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Topic:Pharmacokinetics

Pharmacokinetics in horses involves the study of how drugs are absorbed, distributed, metabolized, and excreted in equine species. This field of study provides insights into the time course of drug concentrations within the horse's body and helps in understanding the effects of various pharmaceuticals. Key parameters in equine pharmacokinetics include absorption rates, bioavailability, half-life, and clearance. These parameters can vary significantly due to factors such as age, breed, and health status of the horse. This page compiles peer-reviewed research studies and scholarly articles that explore the pharmacokinetic profiles of different drugs in horses, aiming to optimize dosing regimens and improve therapeutic outcomes in equine medicine.
Cardiopulmonary effects and pharmacokinetics of i.v. dexmedetomidine in ponies.
Equine veterinary journal    January 18, 2005   Volume 37, Issue 1 60-64 doi: 10.2746/0425164054406801
Bettschart-Wolfensberger R, Freeman SL, Bowen IM, Aliabadi FS, Weller R, Huhtinen M, Clarke KW.Currently available sedatives depress cardiopulmonary function considerably; therefore, it is important to search for new, less depressive sedatives. The study was performed to assess duration and intensity of cardiopulmonary side effects of a new sedative, dexmedetomidine (DEX), in horses. Objective: To study pharmacokinetics and cardiopulmonary effects of i.v. DEX. Methods: Pharmacokinetics of 3.5 microg/kg bwt i.v. DEX were studied in a group of 8 mature (mean age 4.4 years) and 6 old ponies (mean age 20 years). Cardiopulmonary data were recorded in mature ponies before and 5, 10, 20, 30, 4...
Synovial fluid levels and serum pharmacokinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses.
Arthritis and rheumatism    January 11, 2005   Volume 52, Issue 1 181-191 doi: 10.1002/art.20762
Laverty S, Sandy JD, Celeste C, Vachon P, Marier JF, Plaas AH.To examine the concentration of glucosamine in the synovial fluid and its pharmacokinetics in serum in a large animal model following dosing with glucosamine HCl at clinically relevant levels. Methods: Eight adult female horses were studied. After an overnight fast, glucosamine HCl (20 mg/kg of body weight) was administered by either nasogastric (NG) intubation or intravenous (IV) injection. Blood samples were collected before dosing and at 5, 15, 30, 60, 120, 180, 240, 360, 480, and 720 minutes after dosing. Synovial fluid samples were collected from the radiocarpal joints 48 hours before dos...
[The current situation pertaining to veterinary drugs for horses].
Tijdschrift voor diergeneeskunde    January 7, 2005   Volume 129, Issue 24 855-857 
Loomans JB.No abstract available
Expression of the cyclooxygenase isoforms in the prodromal stage of black walnut-induced laminitis in horses.
American journal of veterinary research    January 6, 2005   Volume 65, Issue 12 1724-1729 doi: 10.2460/ajvr.2004.65.1724
Waguespack RW, Cochran A, Belknap JK.To compare the levels of mRNA expression of cycooxygenase (COX)-1 and COX-2 in the digital laminae of normal horses and horses in the developmental stages of laminitis experimentally induced by administration of black walnut extract (BWE). Methods: Samples of mRNA extracted from the digital laminae of 5 control horses and 5 horses at the onset of leukopenia after administration of BWE. Methods: Specimens of laminae were collected from anesthetized horses prior to euthanasia. Expression of COX-1 and COX-2 mRNA in laminae of control and affected horses was evaluated via real-time quantitative po...
Pharmacodynamics and pharmacokinetics of nonsteroidal anti-inflammatory drugs in species of veterinary interest.
Journal of veterinary pharmacology and therapeutics    December 17, 2004   Volume 27, Issue 6 479-490 doi: 10.1111/j.1365-2885.2004.00617.x
Lees P, Landoni MF, Giraudel J, Toutain PL.This review summarises selected aspects of the pharmacokinetics (PK) and pharmacodynamics (PD) of nonsteroidal anti-inflammatory drugs (NSAIDs). It is not intended to be comprehensive, in that it covers neither minor species nor several important aspects of NSAID PD. The limited objective of the review is to summarise those aspects of NSAID PK and PD, which are important to an understanding of PK-PD integration and PK-PD modelling (the subject of the next review in this issue). The general features of NSAID PK are: usually good bioavailability from oral, intramuscular and subcutaneous administ...
