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European Heart Journal 1983 4(11):810-814;
Copyright © 1983 by the European Society of Cardiology.
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© 1983, by the European Society of Cardiology

Increase of mexiletine plasma levels due to delayed hepatic metabolism in patients with chronic liver disease*

J. NITSCH{dagger},, G. STEINBECK{ddagger} and B. LÜDERITZ{dagger}

{dagger}Department of Medicine-Cardiology, University of Bonn-Venusberg Klinikum GroBhadern, FRG
{ddagger}Department of Medicine I, University of Munich Klinikum GroBhadern, FRG

Received 5 August 1982; revised 23 February 1983; .

Requests for reprints to: Dr J. Nitsch, Department of Medicine-Cardiology, Sigmund-Freud-Str. 25, D-5300, Bonn-Venusberg, FRG.

Abstract

The clinical relevance of changes in pharmacokinetics of oral mexiletine (600 mg daily dose) was studied in 82 patients with ventricular arrhythmias and impaired liver, renal or heart function (control group n = 51, patients with liver cirrhosis n = 9, with renal insufficiency n = 14, or heart failure n = 8). Increased plasma levels of mexiletine were found in patients with chronic liver disease (2.21 ± 0.94 µg/ml, versus, 0.63 ± 0.22µg/ml of controls, P < 0.01).

Plasma levels in patients with renal insufficiency or heart failure were not significantly different from the controls. The resulting elevated plasma levels in patients with liver cirrhosis emphasize the importance of hepatic metabolism in the elimination of mexiletine. Drug monitoring must be considered necessary in patients with impaired liver function.

Key Words: Mexiletine • antiarrhythmic therapy • hepatic metabolism


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