Disposition of pentopril, a new orally active angiotensin-converting enzyme inhibitor, and its active metabolite in rats

The disposition characteristics of pentopril (the ethyl ester) and its active carboxylic acid metabolite (CGS 13934) were determined in conscious rats after separate intravenous administrations of both compounds. The relationship between plasma concentration and pharmacological effect was also evaluated. The extent of apparent bioavailability of the active metabolite was determined after oral administration of pentopril. Pharmacokinetic parameters were calculated from the plasma concentration-time data for both the parent drug and its active metabolite after their separate intravenous administrations using a one-compartment model for the drug and a two-compartment model for the metabolite. The elimination half-life for the drug was approximately 1 min. The elimination half-life for the metabolite was 13 min (SD, +/- 3.5, n = 4) after its direct intravenous administration, but increased to an apparent half-life of 20 min (SD +/- 5, n = 5) when formed in vivo as a metabolite. Comparison of the formation rate of the metabolite and the elimination rate of the parent drug indicated that the parent drug was rapidly and completely hydrolyzed to the acid metabolite as soon as it reached the systemic circulation. No parent drug was detected in plasma after its oral administration. The apparent bioavailability of the acid metabolite was 66% after oral drug administration. A close relation between inhibition of pressor response to angiotensin I (AI) and plasma concentration of the active metabolite was observed when plotted against time after drug or metabolite administration. A Michaelis-Menten function correlated (multiple r2:0.995) well between effect and plasma metabolite concentration with mean concentration for 50% of maximum inhibition, IC50, of 3.6 X 10(-7) M (0.11 microgram/mL).     

Mean Residence Time of Oral Drugs Undergoing First-Pass and Linear Reversible Metabolism

Equations for the mean residence times in the body (MRT) and AUMC/AUC of a drug and its metabolite have been derived for an oral drug undergoing first-pass and linear reversible metabolism. The mean residence times of the drug or interconversion metabolite in the body after oral drug are described by equations which include the mean absorption time (MAT), the mean residence times of the drug or metabolite in the body after intravenous administration of the drug, the fractions of the dose entering the systemic circulation as the parent drug and metabolite, and the systemically available fractions of the drug (F _p ^p) or metabolite (F _m ^p). Similarly, the AUMC/AUC of the drug and metabolite after oral drug can be related to the MAT, ratios of the fraction of the dose entering the systemic circulation to the systemically available fraction, the first-time fractional conversion of each compound, and AUMC/AUC ratios after separate intravenous administration of each compound. The F _p ^p and F _m ^p values, in turn, are related to the first-pass availabilities of both drug and metabolite and the first-time fractional conversion fractions. The application of these equations to a dual reversible two-compartment model is illustrated by computer simulations.     

An algorithm and computer program for calculating the mean transit time and distribution rate parameters of generated metabolites undergoing linear tissue distribution and linear or non-linear central elimination

A method is described for calculating the mean transit time and distribution rate parameters of a generated primary metabolite undergoing linear distribution and linear or non-linear central elimination, and of catenary metabolites with any precursor order. It is also applicable to a drug and its interconversion metabolite and does not require separate administration of the metabolite. The method allows steady-state volume of distribution and distribution clearance of a metabolite to be calculated, provided that the central volume of distribution of the metabolite is known. An algorithm and computer program to implement the proposed method are presented. The calculations require the plasma concentration versus time curves of the metabolite and its precursor. The method is applied to both published and simulated data.     

A theoretical examination of the effects of gut wall metabolism,hepatic elimination,and enterohepatic recycling on estimates of bioavailability and of hepatic blood flow

