Protein bound (very highly)

Interaction at a glance

• Nearly all circulating drug is protein-bound

Mechanism

• Nearly all circulating drug is protein-bound
• Small binding shifts can change free fraction transiently

Magnitude / time course

• Dialysis removal is often limited
• Clearance may compensate for displacement

Mechanism / modifiers

• Total level may mislead in hypoalbuminemia

Self-check

• What may compensate for protein-binding displacement?
  Clearance.
• When may total drug levels mislead for very highly bound drugs?
  Hypoalbuminemia.

Drugs in this interaction (25)

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