Tegaserod (HTF 919) stimulates gut motility in normal horses.
Equine veterinary journal    December 8, 2004   Volume 36, Issue 7 622-627 doi: 10.2746/0425164044864543
Lippold BS, Hildebrand J, Straub R.It has been shown that the selective 5-HT4 receptor agonist tegaserod induces an increase in frequency and amplitude of contractions in isolated muscle preparations of equine ileum and pelvic flexure. Objective: To investigate the effects of tegaserod on gut motility and transit of spheres in normal horses. Methods: Six mature Freiberger horses were kept under standardised conditions. Effects of tegaserod (0.02 mg/kg bwt i.v. b.i.d. for 2 days) or vehicle on intestinal transit of barium-filled spheres, defaecation and gut sounds were studied in a cross-over design. Spheres were given via stoma...
Pharmacokinetics of R(-) and S(+) carprofen after administration of racemic carprofen in donkeys and horses.
American journal of veterinary research    November 30, 2004   Volume 65, Issue 11 1479-1482 doi: 10.2460/ajvr.2004.65.1479
Mealey KL, Matthews NS, Peck KE, Burchfield ML, Bennett BS, Taylor TS.To compare plasma disposition of the R(-) and S(+) enantiomers of carprofen after IV administration of a bolus dose to donkeys and horses. Methods: 5 clinically normal donkeys and 3 clinically normal horses. Methods: Blood samples were collected from all animals at time 0 (before) and at 10, 15, 20, 30, and 45 minutes and 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 10, 24, 28, 32, and 48 hours after IV administration of a bolus of carprofen (0.7 mg/kg). Plasma was analyzed in triplicate via high-performance liquid chromatography to determine the concentrations of the carprofen enantiomers. A plasma concent...
Pharmacokinetics of meloxicam in plasma and urine of horses.
American journal of veterinary research    November 30, 2004   Volume 65, Issue 11 1542-1547 doi: 10.2460/ajvr.2004.65.1542
Toutain PL, Reymond N, Laroute V, Garcia P, Popot MA, Bonnaire Y, Hirsch A, Narbe R.To determine pharmacokinetic parameters for meloxicam, a nonsteroidal anti-inflammatory drug, in horses. Methods: 8 healthy horses. Methods: In the first phase of the study, horses were administered meloxicam once in accordance with a 2 x 2 crossover design (IV or PO drug administration; horses fed or not fed). The second phase used a multiple-dose regimen (daily oral administration of meloxicam for 14 days), with meloxicam administered at the recommended dosage (0.6 mg/kg). Plasma and urine concentrations of meloxicam were measured by use of validated methods with a limit of quantification of...
Pharmacokinetic-pharmacodynamic relationships and dose response to meloxicam in horses with induced arthritis in the right carpal joint.
American journal of veterinary research    November 30, 2004   Volume 65, Issue 11 1533-1541 doi: 10.2460/ajvr.2004.65.1533
Toutain PL, Cester CC.To determine pharmacokinetic-pharmacodynamic (PK-PD) relationships and dose effects for meloxicam in horses and to propose a suitable dosage for use in clinical studies. Methods: 6 adult horses. Methods: The study was conducted by use of a randomized, Latin-square design. Arthritis was induced in the right carpal joint of each horse by administration of Freund's complete adjuvant. Various dosages of meloxicam (0, 0.25, 0.5, 1.0, and 2.0 mg/kg, IV) were then administered. Validated endpoints including stride length and overall clinical lameness score (scale of 0 to 20) were used to assess the e...
Direct detection of boldenone sulfate and glucuronide conjugates in horse urine by ion trap liquid chromatography-mass spectrometry.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences    November 24, 2004   Volume 813, Issue 1-2 241-246 doi: 10.1016/j.jchromb.2004.09.052
Pu F, McKinney AR, Stenhouse AM, Suann CJ, McLeod MD.A study of the equine phase II metabolism of the anabolic agent boldenone is reported. Boldenone sulfate, boldenone glucuronide and their C17-epimers were synthesised as reference standards in our lab and a method was developed for their detection in a horse urine matrix. Solid phase extraction was used to purify the analytes, which were then detected by ion trap LC/MS. Negative and positive ionisation mode MS(2) were used for the detection of sulfate and glucuronide conjugates, respectively. Boldenone sulfate and 17-epiboldenone glucuronide were detected as the major and minor phase II metabo...
