From the Guidelines
Propranolol's renal clearance is approximately 3-5% of its total clearance, with a clearance rate of around 188-191 mL/min during hemoperfusion (HP) and 3-26.5 mL/min during hemodialysis (HD), as reported in the most recent study 1.
Key Points:
- Propranolol undergoes extensive hepatic metabolism, with only a small fraction eliminated unchanged through the kidneys.
- The majority of propranolol (about 90%) is metabolized by the cytochrome P450 system, primarily through CYP2D6 and CYP1A2 enzymes.
- Propranolol's lipophilic properties allow it to cross the blood-brain barrier and contribute to its extensive tissue distribution, affecting its clearance profile.
- The drug's half-life ranges from 3-6 hours, reflecting its metabolism pattern, though extended-release formulations have longer effective durations of action.
- In patients with severe renal dysfunction, there may be accumulation of active metabolites, so some caution is warranted when using propranolol.
Clearance Rates:
- Hemoperfusion (HP): 188-191 mL/min
- Hemodialysis (HD): 3-26.5 mL/min
Important Considerations:
- Propranolol dosage typically doesn't need significant adjustment in patients with mild to moderate renal impairment.
- However, in severe renal dysfunction, careful monitoring and potential dosage adjustments may be necessary to avoid accumulation of active metabolites.
From the Research
Propranolol Renal Clearance
- The renal clearance of propranolol is not directly stated in the provided studies, but it is mentioned that the renal clearance of total radioactive compounds is directly related to renal function 2.
- A study on propranolol disposition in renal failure found that the half-life of propranolol was significantly shortened in patients with renal failure, but there was no change in the apparent liver blood flow, extraction ratio, or the principal determinants of steady-state drug concentrations in blood, including oral and intravenous clearance from blood 3.
- Another study compared the pharmacokinetic profiles of different beta-adrenoceptor-blocking agents, including propranolol, and found that propranolol has a low bioavailability due to extensive first-pass metabolism, which can lead to large biologic variations and nonlinearities 4.
- The effects of propranolol on renal blood flow and renal function were studied in patients with cirrhosis, and it was found that propranolol did not alter renal function in these patients 5.
- A study on beta blockers and renal function found that the chronic use of propranolol is characterized by 10%-20% decrements of renal plasma flow and glomerular filtration rate, but the clinical implications of these changes are unknown 6.