Phenobarbital pharmacokinetics in rat as a function of age

Biodisposition of phenobarbital was examined in male Fischer-344 rats of different ages (3-4, 11-12, 23-24, and 32-34 months). Phenobarbital was administered intraperitoneally as a bolus (20 mg/kg) or continuously for 5 days from an implanted osmotic minipump (4.73 mg/day). Phenobarbital concentrations were determined by gas chromatography with a nitrogen-selective detector after extraction from plasma, plasma ultrafiltrate, and brain (cortex and cerebellum). Higher plasma and brain concentrations were found in the aged animals after a bolus injection or during continuous administration, and were related to decreases in the apparent plasma clearance of the drug. Apparent clearance was greater during continuous administration than following a bolus in 3- to 4-month- and in 32- to 34-month-old rats, which suggested autoinduction of phenobarbital metabolism. In addition, the plasma/brain distribution ratio of phenobarbital was elevated in the older animals.     

Phenobarbital pharmacokinetics in obesity. A case report.

A morbidly obese woman [190 kg total bodyweight (TBW)] was admitted to hospital with a rapidly progressing wound infection. Over the next 2 weeks the patient developed congestive heart failure, acute renal failure, septic shock and multiple seizure episodes. Intravenous phenobarbital was added to phenytoin therapy to achieve seizure control. A total loading dose of phenobarbital 3700 mg (19.5 mg/kg TBW) was administered in 3 divided doses. The initial dose of 1100 mg resulted in a serum phenobarbital concentration of 6.3 mg/L 5h postinfusion, a second 1100 mg dose increased the concentration to 13.1 mg/L 1h postinfusion and a final dose of 1500 mg resulted in a 22.5 mg/L concentration at the end of the infusion. A phenobarbital maintenance regimen of 120 mg every 12h was then started. Peak serum concentrations of 19.8 and 17.8 mg/L were measured. All of the available serum phenobarbital concentrations and dosage amounts were fitted with least-squares nonlinear regression analysis to a 1-compartment model. An apparent volume of distribution (Vd) of 154.9L (0.82 L/kg TBW), total body clearance (CL) of 29 ml/min (1.74 L/h) and elimination half-life of 61h were determined. Our case report suggests that the dose of intravenous phenobarbital should be calculated using TBW. Additional studies are needed to precisely define the appropriate dosage weight, serum concentrations and clinical efficacy associated with intravenous phenobarbital in morbidly obese patients.     

用群体药代动力学预测癫痫儿童丙戊酸钠血药浓度

目的 用群体药代动力(PPK)模型和贝叶斯法预测血药浓度。方法 用癫痫儿童丙戊酸钠PPK模型和USC~*PACK软件中的贝叶斯程序,对100例新癫痫患儿丙戊酸钠的血药浓度进行预测。将预测值与实测值做配对t检验,相关和回归分析,计算平均预测误差、预测误差的百分比、不同预测误差百分比的符合率及其95％可信区间、构成比和评价预测的准确程度。结果 预测值与实测值的相关系数为0.99,P<0.001,线性回归Y_(OBS)=0.99)Y_(PRED),决定系数为0.98,P<0.001;平均预测误差为-0.43μg·mL~(-1),预测误差百分比分别为5％,10％,15％,20％,25％,30％的符合率为62％,74％,82％,85％,89％,93％。结论 PPK模型和贝叶斯法可准确预测丙戊酸钠稳态血药浓度。     

Plasma and salivary pharmacokinetics of caffeine in man

Summary Plasma and salivary caffeine concentrations were measured by gas-liquid chromatography in 6 healthy caffeine-free volunteers following oral administration of 50, 300, 500 and 750 mg caffeine. Caffeine was also given to a single subject intravenously in doses of 300, 500 and 750 mg. Caffeine was rapidly absorbed and was completely available at all doses. The apparent first-order elimination rate constant decreased linearly with dose and was 0.163±0.081 h^–1 for 50 mg and 0.098±0.027 h^–1 for 750 mg. The total body clearance was unaffected by dose and was 0.98±0.38 ml/min/kg. There was a trend towards increasing apparent volume of distribution with increasing dose. A linear relationship existed between the area under the plasma concentration, time curve and dose and dose-normalised plasma concentration, time plots were superimposable. These findings suggest that caffeine obeys linear pharmacokinetics over the dose range investigated. Despite significant inter-individual differences in pharmacokinetic parameters there was good reproducibility within 5 subjects given 300 mg caffeine orally on 3 occasions. Salivary caffeine levels probably reflect the unbound plasma caffeine concentration and can be used to estimate the pharmacokinetic parameters of the drug. Overall the saliva/plasma concentration ratio was 0.74±0.08 but within subjects some time-dependence of the ratio was found with higher ratios initially (even after intravenous administration) and lower ratios at longer time intervals after the dose. Urinary elimination of caffeine was low and independent of dose: 1.83% of the dose was eliminated unchanged.     