Study of caffeine in urine and saliva of horses subjected to urinary acidification.
Journal of applied toxicology : JAT    November 20, 2004   Volume 24, Issue 6 513-518 doi: 10.1002/jat.1011
Carregaro AB, Mataqueiro MI, Soares OA, Queiroz-Neto A.The study of caffeine in racing horses has been of growing concern in veterinary sports medicine since the Association of Racing Commissioners International (ARCI) stated that it has no valid therapeutic use in racehorses. We examined the kinetic alterations in the urinary excretion and salivary secretion of caffeine in seven horses subjected to urinary acidification using ascorbic acid because this procedure can simulate the acidosis that follows anaerobic exercise. They participated in two treatment groups: the control group (SG) received 500 ml of saline and then 2.0 mg kg(-1) caffeine i.v....
CYP3A in horse intestines.
Toxicology and applied pharmacology    November 16, 2004   Volume 201, Issue 2 112-119 doi: 10.1016/j.taap.2004.05.015
Tydén E, Olsén L, Tallkvist J, Larsson P, Tjälve H.The intestinal enterocytes provide the initial site for cytochrome P450 (CYP)-mediated metabolism of orally absorbed xenobiotics. In man and some animal species, the CYP3A subfamily is highly expressed in the intestines and considered to be important in the first-pass metabolism of drugs and other xenobiotics. The aim of the present study was to investigate the mRNA expression, immunohistochemical localization and catalytic activity of CYP3A in the intestines of horse. Real-time RT-PCR analyses showed that the highest CYP3A mRNA expression was present in the duodenum with a decreasing level to...
Pharmacokinetics of once-daily amikacin in healthy foals and therapeutic drug monitoring in hospitalized equine neonates.
Journal of veterinary internal medicine    November 2, 2004   Volume 18, Issue 5 728-733 doi: 10.1892/0891-6640(2004)182.0.co;2
Bucki EP, Giguère S, Macpherson M, Davis R.The objectives of this study were to investigate the pharmacokinetics of once-daily amikacin in healthy neonates, to determine amikacin concentrations in hospitalized foals, and to determine the minimum inhibitory concentrations (MICs) of amikacin against gram-negative isolates from blood cultures in septic foals. Median half-life, clearance, and volume of distribution of amikacin in healthy 2- to 3-day-old foals after administration of an intravenous bolus of amikacin (25 mg/kg) were 5.07 hours (4.86-5.45 hours), 1.82 mL/min/kg (1.35-1.97 mL/min/kg), and 0.785 L/kg (0.638-0.862 L/kg), respect...
Pharmacokinetics and pharmacodynamics of furosemide after oral administration to horses.
Journal of veterinary internal medicine    November 2, 2004   Volume 18, Issue 5 739-743 doi: 10.1892/0891-6640(2004)18<739:papofa>2.0.co;2
Johansson AM, Gardner SY, Levine JF, Papich MG, Lafevers DH, Goldman RB, Sheets MK, Atkins CE.Furosemide is the most common diuretic drug used in horses. Furosemide is routinely administered as IV or IM bolus doses 3-4 times a day. Administration PO is often suggested as an alternative, even though documentation of absorption and efficacy in horses is lacking. This study was carried out in a randomized, crossover design and compared 8-hour urine volume among control horses that received placebo, horses that received furosemide at 1 mg/kg PO, and horses that received furosemide at 1 mg/kg IV. Blood samples for analysis of plasma furosemide concentrations, PCV, and total solids were obta...
Population pharmacokinetics of marbofloxacin in horses: preliminary analysis.
Journal of veterinary pharmacology and therapeutics    October 27, 2004   Volume 27, Issue 5 283-288 doi: 10.1111/j.1365-2885.2004.00591.x
Peyrou M, Doucet MY, Vrins A, Concordet D, Schneider M, Bousquet-Mélou A.Population pharmacokinetic of marbofloxacin was investigated on 21 healthy and 16 diseased horses to assess interindividual variability of drug exposure. Demographic, physiologic and disease covariables were tested using mixed effects models. As a preliminary analysis, this study has demonstrated that none of the tested covariables were significant in regression models for compartmental volumes or clearance of distribution, but the clinical status of the horse (healthy/diseased) was a significant covariable (P < 0.01) for systemic clearance. Clearance had a lower mean and a higher variance ...
