Mexiletin bei terminaler Niereninsuffizienz und verschiedenen Dialyseverfahren

Summary

We monitored the plasma levels of mexiletine in 20 dialysis patients with severe cardiac arrhythmias after repeated oral administration and the elimination by various dialysis procedures. The levels of mexiletine in plasma and dialysate were assayed by high-pressure liquid chromatography. After repeated administration of mexiletine 400–600 mg/day trough levels were in the range from 500–2,000 ng/ml. Treatment controlled by Holter monitoring was effective in 13/20 patients. Doses of 600 mg/day and more often were not tolerated by patients with dialysis after some weeks. There was no important removal of mexiletine from plasma during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis. In conclusion, we recommend a slightly reduced dosage of 400–600 mg mexiletine/day (usually 600–800 mg) for patients with end-stage renal insufficiency, irrespective of dialysis.