Relationship between α1-acid glycoprotein and lidocaine disposition in myocardial infarction

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Abstract
The effects of myocardial infarction (MI) on lidocaine disposition were investigated in 8 patients during a constant infusion of 2 mg/min. Plasma lidocaine binding and total plasma and free lidocaine concentrations were measured 12, 24, 36 and 48 h after beginning therapy and were related to .alpha.1-acid glycoprotein (AAG) concentrations. By 48 h total plasma lidocaine and AAG concentrations had risen, as had plasma lidocaine binding. Due to enhanced binding, free lidocaine concentrations did not change significantly over this time. There was a correlation between AAG and the binding ratio for lidocaine (r = 0.87) and between AAG and total plasma lidocaine concentrations (r = 0.81). The rise in AAG seen after MI is responsible for enhanced plasma lidocaine binding and may be related to lidocaine cumulation.