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Mutual Suppression of the Uricosuric Effects of Sulfinpyrazone and Salicylate: a Study in Interactions Between Drugs

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Mutual Suppression of the Uricosuric Effects of Sulfinpyrazone and Salicylate: a Study in Interactions Between Drugs MUTUAL SUPPRESSION OF THE URICOSURIC EFFECTS OF SULFINPYRAZONE AND SALICYLATE: A STUDY IN INTERACTIONS BETWEEN DRUGS T. F. Yü, … , P. G. Dayton, A. B. Gutman J Clin Invest. 1963;42(8):1330-1339. https://doi.org/10.1172/JCI104817. Research Article Find the latest version: https://jci.me/104817/pdf Journal of Clinical Investigation Vol. 42, No. 8, 1963 MUTUAL SUPPRESSION OF THE URICOSURIC EFFECTS OF SULFINPYRAZONE AND SALICYLATE: A STUDY IN INTERACTIONS BETWEEN DRUGS * By T. F. YU, P. G. DAYTON, AND A. B. GUTMAN (From the Department of Medicine, The Mount Sinai Hospital, and the New York University Research Service, Goldwater Memorial Hospital, New York, N. Y.) (Submitted for publication March 1, 1963; accepted May 2, 1963) A striking example of antagonistic drug effects concentrations were measured over three or four 10- (2) is afforded by the observation that in man minute collection periods. With the sustaining sulfinpyra- salicylate, itself uricosuric in zone infusion continued at the same rate, sodium salicylate high dose, inhibits was then infused concurrently, 3 g to prime and 10 to 20 the pronounced uricosuria produced by probenecid mg per minute to sustain. The collection periods were (3, 4), sulfinpyrazone1 (5-9), and zoxazolamine continued for about 1 hour. Two of the five men (NG (9-11). This suppressive action of salicylate has and ER) received sodium bicarbonate together with the been assumed to be due to its successful compe- salicylate to allow study of the effect of alkalinization of the urine. tition with these drugs, and with uric acid, for Three companion experiments in men followed the same renal tubular transport; one aspect of this procedure except for reversal of the order of infusion: competition is expressed as inhibition of tubular sodium salicylate was given first, and then sulfinpyrazone, secretion of uric acid by small (and large) doses of both in the same dosages as before. For analysis in salicylate, which partially counterbalances the in- greater detail of the effect of salicylate upon the plasma concentrations of sulfinpyrazone (P8pz), a ninth man was hibition of tubular reabsorption of uric acid pro- given 800 mg iv sulfinpyrazone first, then 3 g of sodium duced by uricosuric agents (12). The present salicylate 1 hour later, and blood samples were taken study provides experimental support for the oper- every 30 minutes. ation of these mechanisms, but indicates that the Parallel studies were made in dogs, each receiving interactions at least of salicylate and sulfinpyra- throughout a urate infusion at the rate of 5 to 10 mg per minute. In four mongrel and two Dalmatian dogs, zone are even more complex, involving competi- sulfinpyrazone was infused first, 300 mg to prime and tion also for binding sites on transporting plasma 1.6 mg per minute to sustain, and then sodium salicylate, proteins, and possibly elsewhere. The conse- 1 g to prime and 10 to 20 mg per minute to sustain. quences of the interplay of competition at these Two mongrels and three Dalmatians received the same various sites are described in man, and also in the infusions in reverse order. For investigation of any para- doxical effect of salicylate on uric acid excretion in the dog, in which mutual suppression of the urico- dog, two mongrels and two Dalmatians were given sodium suric effects of sulfinpyrazone and salicylate, so ap- salicylate infusions at a slowly increasing rate, as pre- parent in man, could not be demonstrated. viously