A model including two eliminating compartments (the liver and the gastrointestinal mucosa) and a noneliminating compartment (the blood or central compartment) was developed to predict the effects of hepatic elimination, gastrointestinal mucosal metabolism, and the occurrence of enterohepatic recycling of a drug and its metabolites on the area under the blood concentrationtime curve (AUC). Several limiting cases where complete absorption or complete or nonexistent enterohepatic recycling of a drug and its metabolite occurred were only considered. Under linear kinetic conditions, the occurrence of hepatic elimination and enterohepatic recycling of a drug and its metabolite in the absence of intestinal mucosal metabolism should affect only the area under the curve and not the availability for both the intraperitoneal and the oral dose. In the presence of intestinal mucosal metabolism, the area under the curve should change with different routes of administration; a larger area, hence a higher availability, should occur after intraperitoneal administration than after oral administration of the drug. For a drug which is eliminated solely by the liver, apparent hepatic flow can be estimated by the dose divided by the difference in the area under the curve for an intravenous dose and the area under the curve for the same intraperitoneal or oral dose. In the absence of gastrointestinal mucosal metabolism, the presence of enterohepatic recycling of a drug and its metabolite should not affect the estimation of apparent hepatic blood flow. However, when gastrointestinal mucosal metabolism is present, there should be an overestimation of hepatic flow when AUC_i.p. and AUC_i.v. are used and a slight underestimation of hepatic flow when AUC_i.v. and AUC_p.o. are used.     

A general model of metabolite kinetics following intravenous and oral administration of the parent drug

A model of metabolite pharmacokinetics is developed in terms of residence time distributions and derived non-compartmental measures. It provides quantitative insight into factors determining the concentration-time curve of metabolite following intravenous and oral administration of the precursor drug. The AUCs and higher curve moments (mean residence times and relative dispersions) are calculated/predicted and their dependence on mean absorption time, fraction of first-pass metabolism and intrinsic disposition residence times of the parent drug and metabolite, respectively, is discussed. An AUC-based method for the determination of the first-pass effect is proposed which is not influenced by drug absorption. The approach is valid for linear pharmacokinetic systems exhibiting hepatic and renal elimination of the precursor drug; it is not restricted to specific compartmental models. Limitations of previous concepts of metabolite kinetics are defined. Criteria are presented for the appearance of concave metabolite curves in a semi-logarithmic scale.     

Mean residence time of drugs administered non-instantaneously and undergoing linear tissue distribution and reversible metabolism and linear or non-linear elimination from the central compartment

Based on disposition decomposition analysis (DDA), equations for the mean residence times (MRT) in the body are derived for a drug and its interconversion metabolite that undergo linear tissue distribution and linear or non-linear elimination from the central compartment after non-instantaneous administration of the drug. The MRT of the drug after non-instantaneous input can be related to the MRT of the drug after intravenous administration, the ratio of the total area under the plasma concentration—time curve of the drug after non-instantaneous administration to that after intravenous administration, the bioavailability of the drug, and the mean input time of the drug. Similar relationships also exist for the MRT of the interconversion metabolite after non-instantaneous input of the drug. The application of these equations to a non-linear reversible metabolic system is illustrated with computer simulations.     

A flip-flop model for nitrofurantoin disposition in the rabbit following oral administration

The influence of route of administration on the absorption of nitrofurantoin and the effect of factors influencing the absorption, such as water volume taken with the drug, change of gastric emptying rate, and effect of particle size, were investigated in rabbits. To clarify the absorption behavior of nitrofurantoin, the Martis-Levy method analogous to the Wagner-Nelson method was used to obtain the absorption kinetics of the drug. Moment analysis was also used to estimate the absorption behavior of the drug.The rate constants of absorption following oral administration of the drug were significantly smaller than those of elimination following intravenous administration. The results of moment analysis (based on a linear approximation) showed that the mean residence time following intravenous administration was much less than the mean absorption time of any oral dosage form. These results clearly show that the pharmacokinetic profile of nitrofurantoin following oral administration is of flip-flop type. Although this result was obtained in the rabbit, the implications of a flip-flop situation for the human case are discussed on the basis of the available published data.     

