Bioavailability of sotalol in patients with short bowel syndrome

Background: The individual bioavailability of eternally administered drugs is usually uncertain in case of reduced bowel length. Routine measurements of plasma concentrations are available only for a small number of drugs. Th e daily dose recommended by the manufacturers may result in subtherapeutic plasma concentrations when given to such patients. Case Report: In 2 patients with hemodynamically relevant atrial fibrillatio n and reduced gut length application of increasing sotalol doses was initia ted. For the assessment of the individual bioavailability plasma concentrat ions were measured via HPLC immediately before and 2 hours after enteral ap plication of sotalol. Judging by clinical criteria both patients were treat ed successfully. Even in the patient with severe short bowel syndrome (stom ach, duodenum and 50 cm jejunal remnant) doubling of the daily dose led to a substantial increase in plasma concentrations. Conclusion: Effective enteral medication with sotalol in patients with shor t residual bowel is possible. Normal plasma concentrations can be achieved by administering doses according to the manufacturers' instructions. In cas e of severe short bowel syndrome, the measurements of plasma concentrations may be beneficial in supervising dose-adjustment.