Pharmacokinetics and pharmacodynamics of gallamine triethiodide in patients with total biliary obstruction

Pharmacokinetics and pharmacodynamics of gallamine were assessed in seven patients undergoing surgery for correction of total biliary obstruction. Results were compared to those obtained in a previous study of 17 patients without obstruction. A significant increase in the steady-state volume of distribution of gallamine was noted in patients with biliary obstruction as compared to the group without obstruction, but no significant differences between the groups were apparent for the biologic half-life and total clearance of the drug. Duration of action of gallamine and rate of recovery together with onset characteristics were similar in both patient groups. Slight accumulation of gallamine was noted in two of the four patients with biliary disease receiving multiple doses of gallamine, but this was also characteristic of data obtained in the patients without obstruction. At completion of surgery to relieve the biliary obstruction all patients showed a measurable degree of recovery from paralysis, and no difficulties were experienced in the reversal of relaxant effect. Contrary to the observed "resistance" of patients with liver disease to the action of d-tubocurarine no such finding was apparent in this study with gallamine. Gallamine may be the relaxant of choice for surgery to relieve total biliary obstruction provided no complicating renal pathology is also present.