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Unpredictability of Plasma Concentrations

Dennis R. Sawyer, PharmD; Thomas M. Ludden, PhD; Michael H. Crawford, MD

Arch Intern Med. 1981;141(1):43-45.

Abstract
Recent studies suggest that lidocaine hydrochloride continues to accumulate during prolonged infusions. Plasma levels of lidocaine and monoethylglycinexylidide (MEGX) were measured in 26 patients with cardiac arrhythmias during lidocaine infusions of 15 to 69 hours' duration. Clearance varied, ranging from 3.2 to 14.7 mL/min/kg, and was significantly less in the ten patients with heart failure (5.8 ±1.7 mL/min/kg) as compared with the remaining 16 (8.4 ± 2.6 mL/min/kg; P <.05). The MEGX levels were <1 µ/mL. In four patients, steady states were achieved at two different infusion rates, and changes in lidocaine plasma levels were generally proportional to changes in infusion rates. Lidocaine elimination half-lives ranged from 3.2 to 8.7 hours, and no accumulation continued beyond four half-lives. Clearance values, elimination half-lives, apparent volumes of distribution, and, consequently, steady-state levels were widely variable, which can be partly explained by the inclusion of patients with congestive heart failure. Monitoring of serum lidocaine levels may aid in individualization of therapy.

(Arch Intern Med 141:43-45, 1981)

Author Affiliations
From the Veterans Administration Hospital (Drs Sawyer, Ludden, and Crawford), and the Divisions of Clinical Pharmacology (Dr Ludden) and Cardiology (Dr Crawford), Department of Medicine, University of Texas Health Science Center, San Antonio; and the College of Pharmacy, University of Texas, Austin (Drs Sawyer and Ludden).

Footnotes
Accepted for publication Feb 20, 1980.

Reprint requests to Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284 (Dr Crawford).

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