Studies with stable isotopes II: Phenobarbital pharmacokinetics during monotherapy

Six healthy adults receiving no other medications were given tracer doses of 90 mg of stable isotope-labeled phenobarbital (PB) intravenously before, and four weeks after, and 12 weeks after beginning therapy. Serum samples were collected for 96 hours after each injection, and the concentration of stable isotope-labeled PB in each sample was determined by gas chromatographic mass spectrometry. The volume of distribution, elimination half-life, and total clearance of PB did not differ significantly on any of the three occasions measured. Phenobarbital clearance did not correlate significantly with total PB serum concentration. Clearances determined from single-dose studies before beginning PB therapy accurately predicted steady-state PB serum concentrations. Therefore, it is not necessary to adjust PB dosage for time-dependent or dose-dependent changes in clearance during monotherapy. In addition, clearance or serum concentration determined at one dosing rate directly predicts serum concentration at another dosing rate.     

102例癫痫患者卡马西平唾液浓度与血药浓度测定及其相关性研究

目的：探讨癫痫患者卡马西平唾液浓度与血药浓度的相关性。方法：选择我院2007年9月至2009年3月住院患者102例,服药达稳态血药浓度后,采集肘静脉血2mL,并同时收集自然状态下分泌的唾液1mL,用反相高效液相色谱法同时测定唾液浓度与血药浓度。数据分析采用SPSS11．5统计学软件。结果：以卡马西平浓度（C）、峰面积（A）作线性回归,分别得到血清浓度与唾液浓度的回归方程：C=1．34&#215;10^-5A-0．25（r=0．9958）和C=4．07&#215;10^-6A-0．30（r=0．9921）;唾液浓度（y）与血药浓度（x）回归方程为y=2．54&#215;10^-1x-1．09&#215;10^12（n=102,r=0．8985,P〈0．01）其比值为24．89％&#177;3．90％。结论：HPLC法测得卡马西平唾液浓度与血药浓度具有显著的相关性,CBZ唾液／血清药物浓度比不受性别、年龄影响,其间无相关性;可以用唾液代替血清对卡马西平作治疗药物监测。     

Diurnal changes in salivary amino acid concentrations

It has been suggested that the features of saliva (e.g. fluidity, secretion and amino acid concentration) reflect physiological and psychological state of primates as well as subprimates, however, studies which revealed the relationship between the circadian rhythm and the concentrations of salivary amino acids have been limited. In order to better understand their physiological role, diurnal changes of salivary amino acids were investigated in three undergraduate students. Salivary amino acids were recovered after deproteinization with 5% trichloroacetic acid and determined by an amino acid analyzer. Most amino acids, except for methionine, cysteine and asparagine, were detected in the saliva. The intake of lunch or amino acid supplement transiently increased the salivary amino acids, and in the latter case, the amino acid levels returned to baseline within 10 minutes. Physical exercise also slightly elevated the salivary amino acid levels. During the university examination period, the secretion of saliva was slightly, but not significantly, increased, accompanied by the elevation of glycine, alanine, ornithine, histidine and threonine, and the decline of lysine, leucine, aspartic acid and hydroxyproline. Salivary amino acid levels may be useful to evaluate stressful conditions.     

