Abstract. The non protein-bound portion of a drug is mainly responsible for the effect of a drug. If this free portion is changed for any reason, drug reactions varying from the normal may occur. Using sodium salicylate as an example, we have investigated this question in newborn children and in infants. It was shown that the newborns had significantly less salicylate protein-binding than the infants had. There was no significant difference of the binding constants between newborns with and without jaundice. In the 75 infants examined, 12 (15%) showed a significant reduction in salicylate protein-binding, but no definite relation to a specific disease could be established. A primary reduction in protein-binding, as well as a secondary reduction because of the disease, must be considered in these children.The importance of this reduced protein-binding should not be underestimated. In patients with restricted renal function or lowered hepatic metabolic capacity, it may lead to a delayed excretion of the drug which has increased penetration into the tissues.
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