Appropriate dosing of pilsicainide hydrochloride in patients on hemodialysis

Appropriate dosing of pilsicainide hydrochloride, an anti-arrhythmic drug e xcreted via the kidney, was investigated in patients on dialysis. Ten chron ic hemodialysis patients with coexisting severe palpitation of supraventric ular premature contractions (SVPC) were treated with 25 mg of pilsicainide hydrochloride before dialysis. All of their plasma concentrations were main tained within the therapeutic range and their mean dialysis rate was 32%. A fter 2 weeks, 7 patients were followed with consecutive daily dose treatmen t. In 3 of them, the dosage was returned to the single pre-dialysis adminis tration because of the elevated plasma concentration reaching the toxic ran ge 1 month after the start of administration. The dose schedule was maintai ned, and plasma pilsicainide concentrations remained within the therapeutic range during the 6-month follow-up, No abnormal findings were found in any parameters of electrocardiography, echocardiography or biochemistry. The n umber of SVPC diminished > 90% compared to the pretreatment level. Copyrigh t (C) 2001 S. Karger AG, Basel.