described in man (12). For study in greater detail of the effect of salicylate on Pspz in the dog, a METHODS mongrel was given 500 mg iv sulfinpyrazone and 1 hour later, 2 g iv sodium salicylate. The standard renal clearance techniques previously em- The glomerular filtration rate (GFR) was measured ployed (13, 14) were used. The studies in man were all in man as the clearance of inulin (Ci.) determined by made in gouty males. In six experiments (in five men), a resorcinol method (15), and in the dog as the exogenous after three or four 15-minute control periods, sulfinpyra- creatinine clearance (Ccr), determination of creatinine, by zone was infused, 300 mg to prime and 10 mg per minute the method of Bonsnes and Taussky (16). Uric acid to sustain. After 30 to 40 minutes for equilibration, the was estimated by differential spectrophotometry (17), and ensuing plasma and urinary sulfinpyrazone and uric acid plasma and urinary salicylate by the method of Brodie, Udenfriend, and Coburn (18). Plasma and urinary *This work was supported in part by U. S. Public sulfinpyrazone was estimated by the method of Burns Health Service grants (A-162 and A-4724) and by the and associates (5), with the following modifications. Health Research Council of the City of New York under After extraction of the drug into ethylene dichloride, the contract U-1089. Preliminary results have been reported organic phase was washed once with an equal volume of in abstract (1). 0.1 M citrate-0.2 M disodium phosphate buffer at pH 11,2-Diphenyl-4- (2-phenylsulfinylethyl) -3,5-pyrazolid ne- 4.8, and then with 5 ml of buffer. This removes inter- dione. fering substances, including salicylate and its oxidation 1330 SULFINPYRAZONE-SALICYLATE INTERACTIONS 1331 TABLE I Interactions of sulfinpyrazone (SPZ) and salicylate (SAL) in man* Urate Sulfinpyrazone Salicylate Urine Sub- ject Period Infusion Cin P UV C Cur/Cin Pt.tai Pfret F UV Ptotai Pflrw F UV pH V min ml/min mg/ mg/ ml/ % mg/1OO ml mg/min mg/1OO ml mg/min ml/min 100 ml min min GH 0 171 10.0 1.27 12.7 7.4 6.3 4.5 30-60 SPZ 167 9.4 6.60 70.0 42.0 3.7 0.08 0.13 1.08 6.5 6.6 70-140 SAL 158 9.4 1.26 13.4 8.5 2.1 0.15 0.23 1.05 16.9 5.1 8.0 1.07 6.5 8.8 MK 0 142 11.6 1.91 16.5 11.6 6.2 14.6 40-71 SPZ 111 9.4 6.12 65.2 58.7 4.9 0.10 0.11 0.26 6.4 11.1 103-149 SAL 111 9.3 1.24 13.3 12.0 2.9 0.20 0.22 0.51 22.5 6.8 7.5 0.37 6.4 14.3 FA 0 63 9.9 0.63 6.4 10.2 3.0 32-72 SPZ 63 9.5 3.66 38.5 61.0 4.1 0.08 0.05 0.69 6.8 141-197 SAL 63 9.1 1.60 17.6 28.0 3.1 0.22 0.14 0.66 21.0 7.0 4.4 0.28 6.1 0 66 10.3 0.73 7.1 10.8 7.1 4.0 30-62 SPZ 66 10.0 3.48 34.8 52.7 7.4 5.2 75-135 SAL 70 9.4 2.04 21.7 31.0 22.3 7.4 5.2 0.58 7.3 7.4 ER 0 154 9.4 0.72 7.7 5.0 7.0 12.3 30-92 SPZ 153 9.0 5.26 58.5 38.2 2.9 0.06 0.10 1.18 7.1 11.1 105-175 SAL+ 151 8.2 1.27 15.5 10.3 0.9 0.06 0.10 0.77 21.8 6.5 9.8 2.88 7.4 12.8 175-223 NaHCO 153 8.5 1.33 15.7 10.3 0.9 0.06 0.10 0.80 21.4 6.4 9.8 3.93 7.6 13.8 NG 0 93 10.0 0.54 5.4 5.8 5.8 9.0 37-103 SPZ 86 9.0 4.62 51.4 60.0 5.8 9.3 146-193 SAL + 93 8.0 1.52 19.0 20.4 18.3 5.5 5.1 1.28 7.0 14.7 NaHCO3 JJ 0 130 10.9 1.16 10.6 8.2 6.0 3.1 23-63 SAL 126 10.9 2.72 25.0 20.0 16.1 4.8 6.1 2.36 6.8 9.6 88-128 SPZ 129 10.9 1.31 12.0 9.3 2.9 0.20 0.26 1.35 16.4 4.9 6.4 0.61 6.4 15.4 LW 0 92 8.4 0.33 3.9 4.2 6.9 22-67 SAL 119 8.5 2.10 24.6 20.8 18.3 5.5 6.6 1.41 8.8 102-142 SPZ 96 8.0 0.50 6.3 6.5 2.3 0.16 0.16 0.65 20.8 6.3 6.1 0.44 10.5 IB 0 124 10.6 0.42 4.0 3.2 5.4 4.7 23-61 SAL 125 9.2 3.32 36.1 28.9 18.6 5.6 7.0 2.95 6.2 15.3 93-113 SPZ 122 9.7 1.71 17.9 14.7 2.2 0.15 0.18 1.11 19.1 5.7 7.1 0.63 6.1 14.9 113-133 SPZ 124 9.7 0.97 10.0 8.3 1.9 . 0.13 0.16 0.99 19.1 5.7 7.1 0.45 6.2 7.5 * C = clearance (of inulin or urate). P = plasma concentration, UV = urinary excretion rate, and F = filtered load, or Pfr.
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