Mean Interconversion Times and Distribution Rate Parameters for Drugs Undergoing Reversible Metabolism

The mean interconversion time and recycling numbers are introduced as intrinsic metabolic interconversion and distribution parameters for drugs undergoing linear reversible metabolism. Equations for these parameters, the distribution clearance, and the mean transit time in the central and peripheral compartments are derived for a metabolic pair where interconversion and elimination occur in central compartments. These parameters can be calculated from plasma concentration versus time slopes and intercepts, AUC, and AUMC data of parent drug and its metabolite partner following iv administration of each compound. The mean time analysis is illustrated with disposition data obtained previously for methylprednisolone and methylprednisone in the rabbit. Examination of mean times and additional properties of the system reveals that total exposure time of methylprednisolone is weakly influenced by the metabolic interconversion process, whereas the total exposure time of methylprednisone is strongly influenced by the process. In addition, the tissue distribution processes moderately influence the total exposure times of both compounds. The derived mean time parameters, along with previously evolved equations for clearances, volumes of distribution, moments, and mean residence times allow comprehensive analysis of linear, multicompartmental reversible metabolic systems.     

Pharmacokinetic and Metabolic Disposition of p-Chloro-m-xylenol (PCMX) in Dogs

The pharmacokinetic and metabolic profile of p-chloro-m-xylenol (PCMX) was studied in healthy mongrel dogs after intravenous and oral administration of single doses of 200 and 2000 mg of PCMX, respectively. Calculation of pharmacokinetic parameters was based on compartmental and noncompartmental methods. The mean pharmacokinetic parameters of elimination half-life and mean residence time were 1.84 and 1.69 hr, respectively. The apparent volume of distribution at steady state was estimated to be 22.4 liters, and the plasma clearance was 14.6 liters/hr. The bioavailability of PCMX was 21%, indicating low absorption for this drug. PCMX's metabolite data show that a presystemic elimination process (first-pass effect) is also occurring. PCMX plasma concentrations after intravenous administration of 500-, 200-, and 100-mg doses were found to be proportional to the dose given, demonstrating that the pharmacokinetic profile of PCMX is linear over the dose range studied. Biotransformation studies showed that urinary excretion was not the major route for rapid elimination of unchanged PCMX and almost all material excreted in urine was associated with the conjugated species (glucuronides and sulfates). Statistical significant differences were not found (P > 0.05) between the percentages excreted in urine of PCMX and its conjugated metabolites after intravenous and oral administration. The percentages excreted in urine after iv and oral doses of unchanged PCMX were, respectively, 0.45 and 0.37; total conjugates, 46.3 and 43.3; sulfates, 38.1 and 33.2; and glucuronides, 8.2 and 10.2.     

An alternative method for calculating absorption and elimination rate constants in first-order processes: application to valproic acid

A simple method for calculating absorption and elimination rate constants from a single linear plot of plasma drug concentration data is presented. This method is applicable to the one-compartment open-body model with first-order processes. It allows an independent determination of the two rate constant values. As the two rate constants are found to be two square-roots of a quadratic equation, the proposed method obviates the fact that it cannot determine the identity of each rate constant from a single extravascular administration of a drug. Supplementary information is needed to complete this identity in order to make the proposed method globally identifiable. An application of the proposed method is presented using plasma data of valproic acid obtained after a single oral administration of the drug to two epileptic patients.     

First dose and steady-state pharmacokinetics of oxcarbazepine and its 10-hydroxy metabolite

Summary The pharmacokinetics of oxcarbazepine (a new anticonvulsant which is a congener of carbamazepine) and of its 10-hydroxy metabolite were studied at the outset of therapy in 8 adult epileptics comedicated with other anticonvulsants. The pharmacokinetic study was repeated under steady-state conditions after 3 months of drug intake in 6 of these subjects.The plasma elimination half-life of oxcarbazepine appeared to lie in the range 1.0–2.5 h, and that of its 10-hydroxy metabolite averaged 8.4 h. The apparent oral clearance of the parent drug (averaging 2.51·kg^–1·h^–1) was high enough to suggest substantial presystemic elimination. The oral clearance fell after 3 months of drug intake, but the half-lives of the drug and metabolite showed no statistically significant change over this time. Steady-state plasma levels of both drug and metabolite were linearly related to drug dose, metabolite levels averaging 9 times those of the parent substance.     

