Aging and renal clearance of procainamide and acetylprocainamide

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Abstract
Thirty-two patients had blood and urine collected simultaneously for measurement of procainamide [an antiarrhythmic] acetylprocainamide and creatinine. The ratios of drug clearance to creatinine clearance were calculated for each. The procainamide:creatinine clearance ratio averaged 2.9 .+-. 1.6 (SD) and fell as age of the patients rose (r = 0.5 P < 0.01). The acetylprocainamide:creatinine clearance ratio averaged 1.7 .+-. 0.8 and also fell with age. The combination of decline in overall renal function with age with this decrease in the rate of renal tubular secretion of these drugs led to a progressive age-related rise in the steady-state serum level of procainamide (r = 0.56 P < 0.01) and acetylprocainamide (r = 0.36 P < 0.1) achieved by an dose of procainamide. The dosage of procainamide must be individualized for both overall renal function and the age-related variations in renal tubular secretion that are of note in children and the elderly.

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