Should Medications be Coadministered with Albumin in Hypoalbuminemic Patients

Abstract

Protein binding significantly influences pharmacokinetic properties of drug distribution. Albumin accounts for approximately 60% of the total plasma protein by mass, thereby making it the major protein in the body. Hypoalbuminemia, a type of hypoproteinemia, is a condition of abnormally low blood albumin levels. Hypoaluminemia causes pharmacokinetic issues in regards to dosing a patient's medication. The purpose of this paper is to review the role of the coadministration of albumin in hypoalbuminemic patients to optimize pharmacotherapy.

HPLC-MS/MS coupled with equilibrium dialysis method for quantification of free drug concentration of pazopanib in plasma

“…Their mean serum albumin level was 38.3 AE 6.3 g/L, with 3 of the patients presented with hypoalbuminemia (defined as when albumin concentration falls below 35 g/L). The optimal time to reach equilibrium dialysis was chosen to be 6 h according to a previously validated method [15]. The average steady state concentration of our measured patients' samples was 30.9 AE 11.2 μg/mL, consistent with what had been reported in studies [2,16] while free drug concentration of pazopanib in our measured patients' samples was found to be 5.84 AE 3.02 ng/mL (expressed in mean AE standard deviations).…”

“…Mathematically, this increases the risk that a small change in the percentage of plasma protein binding would lead to a disproportionate change in plasma free drug concentration. In the clinical context, inter-patient variability in the level of plasma proteins is likely to accentuate the variation in free drug concentration [14,15,16].…”