Summary
The total and free steady-state plasma levels of nifedipine in patients with renal failure have been compared with those in subjects with normal renal function. Studies were done after administration of nifedipine 10 mg t.d.s. p.o. for 5 days, after i.v. infusion of 4·4 mg, and after a single 10 mg oral dose.
The systemic clearance of nifedipine after a single i.v.-dose was higher in subjects with renal insufficiency (854 ml/min) than in those with normal renal function (468 ml/min). After the single oral dose the AUC (6100 ng·min·ml−1) and maximum plasma concentration (75.0 ng·ml−1) were lower than in subjects with normal renal function (19300 ng·ml−1; 122 ng·ml−1). The plasma protein binding of nifedipine averaged 95.5% in normal subjects and 94.8% in patients with renal failure.
Although free and total steady-state plasma levels of nifedipine tended to be somewhat lower than normal in renal failure, the changes in pharmacokinetics and decreased protein binding of nifedipine did not result in a significantly different steady-state plasma level of the drug. The blood pressure response to a given plasma nifedipine level appeared to be enhanced in renal failure.
Similar content being viewed by others
References
Martre H, Jacobs C, Singlas E, Sari R, Taburet AM (1985) Kinetics of nifedipine in patients treated with maintenance haemodialysis. Proc EDTA-ERA 22: 889–893
Ittel TH, Raemsch KD, Wingender W, Matthies U, Wolff F, Sieberth HG (1987) Pharmakokinetik und Pharmakodynamik von Nifedipin nach intravenöser Applikation bei eingeschränkter Nierenfunktion. Klin Wochenschr 65: S 255
Bogaert MG, Rosseel MT, Joos R, Boelaert J (1984) Plasma concentrations of nifedipine in patients with renal failure. Drug Res 34: 307–308
Kleinbloesem CH, van Brummelen P, van Harten J, Danhof M, and Breimer DD (1985) Nifedipine: Influence of renal function on pharmacokinetic/hemodynamic relationship. Clin Pharmacol Ther 37: 563–574
Reidenberg MM, Drayer DE (1980) Drug therapy in renal failure. Ann Rev Pharmacol Toxicol 20: 45–54
Challenor VF, Waller DG, Gruchy BS, Renwick AG, George CF (1987) Food and nifedipine pharmacokinetics. Br J Clin Pharmacol 23: 248–249
Reitberg DP, Love SJ, Quercia GT, Zinny MA (1987) Effect of food on nifedipine pharmacokinetics. Clin Pharmacol Ther 42; 72–75
Renwick AG, Le Vie J, Challenor VF, Waller DG, Gruchy B, George CF (1987) Factors affecting the pharmacokinetics of nifedipine. Eur J Clin Pharmacol 32: 351–355
Kleinbloesem CH, van Harten J, van Brummelen P, Breimer DD (1984) Liquid chromatographic determination of nifedipine in plasma and of its main metabolite in urine. J Chromatogr 308: 209–216
Lohman JJHM, Hooymans PM, Verhey MTJM, Koten MLP, Merkus FWHM (1984) Influence of volume shift in equilibrium dialysis to estimate plasma protein binding of drugs. Pharm Res 1: 187–188
Forster TS, Hamann SR, Richards VR, Bryant PJ, Graves DA, McAllister RG (1983) Nifedipine kinetics and bioavailability after single intravenous and oral doses in normal subjects. J Clin Pharmacol 23: 161–170
Kleinbloesem CH, van Brummelen P, van de Linde JA, Voogd PJ, Breimer DD (1984) Nifedipine: Kinetics and dynamics in healthy subjects. Clin Pharmacol Ther 35: 742–749
Raemsch KD, Sommer J (1983) Pharmacokinetics and metabolism of nifedipine. Hypertension 5: S18-S24
Waller DG, Renwick AG, Gruchy BS, George CF (1984) The first pass metabolism of nifedipine in man. Br J Clin Pharmacol 18: 951–954
Rosenkranz H, Schlossmann K, Scholtan W (1974) Die Bindung von 4-(2′Nitrophenyl)-2,6-dimethyl-1,4-dihydropyridin-3,5-dicarbonsauredimethylester (Nifedipine) sowie von anderen koronar wirksamen Stoffen an die Eiweißkörper des Serums. Drug Res 24: 455–466
Kleinbloesem CH, van Brummelen P, Faber H, Breimer DD (1987) Pharmacokinetics and hemodynamic effects of long-term nifedipine treatment in hypertensive patients. J Cardiovasc Pharmacol 9: 202–208
Kleinbloesem CH, van Brummelen P, Breimer DD (1987) Nifedipine relationship between pharmacokinetics and pharmacodynamics. Clin Pharmacokinet 12: 12–29
Heidbreder E, Schafferhans K, Heidland A (1985) Disturbances of peripheral and autonomic nervous system in chronic renal failure: effects of haemodialysis and tranplantation. Clin Nephrol 222–228
Kusano E, Asano Y, Takeda K, Matsumoto Y, Ebihara A, Hosoda S (1982) Hypotensive effect of nifedipine in hypertensive patients with chronic renal failure. Drug Res 32: 1575–1580
Kleinbloesem CH, van Brummelen P, Danhof M, Faber H, Urquhart J, Breimer DD (1987) Rate of increase in the plasma concentration of nifedipine as a major determinant of its hemodynamic effects in humans. Clin Pharmacol Ther 41; 26–30
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
v. Bortel, L., Böhm, R., Mooij, J. et al. Total and free steady-state plasma levels and pharmacokinetics of nifedipine in patients with terminal renal failure. Eur J Clin Pharmacol 37, 185–189 (1989). https://doi.org/10.1007/BF00558229
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00558229