Ioglycamide (Biligram) studies in man—plasma binding, renal and biliary excretion studies in jaundiced and anicteric patients

Abstract

When 5 patients with varying degrees of hepatic impairment and a T-tube in situ were given i.v. ioglycamide at a rate of 2 mg/kg per min for 2 h the mean biliary excretion in the first 2 h was only 3.2% of the administered dose. In contrast, in 5 T-tube patients with relatively normal liver function the mean biliary excretion over the same time interval was 20.6%. The mean plasma concentration of ioglycamide achieved at the end of a 2-h i.v. infusion at 2 mg/kg per min was 1427 .+-. 187 .mu.g/ml in 6 anicteric patients and 1262 .+-. 82 in 6 jaundiced patients. Despite these very similar plasma levels the 24-h urinary excretion of ioglycamide was 42.3 .+-. 3.8% of the administered dose in the patients with jaundice compared with only 18.1 .+-. 2.4% in the anicteric group. These differences probably reflect the fact that the percentage of unbound contrast agent in the plasma of the jaundiced group (11.9 .+-. 1.9%) was significantly higher than that of the anicteric group (6.4 .+-. 0.9%). Bilirubin and possibly other substances in the plasma are competing with ioglycamide for binding sites on albumin. These factors need to be considered when performing i.v. cholangiograms on jaundiced patients.