Effect of Posture on Total Cortisol Plasma Concentration

Abalan, F.; Hui-Bon-Hoa, A.; Guillonneau, D; Ruedas, E; Calache, M; Ellison, Wesley A.; Rigal, F.; Perey, F.; Sousselier, M; Bourgeois, Michaël

doi:10.1055/s-2007-1003399

Cited by 8 publications

(7 citation statements)

References 5 publications

(6 reference statements)

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“…In addition, the plasma level of endogenous hormones (thyroxine, cortisol) can be influenced to a similar extent (mean increase: 6.8 and 32.6%, respectively) [30,31]. The large increase in cortisol is explained by a second effect of posture in this case: standing induces cortisol secretion as a physiological response to the resulting changes in plasma volume, circulation and blood pressure.…”

Section: Effects Of Posture On the Absorption Of Orally Administered mentioning

confidence: 89%

Influence of posture on pharmacokinetics

Queckenberg

Fuhr

2008

Eur J Clin Pharmacol

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Introduction Body position may influence physiological characteristics, such as perfusion, gastrointestinal function and plasma volume. These characteristics may interact with key factors determining the pharmacokinetics of drugs (dissolution, absorption, distribution, metabolism, excretion). Objectives Based on a systematic literature search, current data on the effect of posture on physiological characteristics and/or pharmacokinetics are summarized, and the relevance of possible effects, such as those presenting in clinical practice and clinical pharmacokinetic studies, is assessed. Results Postures which favour rapid gastric emptying (sitting, standing, recumbent right) accelerate the absorption of orally administered drugs. Consequently, these postures favour a shorter time to reach peak plasma drug concentration (t max ) and a higher maximum plasma drug concentration (C max ) and-in the case of transient saturation of first-pass metabolism-total exposure (area under the concentration-time curve, AUC) in comparison to recumbent left and supine positions (e.g. nifedipine: AUC 30 and 38% higher in standing and right lateral position vs. left lateral position; C max 149 and 80% higher, respectively). The magnitude of these postural effects depends strongly on the nature and amount of liquids and food ingested before drug administration and is most pronounced in the fasting state and after administration with a nonnutrient liquid. Changes in splanchnic-hepatic blood flow (e.g. reduction of estimated hepatic perfusion by 37% in standing vs. supine position) may substantially affect the metabolism of orally administered drugs, especially of those with a high/saturable first-pass metabolism. For highly protein-bound drugs (e.g. phenytoin, imipramine), the total plasma concentration has been found to be approximately 10% higher in standing than lying subjects due to changes in plasma volume. Conclusions Positioning of a patient may be an effective method of enhancing or retarding absorption of some drugs in appropriate clinical situations (e.g. toxic ingestions, bedridden patients). In clinical pharmacokinetic trials, such as bioequivalence studies, defining and maintaining posture precisely is a useful approach for reducing within-and between-subject variability.Keywords Absorption . Gastric emptying . Pharmacokinetics . Posture IntroductionThe influence of body position on physiological characteristics and pharmacokinetics has been investigated for several decades. The first study on this topic (effects of posture on gastric emptying) was reported to have been performed as early as 1918 [1] when it was observed that barium was emptied faster when subjects lay on the right side compared to other positions. Since then, a multitude of studies has addressed various aspects of postural effects, especially those on gastrointestinal motility, haematological parameters/perfusion and the pharmacokinetics of orally administered drugs.

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Section: Effects Of Posture On the Absorption Of Orally Administered mentioning

confidence: 89%

Influence of posture on pharmacokinetics

Queckenberg

Fuhr

2008

Eur J Clin Pharmacol

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“…Recently, Deacon and Arendt [ 19941 showed that changing from a supine to standing position increased plasma melatonin concentration in humans. Similarly an increase in plasma cortisol, prolactin, renin, aldosterone [Abalan et al, 1992;Matzen et al, 19931, and serum lipids [Tan et al, 19731 have been found with a changes in posture from a recumbent to an upright position. The changes observed in the latter study also correlated well with changes in the hematocrit.…”

