Pharmaceutical Care with Pilsicainide Based on Renal Function Tests and Electrocardiograms

It has been reported that pilsicainide is effective for the treatment of paroxysmal atrial fibrillation (PAf).As pilsicainide is excreted from the kidneys,however,it is important to devise dosage regimens in consideration of individual patients’renal function.At Chugoku Rosai Hospital we monitor plasma concentrations of pilsicainide as well as its effectiveness,and reflect the findings in treatment.We first adjusted the dosage of pilsicainide based on the creatinine clearance (Ccr) and then monitored plasma concentrations and the effectiveness of the drug.We found that in many patients,as the state of their disease changed,there was a change in Ccr which resulted in increased in plasma concentrations of pilsicainide.Thinking that more detailed dosage regimens were thus required,we calculated a linear regression equation based on Ccr and pilsicainide clearance,and prepared a table of estimated plasma concentrations from the equation.With reference to this table,we devised dosage regimens for pilsicainide and compared plasma concentrations of the drug with the effect as shown by electrocardiograms,and discussed the results with physicians.This system has made it possible to provide more useful drug management.