Cefotaxime kinetics in plasma and synovial fluid following intravenous administration in horses.
Journal of veterinary pharmacology and therapeutics    October 27, 2004   Volume 27, Issue 5 293-298 doi: 10.1111/j.1365-2885.2004.00596.x
Orsini JA, Moate PJ, Engiles J, Norman T, Poppenga R, Benson CE, Boston RC.Cefotaxime powder was diluted with sterile water to a concentration of 100 mg/mL. The volume of solution was adjusted for each experimental horse to provide a total dose of 15, 20, and 25 mg/kg and was administered by infusion through a jugular vein catheter over a 10-min period. All three doses were administered to each of the six experimental horses at three different times. Cefotaxime concentrations in plasma and synovial fluid samples were measured by high-performance liquid chromatography (HPLC). Standard compartmental analysis techniques and the WinSAAM modeling program were used to dete...
Biological availability of inhaled fluticasone propionate in horses.
The Veterinary record    October 21, 2004   Volume 155, Issue 12 361-364 doi: 10.1136/vr.155.12.361
Laan TT, Westermann CM, Dijkstra AV, van Nieuwstadt RA, Fink-Gremmels J.Healthy horses received aerosolised, intranasal or oral doses of 3 mg of fluticasone propionate evenly divided over morning and evening treatments for seven days. The bioavailability of the drug was determined in terms of the suppression of the endogenous cortisol concentrations in the horses during the period of treatment. The horses which received the aerosolised drug had significantly lower concentrations of endogenous cortisol on days 5 and 8 than the horses which received aerosolised placebo. The horses which received nasal and oral doses of fluticasone propionate showed no significant ch...
Pharmacokinetics, stability, and retrospective analysis of use of an oral gel formulation of the bovine injectable enrofloxacin in horses.
Veterinary therapeutics : research in applied veterinary medicine    October 7, 2004   Volume 5, Issue 2 155-167 
Epstein K, Cohen N, Boothe D, Nieuwoudt C, Chandler J.In many cases of equine infectious disease, long-term administration of antimicrobial drugs is required. Oral agents are preferred because of the relative ease of administration compared with other routes. Enrofloxacin has been shown to be effective against a variety of equine pathogens, but oral administration of this drug has proved difficult in horses. An oral gel formulation made from the injectable cattle product produces blood levels sufficient to resolve infections caused by a variety of common equine pathogens.
Diagnostic anaesthesia of the equine lower limb: a comparison of lidocaine and lidocaine with epinephrine.
Tijdschrift voor diergeneeskunde    October 6, 2004   Volume 129, Issue 17 548-551 
Spoormakers TJ, Donker SH, Ensink JM.The anaesthetic potency, onset of action, duration of action, and side effects of lidocaine and lidocaine plus epinephrine for proximal metacarpal block of the lateral and medial palmar nerves were determined. Ten horses were used and legs were injected using a cross-over model with three test solutions: 1) solvent and lidocaine (2%) plus epinephrine (SLE); 2) solvent and lidocaine (2%) without epinephrine (SL); and 3) solvent only (S). The contra-lateral leg was injected with saline (placebo; P). In both the SL and SLE groups, the onset of anaesthesia occurred between 5 and 15 minutes after i...
Hyaluronan in horses: physiological production rate, plasma and synovial fluid concentrations in control conditions and following sodium hyaluronate administration.
Equine veterinary journal    October 6, 2004   Volume 36, Issue 6 482-487 doi: 10.2746/0425164044877350
Popot MA, Bonnaire Y, Guéchot J, Toutain PL.Hyaluronic acid (HA) is an endogenous glycosaminoglycan used in the treatment of joint diseases, but medication control is required by horseracing authorities. Therefore, a medication control policy needs to be established. Objective: To establish physiological plasma HA concentrations in post race horses, determine the HA endogenous production rate and document the disposition of HA after i.v. and intra-articular hyaluronic acid administration at recommended therapeutic doses. Methods: Hyaluronan concentrations in plasma were determined using an ELISA specific test; concentrations in synovial...
Identification of some new clemastine metabolites in dog, horse, and human urine with liquid chromatography/tandem mass spectrometry.