Pharmacokinetics and bioavailability of theophylline following enema and suppository administration in man

The pharmacokinetics and bioavailability of theophylline from a commercial oral elixir of theophylline, a rectal suppository of aminophylline, and a rectal enema of theophylline monoethanolamine was compared in six normal subjects. Using a complete crossover design, the fasted subjects received a single dose of each dosage form. Blood and saliva samples were collected at frequent time intervals for 24 h, and the plasma assayed for theophylline by a specific thin-layer chromatography densitometric method. No statistically significant differences existed among the three dosage forms with respect to Cmax and AUC corrected for the elimination rate constant and the dose (mg kg-1). However, tmax was significantly larger for the suppository. While the rate of absorption was significantly slower for the suppository, no differences in the extent of absorption existed among the three dosage forms. A one-compartment open model with apparent first-order absorption adequately described the plasma concentration-time data for the elixir and enema, whereas the suppository data were best fitted by a one-compartment open model with apparent zero-order absorption and a lag time. A rate-limiting, concentration-independent release of drug from the base most likely accounts for the slow absorption of theophylline from the suppository. While the saliva:plasma ratio remained fairly constant for most of the study period, the large variability found during the absorption phase following drug administration limits the usefulness of this parameter as a monitor of theophylline plasma concentrations.     

The pharmacokinetics of escitalopram after oral and intravenous administration of single and multiple doses to healthy subjects

The pharmacokinetics of escitalopram (S-citalopram) and its principal metabolite, S-demethylcitalopram (S-DCT), were investigated after intravenous and oral administration to healthy subjects. After intravenous infusion of escitalopram, the mean systemic clearance and volume of distribution were 31 L/h and 1,100 L, respectively. After oral administration of single or multiple doses, the absorption was relatively fast, with the maximum observed plasma or serum concentration (C(max)) attained after 3 to 4 hours. The mean half-lives were 27 and 33 hours, respectively; steady state was attained within 10 days. The area under the plasma or serum concentration time curve from time zero to 24 hours and C(max) was both linear and proportional to the dose. The apparent volume of distribution was around 20 L/kg. Comparison of the systemic and oral clearance implied a high absolute bioavailability. There was no evidence of interconversion from S-citalopram to R-citalopram either in plasma or in urine. Concurrent intake of food had no effect on the pharmacokinetics of escitalopram or its metabolite. All treatments were well tolerated.     

The ratio of first to zeroth moments of the plasma profile of an oral drug undergoing first-pass and linear reversible metabolism

Based on the convolution integral, equations have been drived for the ratio of the first to the zeroth moments of the plasma concentration—time curve (AUMC/AUC) parameters for a drug (p) undergoing first-pass and reversible metabolism and its reversible metabolite (m). According to these equations, the AUMC/AUC of a drug administered orally and of its reversible metabolite can be related to the mean absorption times, the ratios of the fraction of the dose entering the systemic circulation to the bioavailability, the first-time fractional conversion of each compound, and the AUMC/AUC ratios after intravenous administration of each compound. The proposed approach allows a more generalized derivation method for AUMC/AUC of a drug administered orally and undergoing first-pass and reversible metabolism. It is also applicable to any other extravascular route.     

An initial slope method for model structure: Independent estimation of the elimination rate constant of a metabolite

A model structure-independent method for calculating the true elimination rate constant of a primary metabolite is presented. It does not require direct metabolite administration and uses data on drug and metabolite blood (plasma) concentrations after a bolus drug input. The method has been tested and compared with the moment method and the area function method using errorless and errant data simulated on the basis of one- and two-compartment models of the metabolite kinetics. In contrast to known methods the proposed method provided exact estimates of the elimination rate constant in the case of errorless data of both one- and two-compartment models. However the estimates are sensitive to random errors in the concentration data.     

