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Methylprednisolone Disposition Kinetics in Patients with Acute Spinal Cord Injury
Author(s) -
Segal Jack L.,
Maltby Brian F.,
Langdorf Mark I.,
Jacobson Ray,
Brunnemann Sherry R.,
Jusko William J.
Publication year - 1998
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1998.tb03821.x
Subject(s) - medicine , methylprednisolone , spinal cord injury , anesthesia , spinal cord , bolus (digestion) , pharmacokinetics , volume of distribution , psychiatry
Study Objective . To evaluate the pharmacokinetics of high‐dose methylprednisolone in patients with acute spinal cord injury (ASCI). Design . Open‐label study of consecutive patients with ASCI, and retrospective review of able‐bodied controls. Setting . Emergency Medicine Department of a large, urban, university‐affiliated, tertiary care trauma center. Patients . Eleven men with ASCI. Interventions . Methylprednisolone sodium succinate 30 mg/kg intravenous bolus, followed by 5.4 mg/kg/hour for 23 hours, administered according to the second National Acute Spinal Cord Injury Study (NASCIS 2) protocol. Measurements and Main Results . The total systemic clearance of methylprednisolone was significantly less in acutely injured patients (mean ± SD 30.04 ± 12.03 L/hr) than in historically reported able‐bodied controls (44.70 ± 4.90 L/hr). An inverse correlation between the neurologic level of injury and systemic clearance was seen. No differences in volume of distribution were discernible between patients (126.90 L) and controls (135.45 L). Conclusion . Patients with acute spinal cord injury administered methylprednisolone according to the NASCIS 2 protocol had an apparent decrease in total systemic clearance of the drug without a commensurate change in volume of distribution. Additional studies are warranted to confirm these findings and assess the potential impact of diminished clearance on the efficacy of the agent in ASCI.