Renal excretion of pseudoephedrine

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Abstract
A patient with renal tubular acidosis developed unanticipated toxicity after ordinary doses of the sympathomimetic pseudoephedrine, prompting the study of renal determinants of its elimination. The patient may accumulate the drug due to her persistently alkaline urine, which would favor tubular resorption of this weak base (pKa [negative log of the Ka] = 9.4). Normal adults and children and 1 adult and 1 child with renal tubular acidosis were studied. Increasing urine pH increased the serum elimination half-life from 1.9-21 h. While urinary pH remained alkaline, renal excretion of pseudoephedrine and its metabolite, norpseudoephedrine, was directly correlated with the flow rate of urine in each subject. Both urine pH and flow are important determinants of the elimination of pseudoephedrine in man and could be critical determinants of unanticipated toxicity.

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