Single dose pharmacokinetics of sumatriptan in healthy volunteers

Sumatriptan is classified as a vascular 5HT₁ receptor agonist and is effective in the acute treatment of migraine and cluster headache. Sumatriptan is available as an injection for subcutaneous administration and as a tablet for oral administration. The pharmacokinetics of sumatriptan differ depending on the route of administration.The mean subcutaneous bioavilability is 96% compared to 14% for the oral tablet. The lower bioavailability following oral administration is due mainly to presystemic metabolism. The inter-subject variability in plasma sumatriptan concentrations is greater following oral administration and a faster rate of absorption of drug into the systemic circulation is achieved following subcutaneous dosing. The pharmacokinetics of sumatriptan are linear up to a subcutaneous dose of 16 mg. Following oral dosing up to 400 mg, the pharmacokinetics are also linear, with the exception of rate of absorption, as indicated by a dose dependent increase in time to peak concentration.Sumatriptan is a highly cleared compound that is eliminated from the body primarily by metabolism to the pharmacologically inactive indoleacetic acid analogue. Both sumatriptan and its metabolite are excreted in the urine. Although the renal clearance of sumatriptan is only 20% of the total clearance, it exceeds the glomerular filtration rate, indicating that sumatriptan undergoes active renal tubular secretion. Sumatriptan has a large apparent volume of distribution (170 1) and an elimination half-life of 2 h.Oral doses of sumatriptan were administered as a solution of dispersible tablets and subcutaneous dosing was by injection into the arm. In clinical practice, sumatriptan is administered as a film coated tablet or by subcutaneous injection into the thigh.     

Pharmacokinetics of topically applied pilocarpine in the albino rabbit eye.

The temporal and spatial pattern of [3H]-pilocarpine nitrate distribution in the albino rabbit eye following topical administration was determined. A four-compartment caternary chain model describing this disposition corresponds to the precorneal area, the cornea, the aqueous humor, and the lens and vitreous. Simultaneous computer fitting of data from tissue corresponding to some compartments in the model supported the proposed model. Additional support was provided by the excellent correlation between predicted and observed values in multiple-dosing studies. Several important aspects of ocular drug disposition are evident from the model. The extensive parallel elimination at the absorption site gives rise to an apparent absorption rate constant that is one to two orders of magnitude larger than the true absorption rate constant. In addition, aqueous flow accounts for most of the drug removal. Thus, major effects on absorption and elimination, independent of the drug structure, suggest the possibility of similar pharmacokinetics for vastly different drugs.     

An initial slope method for model structure: independent estimation of the elimination rate constant of a metabolite

A model structure-independent method for calculating the true elimination rate constant of a primary metabolite is presented. It does not require direct metabolite administration and uses data on drug and metabolite blood (plasma) concentrations after a bolus drug input. The method has been tested and compared with the moment method and the area function method using errorless and errant data simulated on the basis of one- and two-compartment models of the metabolite kinetics. In contrast to known methods the proposed method provided exact estimates of the elimination rate constant in the case of errorless data of both one- and two-compartment models. However the estimates are sensitive to random errors in the concentration data.     

Drug metabolite concentration-time profiles: influence of route of drug administration.

In order to assess the contribution of an active metabolite to the overall pharmacological response following drug administration it is necessary to characterise the metabolite concentration-time profile. The influence of route of drug administration on metabolite kinetics has been investigated by computer simulation. Comparisons between simulated profiles and published concentration-time data have been carried out. A route dependence in metabolite concentration-time curves is readily apparent provided the metabolite kinetics are formation rate limited and the hepatic clearance of drug is greater than 25 l/h (medium to highly cleared). Oral drug administration produces a triphasic metabolite concentration-time profile whereas only two phases are discernable after intravenous drug administration. The magnitude of the difference in maximum metabolite concentration is directly proportional to the hepatic clearance of drug due to first-pass metabolite production. The route dependence in the shape of the metabolite concentration-time curves is most dramatic when the absorption and distribution of drug and the elimination of metabolite is rapid. A reduction in the rate of either of these processes alters the shape of the metabolite concentration-time profile such that the consequence of first-pass metabolite formation may be reduced.     

An area function method for calculating the apparent elimination rate constant of a metabolite

A simple method for determination of the apparent elimination rate constant of a metabolite (km) has been developed. This procedure requires calculation of area intervals under the plasma concentration-time curves of the parent drug and its derived metabolite. The method has been evaluated and compared with the Chan moment method using both errorless and errant data. The approach is accurate for various ratios of elimination rate constants of drug and metabolite, allows several values of km to be averaged, but works best using data prior to the metabolite tmax.