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The protein binding of diazepam, indomethacin, salicylic acid, sulfadimetoxine and warfarin in serum of uremic patients has been studied by equilibrium dialysis and circular dichroism measurements and compared with that in normal serum. Comparisons have also been made with isolated human serum albumin (HSA) from uremic patients and healthy individuals. The binding of diazepam, salicylic acid, sulfadimetoxine and warfarin is impaired in the uremic sera, while the binding of indomethacin is apparently unchanged. The apparent binding constants of salicylic acid and warfarin in both uremic and normal sera are affected by dilution of the sera in buffer. The binding constants obtained with isolated albumins, however, are unaffected by dilution. The albumin isolated from uremic serum shows lower binding affinity for salicylic acid and warfarin than normal HSA, but the affinity was normalized by charcoal treatment at pH 3.0. It is shown that the binding both in normal and uremic sera is impaired compared with isolated defatted serum albumin due to the presence of competitive inhibitors. The inhibition is more pronounced in uremic serum. In addition, the binding to albumin in uremic sera is impaired by strongly bound allosteric inhibitors. It is also emphasized that determinations of association constants have to be related to the dilution of the serum, plasma or blood, respectively.

The protein binding of diazepam, salicylic acid and warfarin in serum of patients with liver cirrhosis has been studied by equilibrium dialysis and circular dichroism measurements and compared with that in normal serum. Diazepam and warfarin are mainly bound to two separate sites on the serum albumin molecule and salicylic acid to both sites. The binding of diazepam and salicylic acid was impaired in serum from the patients when compared with the binding in serum from healthy individuals, while the binding of warfarin was unchanged. The results were the same when the binding was studied with albumin isolated from patient serum and normal serum. After treatment of the albumin with charcoal at pH 3, however, the binding was improved. The apparent binding constants of the drugs in serum both from patients with liver cirrhosis and from healthy persons were increased by dilution of the sera in buffer. This effect is due to the presence of competitive inhibitors in the sera. The decreased binding of diazepam and salicylic acid in the serum from the patients with liver cirrhosis can in addition be related to the presence of allosteric inhibitors specifically affecting the diazepam binding site on albumin, while the warfarin site apparently is unaffected.

The binding of various tricyclic antidepressants to human plasma and the effects thereupon of other drugs were studied by an ultrafiltration technique utilizing labeled compounds. At a total concentration of 0·29 μ/ml the percentage of unbound desmethylimipramine(DMI) was found to be 9·5 ± 1·4 in 41 individuals. The unbound fraction of DMI in plasma increased only twofold when the total concentration of the drug was increased a thousand times. The degree of binding over the entire range of therapeutic plasma drug concentration was relatively constant. The binding of various tricyclic antidepressants was compared at a drug concentration of 1·1 μM. The percentage of unbound drug was for nortriptyline (NT) 5·5 ± 0·6, for amitriptyline (AT) 3·6 ± 0·8, for imipramine (I) 4·2 ± 0·8, for protriptyline (PT) 8·0 ± 0·6 (tested at a cone, of 7·7 μM) and for Leo 640, an imipramine analogue, 0·7 ± 0·7. The acetyl derivatives of DMI, NT and PT were much more bound than the parent compounds. The addition of NT, PT or AT in a “therapeutic” concentration of 0·2 μg/ml didnot displace DMI, nor did chlorpromazine in supratherapeutic concentration. Diphenylhydantoin was found to displace DMI, NT, PT, AT and particularly I.