Influence of Haemodialysis on the Pharmacokinetics and Haemodynamic Effects of Nifedipine During Continuous Intravenous Infusion

Abstract

The pharmacokinetics and haemodynamic effects of nifedipine were studied in 5 patients on long term haemodialysis. In addition, clearance of the drug on 2 different types of artificial kidneys were measured in vitro. Nifedipine was administered intravenously (1.3 mg/h) from 6 hours before starting haemodialysis to the end of haemodialysis, performed according to the standard protocol of each patient. Before and during haemodialysis, blood samples were taken for determination of free and total plasma nifedipine concentrations. Recovery was determined by measuring nifedipine concentrations in the dialysate. Heart rate and systolic and diastolic blood pressures were determined serially. The haemodynamic changes during nifedipine were compared with those of 3 previous dialysis sessions. Haemodialysis was accompanied by a slight decrease in steady-state nifedipine concentrations. The recovery in dialysate varied between 0.6 and 0.9% of the amount infused during the period of dialysis. Artificial kidney clearance of nifedipine varied between 2.8 and 8.3 ml/min, which was in agreement with in vitro data. Changes in steady-state nifedipine concentrations were most likely due to changes in systemic clearance caused by haemodialysis itself. Systolic and diastolic blood pressure dropped by approximately 15% and 25%, respectively, in comparison with dialysis without nifedipine, but changes in heart rate were not different. It is concluded that nifedipine is poorly dialysable. During haemodialysis, blood pressure is markedly reduced but dose schedules need not to be changed.

Converting‐enzyme inhibition buffers the counter‐regulatory response to acute administration of nicardipine.

“…This discrepancy might be due to a specific effect of dihydropyridine on baroreflex function (Heesch et al, 1983) or to the higher reflex tachycardia ratio recorded in our work. It has been demonstrated that the speed of dihydropyridine intravenous administration greatly influences the degree of the tachycardia (Kleinbloesem et al, 1985). Our protocol created more marked stimulation of the sympathetic nervous system, and therefore facilitated demonstration of sympathetic inhibition after ACE inhibition.…”