Pharmacokinetic modeling and simulation of procainamide and n-acetylprocainamide in a patient receiving continuous renal replacement therapy: A novel approach to guide renal dose adjustments

摘要

To the Editor: Procainamide and its major metabolite, N-acetylprocainamide (NAPA), prolong the QTc interval and can promote torsades de pointes, particularly at high concentrations (>30 mg/L combined procainamide/NAPA). Excretion of procainamide and NAPA is reduced in patients with CKD; their elimination in patients undergoing continuous renal replacement therapy (CRRT) has not been evaluated. Therefore, appropriate dose adjustments in this population are unknown. This report describes the pharmacokinetics (PK) of procainamide and NAPA in a CKD stage 5 patient undergoing CRRT. PK simulations of drug exposure following several dosing regimens were performed to help guide dosing in patients undergoing CRRT.