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(Circulation. 1998;98:2702-2708.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Modulation by Dietary Salt of Verapamil Disposition in Humans

Dawood Darbar, MD; Martin F. Fromm, MD; Simonetta Dell'Orto, MD; Richard B. Kim, MD; Heyo K. Kroemer, PhD; Michel Eichelbaum, MD; Dan M. Roden, MD

From the Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn (D.D., M.F.F., S.D., R.B.K., D.M.R.); the Dr Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart, Germany (M.F.F., H.K.K., M.E.); and the Abteilung für Klinische Pharmakologie, Eberhard-Karls-Universität, Tübingen, Germany (M.E.). Dr Kroemer is now Chair of the Department of Pharmacology, University of Greifswald, Germany.

Correspondence to Dan M. Roden, MD, Director, Division of Clinical Pharmacology, 532 Medical Research Building-I, Vanderbilt University School of Medicine, Nashville, TN 37232-6602. E-mail dan.roden{at}mcmail.vanderbilt.edu

Background—The intestine is an increasingly well-recognized site of first-pass drug metabolism. In this study, we determined the influence of dietary salt on the steady-state disposition of verapamil, a drug that undergoes extensive first-pass metabolism.

Methods and Results—Eight normal volunteers received 120 mg of racemic verapamil orally twice a day for 21 days. The disposition kinetics of verapamil enantiomers were determined after coadministration of intravenous deuterated verapamil with the morning oral dose on days 7, 14, and 21. Each study day was preceded by 7 days on a fixed-salt diet: in 5 subjects, the initial study was conducted during a low-salt (10 mEq/d) diet, the second study during a high-salt (400 mEq/d) diet, and the third during a low-salt diet, whereas in the other 3 subjects, the sequence of diets was reversed. Plasma concentrations of both unlabeled enantiomers (ie, from oral therapy) were significantly (P<0.05) lower during the high-salt phase (eg, mean area under the time-concentration curve [0 to 12 hours] for S-verapamil: 7765±2591 ng · min · mL^-1 [high salt] versus 12 514±3527 ng · min · mL^-1 [low salt], P<0.05). Peak plasma concentrations were significantly lower and the extent of PR interval prolongation significantly blunted with the high-salt diet. In contrast, data with labeled drug (ie, reflecting the intravenous route) were nearly identical for the 2 diets.

Conclusions—These data indicate that a clinically important component of presystemic drug disposition occurs at the prehepatic (presumably intestinal) level and is sensitive to dietary salt.

Key Words: diet • metabolism • sodium • stereoisomers

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