Ritodrine pharmacokinetics in twin pregnancy patients

Objectives To establish a rational ritodrine therapy in relation to serum ritodrine concentration, we examined 14 twin pregnancy patients and determined their pharmacokinetic data. Methods We measured serum concentrations of ritodrine in twin pregnancy patients using high-performance liquid chromatography (HPLC). Results The twin pregnancy patients all exhibited linear ritodrine pharmacokinetic profiles. There was a statistically significant but slight negative correlation between gestation period and ritodrine clearance (y = − 0.038x + 2.75, r = 0.349, p < 0.001) among all patients. However, when analyzed on an individual basis, there was a high correlation found in three of the 14 patients. Conclusion Due to a decrease in total body clearance in three of the 14 patients, overall serum concentration of ritodrine increased at the end of the pregnancies. To further characterize ritodrine kinetics, additional studies are needed to determine an effective and safe therapy for ritodrine use in twin pregnancy patients.     

高效液相色谱法测定血清中苯巴比妥、卡马西平、苯妥英的浓度

目的 建立HPLC法测定抗癫痫药苯巴比妥(PB)、卡马西平(CBZ)、苯妥英(PT)的血药浓度.方法 Diamonsil C18色谱柱(250×4.6mm,5μm),流动相为甲醇:水:乙腈(160:180 :60 V/V/V),流速1.2ml·min-1,柱温30℃,检测波长212nm.以上3种药物互为内标.标本经乙醚提取,水浴氮气挥干,流动相重溶后进样.结果 PB、PT、CBZ的保留时间(tR)分别为5.76、8.56、9.80min;最低检测浓度分别为1.0、2.0和0.5μg·mL-1;线性范围分别为5～30、5～30、2～15μg·mL-1.日内RSD分别为3.06%、2.18%、1.86%;日间RSD分别为1.73%、3.35%、2.13%.结论 本法操作简便、快速、准确,可满足临床快速监测的需要.     

Effective serum concentration and action in pharmacokinetics

Summary A formula has been derived for the calculation of effective serum concentration based on the assumption of both exponential absorption and exponential elimination of an administered drug. In order to permit quantitative comparisons of different drugs and/or different dosage schedules, a new term is proposed called action or COTT (for concentration times time).This paper is dedicated to Prof. Heinz Oeser, M. D., on his 60th birthday.     

Blood and salivary concentrations of sulfamethoxazole and trimethoprim in man

Saliva/blood and saliva/plasma concentration ratios were determined for sulfamethoxazole and trimethoprim following oral administration of cotrimoxazole to healthy human subjects. The mean experimentally determined saliva/plasma concentration ratios for sulfamethoxazole and trimethoprim were 0.0157 and 1.13, respectively. These values were shown to be in reasonable agreement with theoretical predictions. It was demonstrated that partitioning of drugs from saliva into the buccal must be considered in making theoretical predictions.     

Bioavailability and pharmacokinetics of phenytoin during pregnancy

Summary Five epileptic women needing to commence phenytoin therapy during pregnancy received a single intravenous and a single oral dose of phenytoin several days apart before starting regular intake of the drug. Plasma phenytoin concentration — time data were analysed by three different pharmacokinetic techniques. However assessed, the mean oral bioavailability of the drug proved to be about 90% of the intravenous bioavailability. This finding makes it unlikely that impaired bioavailability accounts for the increase in oral phenytoin dosage necessary in pregnancy to maintain plasma phenytoin concentrations at pre-pregnancy values. Phenytoin clearance in the pregnant subjects was approximately double the published values for phenytoin clearance in nonpregnant persons. This suggests that increased (metabolic) clearance accounts for the increased phenytoin dosage requirement of pregnancy.     

Population pharmacokinetics of metformin in late pregnancy

The pharmacokinetic disposition of metformin in late pregnancy was studied together with the level of fetal exposure at birth. Blood samples were obtained in the third trimester of pregnancy from women with gestational diabetes or type 2 diabetes; 5 had a previous diagnosis of polycystic ovary syndrome. A cord blood sample also was obtained at the delivery of some of these women, and also at delivery of others who had been taking metformin during pregnancy but from whom no blood had been taken. Plasma metformin concentrations were assayed by a new, validated, reverse-phase HPLC method. A 2-compartment, extravascular maternal model with transplacental partitioning of drug to a fetal compartment was fitted to the data. Nonlinear mixed-effects modeling was performed in NONMEM using FOCE with INTERACTION. Variability was estimated using logarithmic interindividual and additive residual variance models; the covariance between clearance and volume was modeled simultaneously. Mean (range) metformin concentrations in cord plasma and in maternal plasma were 0.81 (range, 0.1-2.6) mg/L and 1.2 (range, 0.1-2.9) mg/L, respectively. Typical population values (interindividual variability, CV%) for allometrically scaled maternal clearance and volume of distribution were 28 L/h/70 kg (17.1%) and 190 L/70 kg (46.3%), giving a derived population-wide half-life of 5.1 hours. The placental partition coefficient for metformin was 1.07 (36.3%). Neither maternal age nor weight significantly influenced the pharmacokinetics. The variability (SD) of observed concentrations about model-predicted concentrations was 0.32 mg/L. The pharmacokinetics were similar to those in nonpregnant patients and, therefore, no dosage adjustment is warranted. Metformin readily crosses the placenta, exposing the fetus to concentrations approaching those in the maternal circulation. The sequelae to such exposure, eg, effects on neonatal obesity and insulin resistance, remain unknown.     

