A. KINETIC PARAMETERS
Bioavailability (F):
Protein Binding:
Volume of
Distribution (Vd):
HALF-LIFE
VOLUME OF
DISTRIBUTION
Adult, normal
renal function
COMMENT
4.5 L/kg
V=
226 +
298 CrCl
( Wt / 70)
where V is digoxin
volume of distribution in
L/70 kg, Wt is body
weight in kg (use ideal
body weight if >30%
overweight) and CrCl is
creatinine clearance
in mL/min.
Moderate/severe
heart failure
See comments
7 L/kg
7 L/kg IBW
Hyperthyroidism
with normal renal
function
24 hours or 1 day
7 L/kg
Farmakodinamik/Farmakokinetik :
Ekskresi : urin (50% hingga 70% dalam bentuk obat yang tidak berubah )
Konsentrasi serum digoksin :
Gagal jantung kongestif : 0,5 -0,8 ng/ml .Aritmia : 0,8-2 ng/ml
Dewasa : < 0,5 ng/ml, kemungkinan menunjukkan underdigitalization, kecuali jika
terdapat hal-hal khusus
Toksik > 2,5 ng/ml\
Bentuk sediaan tablet, eliksir, kapsul cair, dan injeksi.
TOBRAMISIN
Farmakodinamika
Tobramisin tidak jauh berbeda sifatnya dengan gentamisin, termasuk spektrum
antimikrobanya. Karena itu, tobramisin digunakan sebagai pengganti gentamisin.
Aktivitas tobramisin yang superior terhadap P. aeruginosa dibanding gentamisin
menyebabkan obat ini terpilih untuk mengatasi infeksi oleh kuman tersebut. Obat ini
tidak memperlihatkan sinergisme dengan penisilin terhadap enterokok dan inaktif
terhadap mycobacterium. Dibandingkan terhadap gentamisin, terdapat petunjuk bahwa
tobramisin bersifat kurang nefrotoksik, tetapi hal ini belum terbukti secara klinis.
Farmakokinetika
The aminoglycosides are eliminated almost completely (90%) unchanged in the urine
primarily by glomerular ltration (Table 4-1).
These antibiotics are usually given by short-term (1/21 hour) intermittent intravenous
infusions, although they can be given intramuscularly. When aminoglycosides are given
intramuscularly they exhibit very good bioavailability of ~100% and are rapidly absorbed
with maximal concentrations occurring about 1 hour after injection. Exceptions to this
situation are patients who are hypotensive or obese.
Nonobese adults with normal renal function (creatinine clearance >80 mL/min, Table 41) have an average aminoglycoside half-life of 2 hours (range: 1.53 hours), and the
average amino- glycoside volume of distribution is 0.26 L/kg (range: 0.20.3 L/kg) in
this population.
DISEASE STATE/
CONDITION
HALF-LIFE
VOLUME OF
DISTRIBUTION
COMMENT
2 hours (range:
1.53 hours)
50 hours (range:
3672 hours)
0.26 L/kg
Burns
1.5 hours
0.26 L/kg
Penicillin therapy
(patients with
creatinine clearance
<30 mL/min)
Variable
0.26 L/kg
23 hours
V (in L) =
Cystic brosis
1.5 hours
0.35 L/kg
Acites/overhydration
Variable
V (in L) =
(0.26
+
(TBW DBW)
DBW)
Aminoglycosides distribute to
excess extracellular uid;
correction equation assumes that
weight gain is due to uid accumulation. Alterations in volume of
distribution can cause secondary
changes in half-life.
0.26
[IBW
+ 0.4
(TBW
IBW)]
Bentuk sediaan Obat ini tersedia sebagai larutan 80 mg/2 ml untu suntikan IM. Untuk
infus Tobramisin dilarutkan dalam Dekstrose 5% atau larutan NaCl isotonis dan diberikan
dalam 30-60 menit. Jangan diberikan lebih dari 10 hari.