Rapid communications in mass spectrometry : RCM    September 24, 2004   Volume 18, Issue 19 2267-2272 doi: 10.1002/rcm.1622
Tevell A, Bondesson U, Törneke K, Hedeland M.The metabolism of clemastine was studied in dogs, horses, and humans after a single dose of Tavegyl. The urine collected was extracted by solid-phase extraction or hydrolyzed with beta-glucuronidase and then extracted by liquid-liquid extraction, prior to analysis for unchanged drug and phase I and II metabolites by liquid chromatography/tandem mass spectrometry. The metabolites were identified by their molecular mass and interpretation of the product ion spectra, since no standard substances were available. Unchanged drug was recovered in urine samples from dogs and humans, but not from horse...
The detection of piroxicam, tenoxicam and their metabolites in equine urine by electrospray ionisation ion trap mass spectrometry.
Rapid communications in mass spectrometry : RCM    September 24, 2004   Volume 18, Issue 19 2338-2342 doi: 10.1002/rcm.1631
McKinney AR, Suann CJ, Stenhouse AM.An investigation has been conducted into the metabolism and urinary excretion of orally administered piroxicam and tenoxicam in the horse. The major component detected in urine after the administration of piroxicam was 5'-hydroxypiroxicam, which was detectable up to 24 h post-administration. Unchanged piroxicam was present only as a minor component. In contrast, unchanged tenoxicam was the major component observed after the administration of tenoxicam, being detectable for 72 h post-administration, while 5'-hydroxytenoxicam was a minor component. Phase II beta-glucuronide conjugation in each c...
Effect of omeprazole paste on intragastric pH in clinically normal neonatal foals.
American journal of veterinary research    September 1, 2004   Volume 65, Issue 8 1039-1041 doi: 10.2460/ajvr.2004.65.1039
Sanchez LC, Murray MJ, Merritt AM.To evaluate the efficacy of omeprazole paste, a commonly used antiulcer drug, on intragastric pH in clinically normal neonatal foals. Methods: 6 clinically normal foals between 5 and 14 days of age. Methods: Intragastric pH was recorded in each foal by use of a disposable antimony pH electrode with internal reference. Values for intragastric pH were recorded every 4 seconds by use of an ambulatory pH monitor. There were two 24-hour recordings of intragastric pH for each foal, with 24 hours between recordings. Foals were not administered any drugs during the first recording. Foals were administ...
Transdermal fentanyl combined with nonsteroidal anti-inflammatory drugs for analgesia in horses.
Journal of veterinary internal medicine    August 24, 2004   Volume 18, Issue 4 550-554 doi: 10.1892/0891-6640(2004)182.0.co;2
Thomasy SM, Slovis N, Maxwell LK, Kollias-Baker C.This study investigated the pharmcokinetics, efficacy, and safety of the fentanyl transdermal therapeutic system (TTS) in horses in which there was an inadequate analgesic response to nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Nine horses with pain that was refractory to therapeutic doses of phenylbutazone (n = 3) or flunixin meglumine (n = 6) subsequently also received between 39 and 110 microg/kg of transdermal fentanyl. Blood samples were collected at 0, 1, 2, 3, 4, 5, 6, 12, 24, 36, 48, 60, and 72 hours after patch application, and a radioimmunoassay was used to determine serum f...
Validated capillary electrophoretic method for the analysis of ivermectin in plasma after intragastric administration in pigs and horses.
Biomedical chromatography : BMC    July 6, 2004   Volume 18, Issue 5 302-310 doi: 10.1002/bmc.320
Kowalski P, Bieniecki M, Oledzka I, Lamparczyk H.A capillary electrophoretic (CE) method has been developed for the determination of ivermectin (CAS 70288-86-7), a new generation drug with antiparasitic activity, in pig and horse plasma. The method was statistically validated for its linearity, accuracy, precision and selectivity. The linear range was from 1 to 30 ng mL(-1) with correlation coefficients greater than 0.999. The limit of detection was 0.3 ng mL(-1), while the quantitative limit was 1 ng mL(-1), using a 0.5 mL sample size. The validated procedure was used to determination of pharmacokinetic parameters of ivermectin after ingest...
Kinetic studies and production rate of equine (e) FSH in ovariectomized pony mares. Application to the determination of a dosage regimen for eFSH in a superovulation treatment.
