Digoxin therapy during T-tube biliary drainage in man

Carruthers, Sam

doi:10.1001/jama.240.25.2756

Cited by 3 publications

(4 citation statements)

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“…Recently, Andrews et al (1985) reported that clamping or removal of the T-tube leads to significantly higher CyA trough levels in liver transplant patients. Similar observations have been made with digoxin and vitamin B12 (Carruthers & Dujovne, 1978;Teo et al, 1980). Blood concentrations of drugs which are extensively excreted unchanged in the bile will increase following T-tube clamping due to increased enterohepatic recycling of the drug.…”

Section: Methodssupporting

confidence: 77%

Effect of bile on cyclosporin absorption in liver transplant patients.

Mehta

Venkataramanan

et al. 1988

Brit J Clinical Pharma

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1. We quantitated the effect of biliary diversion on cyclosporin (CyA) absorption in liver transplant patients. Multiple blood samples were obtained over one dosing interval following oral CyA administration in eight liver transplant patients before and after T‐tube clamping. 2. Cyclosporin concentrations were measured by a high pressure liquid chromatographic method. 3. The mean (+/‐ s.d.) dose‐normalized area under the blood concentration vs time curve (AUC) over a dosing interval was 5.23 (+/‐ 3.22) ng ml‐1 h during the pre clamping period and 15.79 +/‐ 7.92 ng ml‐1 h during the post clamping period. A significant (P less than 0.05) increase (276%) in the dose normalized AUC was observed following the T‐tube clamping. 4. Analysis of bile revealed less than 1 mg (less than 1% of dose) of unchanged CyA to be eliminated in bile over 12 h. Therefore the increased CyA AUC/dose following T‐tube ligation cannot be explained by enterohepatic recirculation. 5. Increased bile flow secondary to clamping of the T‐ tube most likely increased the absorption of CyA. Increase in CyA absorption may be due to a bile mediated increase in CyA solubility or gastrointestinal membrane permeability, or increased residence time at the site of absorption. 6. Independent of the mechanism involved, our results indicate that adjustments in CyA dosage must be made whenever external bile diversion is instituted or discontinued.

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Section: Methodssupporting

confidence: 77%

Effect of bile on cyclosporin absorption in liver transplant patients.

Mehta

Venkataramanan

et al. 1988

Brit J Clinical Pharma

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Section: T-tube Clamping and Mycophenolic Acid Kineticsmentioning

confidence: 99%

“…[4][5][6] The increased concentration of digoxin after t-tube clamping has been ascribed to improved enterohepatic recycling of digoxin. 6 The plasma concentration-versus-time profile for MPA shows secondary peaks between 6 and 12 hours after MMF dosing. 2 This observation, along with the facts that MPA is primarily converted to a glucuronide conjugate that is significantly excreted in the bile and that the plasma MPA AUC decreases by 37% when cholestyramine is administered to patients, 2 suggests that MPA undergoes enterohepatic recirculation.…”

Section: T-tube Clamping and Mycophenolic Acid Kineticsmentioning

confidence: 99%

“…T-tube clamping can increase the blood/plasma concentration of certain drugs, either because of increased availability of bile for dissolution of the drugs that are very lipid soluble and require bile for dissolution or because of improved enterohepatic recycling of the drugs. [4][5][6] The blood concentration of cyclosporine increases significantly after t-tube clamping because of the increased availability of bile in the gut, leading to improved solubility and absorption of cyclosporine from the conventional formulation. 5 Conversely, clamping the t-tube does not affect the blood concentration of tacrolimus.…”

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Effect of T-tube clamping on the pharmacokinetics of mycophenolic acid in liver transplant patients on oral therapy of mycophenolate mofetil

et al. 1999

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The aim of the study was to evaluate the effect of t-tube clamping on the pharmacokinetics of mycophenolic acid (MPA) after oral administration of mycophenolate mofetil (MMF) in primary liver transplant recipients treated with tacrolimus as the primary immunosuppressive drug. We evaluated the pharmacokinetics of MPA and its primary metabolite, mycophenolic acid glucuronide (MPAG), before and after clamping the t-tube in 8 primary liver transplant recipients treated with oral MMF and tacrolimus. The concentration of MPA and MPAG in plasma, bile, and urine samples obtained over one dosing interval was measured by high-pressure liquid chromatography. Pharmacokinetic parameters of MPA estimated before and after clamping the t-tube were compared to evaluate any significant differences at a P of .05 or less. There were no significant differences in the time to reach peak plasma concentration (1.8 ؎ 1.7 v 1.0 ؎ 0.5 hours), trough plasma concentration of MPA (1.1 ؎ 1.4 v 1.4 ؎ 1.1 g/mL), peak plasma concentration of MPA (10.6 ؎ 7.5 v 11.1 ؎ 4.6 g/ mL), area under the plasma concentration-versustime curve (AUC) (40.1 ؎ 31.9 v 43.2 ؎ 21.1 g/ mL/h) of MPA, or the percentage of MPA that is free or unbound in the plasma (3.9% ؎ 1.6% v 4.1% ؎ 3.0%). There was also no significant difference in the ratio of the AUC of MPAG to MPA. These observations suggest that t-tube clamping does not affect the kinetics of MPA or MPAG and that no dosing alterations of MMF are required when the t-tube is clamped in liver transplant recipients.

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Glykosidintoxikation und deren Behandlung

Schölmerich

Gilfrich

1982

Fortschritte in Der Kardiologie

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Digoxin therapy during T-tube biliary drainage in man

Cited by 3 publications

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Effect of bile on cyclosporin absorption in liver transplant patients.

Effect of bile on cyclosporin absorption in liver transplant patients.

Effect of T-tube clamping on the pharmacokinetics of mycophenolic acid in liver transplant patients on oral therapy of mycophenolate mofetil

Glykosidintoxikation und deren Behandlung

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