalene ring oxidation as a main determinant of propranolol bioavailability.

The influence of a meal on the disposition and metabolism of oral propranolol was examined in six normal subjects. The meal induced a mean 53% increase in propranolol bioavailability (range 2% to 92%; P less than 0.01) without affecting time to maximum concentration, half-life, or the amount of unchanges drug in urine. There was no effect on the plasma concentrations of 4-hydroxypropranolol or four other metabolites. The increased bioavailability was linearly related to the protein content of the meal (r = 0.884, P less than 0.02) above a threshold content of about 7 gm.