Clinical pharmacokinetics of drugs in cardiopulmonary associated cachexia without hepatorenal pathology: a systematic review

Abstract

Cachexia not only has a dramatically harmful impact on a patient’s life, but also a poor response

to therapeutic agents. The purpose of the present review is to provide updated information con- cerning the pharmacokinetic aspects of drugs used to treat cardiopulmonary cachexia in patients

with no signs of hepatic or renal pathology. A systematic search of PubMed, the Cochrane Central Register of Control Trials, Science Direct, and Clinical Trials Registry (ClinicalTrials.gov), encompassing the period between 2000 and 2017, was conducted in accordance to PRISMA

guidelines. Seven studies were identified. Collectively, these studies included a total of 196 indi- viduals (19 healthy subjects and 177 diseased patients). This data review found no differences in

bisoprolol and prothionamide absorption in cachectic patients with chronic heart failure and tuberculosis, but higher absorption of oflaxocin in the same set of patients was observed. The

distribution of bisoprolol, prothionmaide, ceftazidime, and cefipirome was reduced in cardiopul- monary cachexia patients. Hepatic clearance of rifampin was equivalent in cachectic and non- cachectic patients that had normal hepatic function. Similarly in cardiopulmonary cachexia

patients, renal clearance of ceftazidime was reduced by 19% but no significant differences in bisoprolol and protionamide clearance were observed. In the case of cefpirome, both renal clearance and creatinine clearance were higher in cachectic patients with cystic fibrosis. From the limited evidence available, the main drug pharmacokinetic changes seen in cardiopulmonary cachexia patients were a reduction in the volume of distribution and impairment of clearance.