Effects of propranolol on the disposition and negative dromotropic activity of diltiazem in the dog during multiple dosing.

The effects of propranolol coadministration on the disposition and negative dromotropic action of intravenous and oral diltiazem were studied in six dogs after 3 days pretreatment with diltiazem alone (2.5 mg/kg, every 8 hr) and with coadministration of oral propranolol (5 mg/kg, every 8 hr). Diltiazem and two of its metabolites, desacetyldiltiazem and demethyldiltiazem, were measured by HPLC. Propranolol coadministration had no significant effects on either the systemic clearance, the apparent volume of distribution, elimination half-life, or the blood binding of diltiazem. On the other hand, the oral clearance of diltiazem was significantly reduced by 51%, and its oral bioavailability was significantly increased by 48% during propranolol coadministration. The area under the plasma demethyldiltiazem concentration-time curve after oral diltiazem increased significantly during propranolol coadministration. This increase was in proportion to the increase in the plasma diltiazem area under the concentration-time curve, such that the ratio of the areas of demethyldiltiazem to that of diltiazem remained the same between control and propranolol coadministration. Propranolol coadministration increased the area under the negative dromotropic activity-time curve after both intravenous and oral diltiazem by 37 and 48%, respectively. Using a log-linear pharmacodynamic model to analyze the data, there were no significant effects on either the slope, y-intercept, or the estimated diltiazem concentration needed to increase the PR interval by 20% of either intravenous or oral diltiazem with propranolol coadministration. These data suggest that propranolol coadministration can result in an increase in the pharmacological activity of diltiazem due to a kinetic drug interaction by increasing its oral bioavailability.