How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients

Show full item record



Permalink

http://hdl.handle.net/10138/302415

Citation

Kokki , H , Maaroos , M , Ellam , S , Halonen , J , Ojanpera , I , Ranta , M , Ranta , V-P , Tolonen , A , Lindberg , O , Viitala , M & Hartikainen , J 2018 , ' How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients ' , European Journal of Clinical Pharmacology , vol. 74 , no. 6 , pp. 785-792 . https://doi.org/10.1007/s00228-018-2437-1

Title: How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients
Author: Kokki, Hannu; Maaroos, Martin; Ellam, Sten; Halonen, Jari; Ojanpera, Ilkka; Ranta, Merja; Ranta, Veli-Pekka; Tolonen, Aleksandra; Lindberg, Oscar; Viitala, Matias; Hartikainen, Juha
Contributor: University of Helsinki, Medicum
University of Helsinki, Medicum
Date: 2018-06
Language: eng
Number of pages: 8
Belongs to series: European Journal of Clinical Pharmacology
ISSN: 0031-6970
URI: http://hdl.handle.net/10138/302415
Abstract: Purpose Cardiac surgery and conventional extracorporeal circulation (CECC) impair the bioavailability of drugs administered by mouth. It is not known whether miniaturized ECC (MECC) or off-pump surgery (OPCAB) affect the bioavailability in similar manner. We evaluated the metoprolol bioavailability in patients undergoing CABG surgery with CECC, MECC, or having OPCAB. Methods Thirty patients, ten in each group, aged 44-79 years, scheduled for CABG surgery were administered 50 mg metoprolol by mouth on the preoperative day at 8-10 a.m. and 8 p.m., 2 h before surgery, and thereafter daily at 8 a.m. and 8 p.m. Blood samples were collected up to 12 h after the morning dose on the preoperative day and on first and third postoperative days. Metoprolol concentration in plasma was analyzed using liquid chromatography-mass spectrometry. Results The absorption of metoprolol was markedly reduced on the first postoperative day in all three groups, but recovered to the preoperative level on the third postoperative day. The geometric means (90% confidence interval) of AUC(0-12) on the first and third postoperative days versus the preoperative day were 44 (26-74)% and 109 (86-139)% in the CECC-group, 28 (16-50)% and 79 (59-105)% in the MECC-group, and 26 (12-56)% and 96 (77-119)% in the OPCAB-group, respectively. Two patients in the CECC-group and two in the MECC-group developed atrial fibrillation (AF). The bioavailability and the drug concentrations of metoprolol in patients developing AF did not differ from those who remained in sinus rhythm. Conclusion The bioavailability of metoprolol by mouth was markedly reduced in the early phase after CABG with no difference between the CECC-, MECC-, and OPCAB-groups.
Subject: Metoprolol
Pharmacokinetics
Area under the curve
Atrial fibrillation
Postoperative
Coronary artery bypass grafting surgery
POSTOPERATIVE ATRIAL-FIBRILLATION
CARDIAC-SURGERY
CARDIOPULMONARY BYPASS
INFLAMMATORY RESPONSE
ON-PUMP
HEART-SURGERY
METAANALYSIS
PREVENTION
THERAPY
PHARMACOKINETICS
317 Pharmacy
3121 Internal medicine
3126 Surgery, anesthesiology, intensive care, radiology
Rights:


Files in this item

Total number of downloads: Loading...

Files Size Format View
10.1007_s00228_018_2437_1.pdf 559.6Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record