The Journal of endocrinology    July 1, 2004   Volume 182, Issue 1 43-54 doi: 10.1677/joe.0.1820043
Briant C, Toutain PL, Ottogalli M, Magallon T, Guillaume D.The appropriate dosage regimen for equine FSH (eFSH) (dose, dosing interval) administration in a superovulation treatment in pony mares was determined by a kinetic approach using production rates and kinetic parameters of elimination of the hormone. Two dosage regimens were then tested in superovulation protocols. The eFSH production rates were determined by sampling four ovariectomized pony mares every 10 min for 8 h during the breeding season. Kinetic parameters were determined by administering four dose levels of a preparation of eFSH (4.4, 8.8, 17.6 and 35.2 micro g/kg) by the i.v. route t...
Effects of flunixin meglumine or etodolac treatment on mucosal recovery of equine jejunum after ischemia.
American journal of veterinary research    June 17, 2004   Volume 65, Issue 6 761-769 doi: 10.2460/ajvr.2004.65.761
Tomlinson JE, Wilder BO, Young KM, Blikslager AT.To examine the effects of flunixin meglumine and etodolac treatment on recovery of ischemic-injured equine jejunal mucosa after 18 hours of reperfusion. Methods: 24 horses. Methods: Jejunum was exposed to 2 hours of ischemia during anesthesia. Horses received saline (0.9% NaCl) solution (12 mL, i.v., q 12 h), flunixin meglumine (1.1 mg/kg, i.v., q 12 h), or etodolac (23 mg/kg, i.v., q 12 h). Tissue specimens were obtained from ischemic-injured and nonischemic jejunum immediately after ischemia and 18 hours after recovery from ischemia. Transepithelial electric resistance (TER) and transepithel...
Detection of enrofloxacin and its metabolite ciprofloxacin in equine hair.
Research in veterinary science    June 16, 2004   Volume 77, Issue 2 143-151 doi: 10.1016/j.rvsc.2004.03.004
Dunnett M, Richardson DW, Lees P.Hair analysis to detect drug administration has not been studied extensively in horses. This study aimed to (a) develop an analytical method for enrofloxacin and its metabolite ciprofloxacin in mane and tail hair, (b) relate measured values to doses, routes of administration, hair colour, and (c) demonstrate long-term detectability. Samples were extracted in trifluoroacetic acid at 70 degrees C. Extracts were cleaned-up by solid-phase extraction and analysed by high-performance liquid chromatography with UV-diode array detection. Analyte recoveries were > 87%. Horses were sampled after therape...
Detection and confirmation of ractopamine and its metabolites in horse urine after Paylean administration.
Journal of analytical toxicology    June 11, 2004   Volume 28, Issue 4 226-238 doi: 10.1093/jat/28.4.226
Lehner AF, Hughes CG, Harkins JD, Nickerson C, Mollett B, Dirikolu L, Bosken J, Camargo F, Boyles J, Troppmann A, Karpiesiuk WW, Woods WE, Tobin T.We have investigated the detection, confirmation, and metabolism of the beta-adrenergic agonist ractopamine administered as Paylean to the horse. A Testing Components Corporation enzyme-linked imunosorbent assay (ELISA) kit for ractopamine displayed linear response between 1.0 and 100 ng/mL with an I-50 of 10 ng/mL and an effective screening limit of detection of 50 ng/mL. The kit was readily able to detect ractopamine equivalents in unhydrolyzed urine up to 24 h following a 300-mg oral dose. Gas chromatography-mass spectrometry (GC-MS) confirmation comprised glucuronidase treatment, solid-pha...
Phenytoin sodium as a treatment for ventricular dysrhythmia in horses.
Journal of veterinary internal medicine    June 11, 2004   Volume 18, Issue 3 350-353 doi: 10.1892/0891-6640(2004)18<350:psaatf>2.0.co;2
Wijnberg ID, Ververs FF.Five adult horses with ventricular extra systoles (VES) and 2 with ventricular tachycardia (VT) refractory to treatment with rest, anti-inflammatory drugs, lidocaine, or procainamide were treated with phenytoin sodium p.o. q12h. The starting dosage of phenytoin was 20 or 22 mg/kg body weight (BW) q12h, and the maintenance dosage varied from 8 to 17 mg/kg BW q12h. The mean +/- standard deviation therapeutic blood concentration of total phenytoin was 8.8 +/- 2.1 mg/L, and the mean concentration of free phenytoin of 2.5 +/- 0.5 mg/L was relatively constant at a range of 24 to 29% of the total phe...
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