J Clin Pharmacol
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CLINICAL STUDIES

Clearance of Imidapril, an Angiotensin-Converting Enzyme Inhibitor, During Hemodialysis in Hypertensive Renal Failure Patients: Comparison With Quinapril and Enalapril

Shuichi Tsuruoka, MD, Yasuhiko Kitoh, PhD, Atsuhiro Kawaguchi, PhD, Koh-ichi Sugimoto, MD, Tokie Hayasaka, RN, Tetsuo Saito, MD and Akio Fujimura, MD

From the Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical School, Tochigi, Japan (Dr Tsuruoka, Dr Kitoh, Dr Kawaguchi, Dr Sugimoto, Dr Fujimura), and Mo-ka Hospital, Tochigi, Japan (Ms Hayasaka, Dr Saito).

The dialyzability of imidaprilat, an active metabolite of the angiotensin-converting enzyme (ACE) inhibitor imidapril, was determined and compared with those of enalaprilat and quinaprilat in hypertensive patients on chronic hemodialysis. Imidapril (5 mg/d, n = 6), enalapril (2.5 mg/d, n = 6), or quinapril (2.5 mg/d, n = 6) was given for at least 8 weeks prior to the trial. During dialysis, enalaprilat, but not imidaprilat or quinaprilat, concentrations in both sides decreased significantly. Compared to enalaprilat, the dialyzabilities of imidaprilat and quinaprilat were significantly lower (dialyzer clearance [mL/min/m2]: enalaprilat, 41.8 ± 7.4; imidaprilat, 19.0 ± 7.8; quinaprilat, 8.9 ± 1.3). The dialyzabilities of the 3 drugs were negatively correlated with their respective protein-binding rates. During hemodialysis, blood pressure did not change significantly in any group. These results suggest that imidapril provides good blood pressure control without a large fluctuation of drug concentration in hypertensive patients undergoing chronic hemodialysis.

Key Words: Dialyzability • enalapril • hemodialysis • imidapril • quinapril

Address for reprints: Address for correspondence: Shuichi Tsuruoka, MD, Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical School, 3311 Yakushiji, Minamikawachi, Tochigi 329-0498, Japan; e-mail: tsuru{at}jichi.ac.jp.


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