Plasma concentrations and pharmacokinetics of midazolam during anaesthesia

Midazolam and 1-hydroxymidazolam plasma concentrations have been monitored and pharmacokinetic parameters of midazolam estimated during anaesthesia induced and maintained by its repeated injection according to two protocols (3 X 0.3 mg kg-1 at 45 min intervals or an induction dose of 0.3 mg kg-1 with maintenance doses of 0.15 mg kg-1 at 30 min intervals). Minimum plasma concentrations of midazolam measured just before each injection were 258.8 +/- 108.4 ng ml-1 for the first protocol and 353.1 +/- 55.2 ng ml-1 for the second protocol; maximum midazolam concentrations, measured 5 min after the last administration, were 1103.1 +/- 237.9 ng ml-1 and 743.0 +/- 103.2 ng ml-1, respectively, suggesting that a continuous infusion of midazolam after a loading dose should be better than repeated injections at keeping the concentration close to the sedative level of 400 ng ml-1. The estimated pharmacokinetic parameters were similar to those already published, except for the beta elimination half-life of midazolam (3.24 +/- 0.90 h for protocol 1 and 3.34 +/- 1.47 h for protocol 2) which was slightly longer than that reported for single dose studies. The comparison of plasma determinations, obtained either by gas-liquid chromatography or by a radioreceptor assay technique, clearly showed that 1-hydroxymidazolam, even after repeated midazolam administration, was not present at a concentration sufficient to affect the overall pharmacological activity of the parent drug.     

Changes in lamotrigine pharmacokinetics during pregnancy and the puerperium

To assess changes in the pharmacokinetics of the anti-epileptic drug lamotrigine (LTG) during pregnancy, plasma LTG concentrations at steady-state were determined at different intervals during 11 pregnancies in 10 women with epilepsy stabilized on long-term LTG therapy. In the five pregnancies that could be assessed both during gestation and after delivery, plasma LTG concentrations increased on average by 164% (range +75 to +351%) between the last observation during pregnancy and the puerperium (P < 0.05). When all pregnancies monitored during pregnancy were considered, plasma LTG concentrations declined by an average of 20% (range -64% to +13%) between the first and the last assessment before delivery. These findings confirm that plasma LTG concentrations decrease markedly during pregnancy and that, at least in some cases, this effect occurs as early as the first trimester. Because there is a large interindividual variability in the magnitude and time course of the pregnancy-associated pharmacokinetic changes, it is desirable to establish baseline plasma LTG concentrations in all women of childbearing potential and to monitor LTG levels at frequent intervals during pregnancy and the puerperium.     

Fallacious results from measuring salivary carbamazepine concentrations

During a carbamazepine (CBZ) relative bioavailability study involving tablets and a syrup preparation, salivary drug concentrations appeared disproportionately high relative to simultaneous plasma drug concentrations in the first 2-3 h after oral drug intake. This raised the suspicion of contamination of saliva by retention of drug in the mouth. In a separate study CBZ was retained in the mouth in tablet form (whole or crushed) or in syrup, for only 5 s before being spat out, and the mouth was carefully rinsed. Despite this, measurable salivary concentrations, sufficient to cause substantial error if extrapolated to simultaneous plasma drug concentrations, were present for at least 2 h after drug administration. CBZ in these studies disappeared from saliva with an apparent mean half-life of 21.0 +/- 4.8 min. This experience suggests that, in therapeutic drug monitoring, salivary CBZ concentrations for at least 2 h after dosage may lead to invalid conclusions about simultaneous plasma CBZ concentrations.