2 research outputs found
Albumin dialysis : a new therapeutic strategy for intoxication from protein-bound drugs
Abstract Objective: Although water-soluble drugs can be removed by
haemofiltration/haemodialysis, morbidity and mortality from intoxication
with protein-bound drugs remains
high. The present study investigates
whether albumin dialysis in the form
of the Molecular Adsorbents Recirculating System (MARS) is effective
in removal of protein-bound drugs.
Design: Prospective animal study.
Setting: Surgical research laboratory
in a university hospital. Subjects:
Seven female Norwegian Landrace
pigs. Intervention: We studied
whether midazolam (97% albuminbound) and fentanyl (85% alpha-1-
acid glycoprotein-bound), administered as anaesthetics to pigs with
induced acute liver failure, could be
removed by MARS dialysis lasting
for 4 h. Measurements: After 4 h of
dialysis, total and free anaesthetic
concentrations were measured in the
blood and dialysate from different
segments of the MARS circuit. Main
results: Midazolam: total plasma
concentrations fell by 47.1€2.1% (in
4 h) across the MARS filter (p<0.01).
The charcoal component of the system reduced the total dialysate drug
concentration by 16.4€2.2%
(p<0.05). Free midazolam removal
followed a similar pattern. Fentanyl:
total plasma concentrations fell by
56.1€2.4% (in 4 h) across the MARS
filter (p<0.01). Clearance of fentanyl
from the dialysate by the charcoal
was 70€0.7% at 4 h (p<0.001).
Conclusions: The results of the study
show that MARS can remove both
albumin and other protein-bound
drugs efficiently from the plasma,
and it may have a place for the
treatment of patients suffering from
intoxication with this class of compounds