NIH Principles of Clinical Pharmacology

Case Study: Steady-State Calculation

A 68-year-old 85 kg male is hospitalized following an acute myocardial infarction complicated by

recurrent episodes of ventricular tachycardia. Treatment is initiated with an initial 85 mg dose of
intravenous lidocaine administered over 2 minutes. Estimated lidocaine distribution volume is 1.0 L/kg
and elimination half-life is estimated at 2 hours.

What maintenance infusion rate (in mg/min) will provide a steady-state plasma lidocaine level of 5
mcg/mL in this patient?
 NIH Principles of Clinical Pharmacology

Answer:

Step 1: Find the volume of distribution for this patient.

Volume of distribution (Vd) = 1.0 L/kg ∙ 85 kg = 85 L

Step 2: Note the half-life of the drug in question.

Half-life (t1/2) = 2 hr

Step 3: The removal of drugs eliminated by first-order kinetics can be defined by an elimination
clearance. Determine the elimination clearance based on the Vd and t1/2 in steps 2 and 3.
Elimination clearance (CLE) = ln2 ∙ Vd = ln2 ∙ 85 L = 29.5 L/hr
t1/2 2 hr

Step 4: When the drug is administered by IV infusion, the infusion rate can be calculated using the
steady-state concentration (Css) provided in the case and the CLE calculated in step 3.

Note: Watch your units! CLE = 5 mcg/mL = 5 mg/L

Infusion rate (I) = Css ∙ CLE = 5 mg/L ∙ 29.5 L/hr = 147.5 mg/hr ∙ 1 hr/60 min = 2.5 mg/min