A B S T R A C T Salicylamide is metabolized in man by biotransformation to salicylalmide glucuronide, salicylamide sulfate, and gentisamide glucuronide. The metabolites are quantitatively and rapidly excreted in urine. Study of the metabolism of this drug in volunteers during episodes of pyrogen-induced fever shows a significant reduction in the half-life (ti) of the excretion of the drug metabolites. The proportion of the drug transformed to its major metabolite, salicylamide glucuronide, is significantly reduced by fever, with concomitant increase in the proportion of one or both of the other metabolites. Thus, the pattern of urinary metabolites of salicylamide is altered. The shortened ti of the metabolite excretion is probably due to increased hepatic and renal blood flow known to accompany pyrogen-induced fever. This concept was supported by the observation that when two subjects were placed in a high-temperature environmental chamber, a condition in which hepatic and renal blood flows are known to diminish, the ti of salicylamide metabolite excretion actually increased. No simple explanation exists to explain the changed metabolite pattern noted during febrile periods. It is most likely to be due to complex interactions between the direct or indirect effects of the pyrogens and the factors affecting the hepatic biotransformation of drugs.
INTRODUCTIONDespite the widespread use of pharmacological agents such as analgesics, antipyretics, antibiotics, and antimetabolites in diseases associated with fever, little is known of the effect of fever on the disposal of drugs in man. We have studied the metabolism of salicylamide in normal volunteers before and after induction of artificial fever by administration of etiocholanolone or endotoxin (1-3). Salicylamide (o-hydroxybenzamide) is an amide