The pharmacokinetic profile of intravenous paracetamol in adult patients undergoing major abdominal surgery.

BACKGROUND: Intravenous (IV) paracetamol is commonly used in the postoperative period for the treatment of mild to moderate pain. The main pathways for paracetamol metabolism are glucuronidation, sulfation, and oxidation, accounting for approximately 55%, 30%, and 10% of urinary metabolites, respectively. The aim of this study was to describe the pharmacokinetics of IV paracetamol and its metabolites in adult patients after major abdominal surgery. METHODS: Twenty patients were given 1 g of paracetamol by IV infusion at induction of anesthesia (Interval 1) and every 6 hours thereafter, with the final dose given at 48-72 hours (Interval 2). Plasma and urine samples were collected for up to 8 hours after infusion for both intervals. The samples were analyzed by high-performance liquid chromatography to determine the amount of paracetamol and its metabolites. The data were modeled in Phoenix WinNonlin using a user-defined ASCII parent-metabolite model with linear disposition, to obtain the estimates for volume of distribution, metabolic and urinary clearance. RESULTS: Mean (95% confidence interval) metabolic clearance to paracetamol glucuronide increased from 0.06 (0.05-0.08) to 0.14 (0.11-0.18) L · h⁻¹ · kg⁻¹, P value <0.001 and urinary clearance increased from 0.08 (0.07-0.09) to 0.14 (0.10-0.17) L · h⁻¹ · kg⁻¹, P value 0.002. The mean (95% confidence interval) volume of distribution of paracetamol increased from 0.17 (0.12-0.21) to 0.43 (0.27-0.59) L · kg⁻¹, P value 0.032. CONCLUSIONS: After major abdominal surgery, there were apparent increases in the metabolic conversion to paracetamol glucuronide and its urinary clearance suggesting potential induction of paracetamol glucuronidation.

Memory-related changes in L-citrulline and agmatine in the rat brain.

L-citrulline, L-ornithine, and agmatine are the metabolites of L-arginine by nitric oxide synthase (NOS), arginase, and arginine decarboxylase (ADC), respectively. In contrast to the NOS and arginase pathways, the role of the ADC-agmatine pathway in learning and memory has only been paid attention lately. Recent evidence suggests a potential involvement of agmatine in learning and memory processing. The present study further addressed this issue by comparing the levels of agmatine, as well as L-arginine, L-citrulline, and L-ornithine, in the hippocampus, parahippocampal region, prefrontal cortex, vestibular nucleus, and cerebellum in rats that were trained in the delayed nonmatch to position task in the T-maze with their yoked controls. There were significantly increased agmatine levels in the prefrontal, entorhinal, and perirhinal cortices and increased L-citrulline concentrations in the dentate gyrus (DG) and prefrontal cortex in the T-maze training group relative to the control one. L-arginine and L-ornithine levels were not significantly different between groups in the brain regions examined. These results demonstrate T-maze training-induced region-specific increases in L-citrulline and agmatine. Significant positive correlations between prefrontal and perirhinal agmatine levels and animals' performance in the T-maze further suggest the direct involvement of agmatine in learning and memory processing.

Spatial learning results in elevated agmatine levels in the rat brain.

Accumulating evidence suggests that agmatine, a metabolite of L-arginine by arginine decarboxylase, is a novel neurotransmitter, and exogenous agmatine can modulate behavior functions including learning and memory. However, direct evidence of its involvement in learning and memory processes is currently lacking. This study measured agmatine levels in the hippocampus, parahippocampal region, cerebellum, and vestibular nucleus in rats that were trained to find a hidden escape platform in the water-maze task, or forced to swim in the pool with no platform presented, or kept in the holding-box, using liquid chromatography/mass spectrometry. Compared with the swimming only group and holding-box group, agmatine levels were significantly increased in the CA1 and dentate gyrus subregions of the hippocampus, the entorhinal cortex and the vestibular nucleus in the water-maze training group. These results, for the first time, demonstrate spatial learning-induced region-specific elevation in agmatine, and raise a novel issue of the involvement of agmatine in the processes of learning and memory.

Effects of aging on agmatine levels in memory-associated brain structures.

Agmatine is a metabolite of L-arginine by arginine decarboxylase. Recent evidence suggests that it exists in mammalian brain and is a novel neurotransmitter. The present study measured agmatine levels in several memory-associated brain structures in aged (24-month-old), middle-aged (12-month-old), and young (4-month-old) male Sprague Dawley rats using liquid chromatography/mass spectrometry. Agmatine levels were significantly decreased in the CA1, but increased in the CA2/3 and dentate gyrus, subregions of the hippocampus in aged and middle-aged rats relative to the young adults. In the prefrontal cortex, a dramatic decrease in agmatine level was found in aged rats as compared with middle-aged and young rats. There were significantly increased levels of agmatine in the entorhinal and perirhinal cortices in aged relative to middle-aged and young rats. In the postrhinal and temporal cortices, agmatine levels were significantly increased in aged and middle-aged rats as compared with young adults. The present findings, for the first time, demonstrate age-related changes in agmatine levels in memory-associated brain structures and raise a novel issue of the potential involvement of agmatine in the aging process.