Can hypothermia affect drug metabolism to a degree that's clinically relevant? Glomerular filtration rate (GFR) is reduced in rats due to prerenal vasoconstriction leading to potentially decreased drug clearance. Could enzymes like cytochrome p450 be reduced in their action as well?

摘要

Multiple preclinical and clinical trials have begun to elucidate the mechanisms by which drugs are metabolized during targeted temperature management (TTM) after cardiac arrest (CA). All investigators agree that, for this vulnerable population, a more thorough understanding of the pharmacokmetics of critical care medications is essential to prevent adverse effects and to devise algorithms for safe drug dosing in this population. Hypothermic patients often exhibit elevated drug levels and prolonged response to medications that often have narrow therapeutic indices. Phenytoin, vecuronium, propofol, opioids, calcium channel blockers, and benzodiazepenes are examples of such drugs (Tortorici et al, 2007; Zhou et al, 2011).