Section: Introductionmentioning

confidence: 95%

Modulation of plasma melatonin concentrations by changes in posture

Nathan

Burrows

et al. 1998

Journal of Pineal Research

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Posture change from a lying position to a standing position results in a decrease in plasma volume, which leads to an increase in plasma constituents, especially that of proteins and blood constituents bound to them. The aim of the present study was to investigate the physiological effects of postural changes on plasma nocturnal melatonin concentrations in healthy human volunteers. The study was divided into four stages. During stage one, subjects were seated from 21.00 hr to 01.00 hr. In stage two, subjects were lying at ground level from 21.00 hr to 01.00 hr. In stage three, subjects were is a sitting position from 2100 hr to 2300 hr and then in a standing position from 23.00 hr to 24.00 hr, and back to the sitting position from 24.00 hr to 01.00 hr. In the final stage, subjects were in a lying position from 21.00 hr to 23.00 hr and then in a standing position from 23.00 hr to 24.00 hr and back to the lying position from 24.00 hr to 01.00 hr. AUC analysis showed significant differences between sitting and lying positions (t=2.84; P<0.05; df=5), with higher melatonin levels associated with the sitting position (mean difference in peak concentration of 17.1 pg/ml). Furthermore a change in posture from the lying to the standing position produced a statistically significant increase in melatonin concentrations (final stage) (t=-3.37; P<0.05; df=5) (mean difference in peak concentration of 28.5 pg/ml). No differences were found with a change in posture from a sitting to a standing position. The hemoconcentration and hemodilution associated with posture changes may play a role in altering plasma protein bound hormones such as melatonin.

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“…A study by Dukova demonstrated a significant increase in the activity of the enzymes creatinine kinase, alkaline phosphatase, and gamma‐glutamyltransferase after a change in body position from supine to standing for 15 minutes. Plasma levels of endogenous hormones (thyroxin, cortisol) are increased by 6.8% and 32.6%, respectively, after standing up . The relatively large increase in cortisol was explained by an additional physiologic cortisol secretion induced by the changes in plasma volume, circulation, and blood pressure .…”

Section: Discussionmentioning

confidence: 95%

“…Plasma levels of endogenous hormones (thyroxin, cortisol) are increased by 6.8% and 32.6%, respectively, after standing up. 21,22 The relatively large increase in cortisol was explained by an additional physiologic cortisol secretion induced by the changes in plasma volume, circulation, and blood pressure. 23 Standing for 30 to 40 minutes increases vitamin B 12 and folate plasma levels by more than 10%.…”

Section: Changes In Plasma Concentrations After Changes In Body Positmentioning

confidence: 99%

A Change in Posture Significantly Affects Plasma Concentrations of Large Molecules Such as IgG Antibodies

Iersel¹,

Velinova²

2018

The Journal of Clinical Pharma

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In several studies with monoclonal antibodies, we observed spikes in plasma concentration profiles coinciding with a change of posture of study subjects. We hypothesized that these unexpected changes were due to fluid shifts from plasma to the interstitium. The objective of this study was to investigate size and time course of the change in total immunoglobulin G (IgG) concentration after a change in posture. Thirty-two healthy subjects were enrolled. After entry in the clinic, subjects remained upright for at least 1 hour, followed by IgG sampling. Thereafter, subjects remained supine or seated (16 subjects each) for 60 minutes while IgG was sampled frequently. The within-subject day-to-day variability of IgG measured in the same position was only 2.6%. After a change in posture from standing to supine, IgG dropped rapidly in all subjects during the first 10 minutes in the supine position (9.0% decrease) and more slowly thereafter, up to a 12.3% decrease after 60 minutes. After a change in posture from standing to sitting, the decrease in IgG was more variable and modest. After 10 minutes of sitting, IgG was 3.6% lower, and after 60 minutes IgG was 7.8% lower. Changing posture causes a bias of more than 10% in plasma concentrations of total IgG. Most of the change is reached after being 15 minutes in the same position. In clinical trials in which plasma concentrations of high-molecular drugs, highly protein-bound drugs, endogenous proteins, or blood cells are assessed, standardizing posture per time point is a useful approach for reducing variability.

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Effect of Posture on Total Cortisol Plasma Concentration

Cited by 8 publications

References 5 publications

Influence of posture on pharmacokinetics

Influence of posture on pharmacokinetics

Modulation of plasma melatonin concentrations by changes in posture

A Change in Posture Significantly Affects Plasma Concentrations of Large Molecules Such as IgG Antibodies

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