洛匹那韦合成工艺研究

目的 洛匹那韦合成工艺的优选.方法 以（2S,3S,5S）-2-胺基-3-羟基-5-（叔丁氧羰基胺基）-1,6-二苯基己烷的丁二酸盐为原料,经酰胺化、氨基脱保护、酰胺化三步反应制备洛匹那韦.结果 较高收率合成了高纯度的洛匹那韦（纯度＞99％;总产率70％）.结论 得到了简洁、绿色、适于工业化生产的洛匹那韦制备工艺.     

洛匹那韦的合成

目的 研究抗病毒药物洛匹那韦的合成.方法 以（2S,3S,5S）-5-（叔丁氧羰基）氨基-2-氨基-3-羟基-1,6-二苯基己烷为起始原料,与2,6-二甲基苯氧乙酸经肽键缩合、脱保护、最终与（2S）-（1-四氢嘧啶-2-酮）-3-甲基丁酸再经肽键缩合制备目标产物洛匹那韦.结果 三步合成了目标产物洛匹那韦,以BDC计,总收率为50.7%,通过1H-NMR、MS、确定了结构.结论 该方法简单,后处理方便,副产物较少,适合工业化生产.     

洛匹那韦药代动力学的研究进展

洛匹那韦作为第二代蛋白酶抑制剂,在艾滋病治疗领域得到广泛应用。然而,该药能被代谢酶CYP3A4快速代谢,在临床应用中,存在较大的个体差异。因此,对洛匹那韦进行药代动力学分析,了解其血药浓度与疗效以及不良反应的关系对优化临床用药具有重要意义。本文全面综述了近年来洛匹那韦浓度分析方法、药代动力学研究进展,为日后洛匹那韦治疗药物监测以及个体化用药研究提供归纳总结材料。     

Monotherapy with lopinavir/ritonavir

Despite the unprecedented pace of development of drugs for the treatment of a viral disease and the unquestionable efficacy of antiretroviral therapy, there is a need for less toxic and cheaper regimens that could simplify the treatment of HIV infection without sacrificing efficacy. The favorable pharmacokinetic profile and the high genetic barrier of boosted protease inhibitors make them ideal candidates for use as monotherapy. Given the encouraging results of available studies on lopinavir/ritonavir monotherapy in patients with no prior failure with protease inhibitors, it may be warranted to conduct trials to investigate the cost-effectiveness of lopinavir/ritonavir monotherapy as second-line therapy in resource-constrained settings where virologic monitoring is not feasible. In addition, larger trials with longer follow up, with particular attention to the potential consequences of viral replication in sites where the penetration of protease inhibitors may be poor, are needed before this strategy can be considered for routine use.     

洛匹那韦/利托那韦片致迟发性过敏性休克

1位29岁女性护士在治疗新型冠状病毒感染患者期间不慎被患者用过的针头扎破手指。因担心职业暴露感染口服洛匹那韦/利托那韦片(洛匹那韦200 mg/利托那韦50 mg)2片,2次/d。首次服药4 h后出现全身红色皮疹,伴颜面部肿胀。给予氯苯那敏片8 mg口服,地塞米松磷酸钠注射液5 mg肌内注射。服药后8.5 h患者出现大汗淋漓,面色苍白,伴腹痛、腹泻,血压70/50 mmHg(1 mmHg=0.133 kPa),体温35.2℃,心率87次/min,呼吸22次/min,脉搏微弱,四肢发冷,血氧饱和度0.93。诊断为洛匹那韦/利托那韦致过敏性休克,给予静脉扩容、鼻导管吸氧及心电监护。患者症状逐渐缓解,2.5 h后患者血压恢复至108/89 mmHg,次日皮疹消退。     

Impurity profile study of lopinavir and validation of HPLC method for the determination of related substances in lopinavir drug substance

Several related substances (RS4–RS10) were detected in lopinavir drug substance at levels ranging from 0.03% to 0.1% by employing gradient RP-HPLC. The related substances were identified by LC–MS analysis. These related substances were isolated and characterized by Mass, ¹H NMR and FT-IR spectral data. The separation was achieved on a YMC Pack ODS-AQ (250 mm × 4.6 mm, 5 μm) column thermostated at 45 °C using 0.02 M KH₂PO₄ (pH 2.5): acetonitrile as a mobile phase in gradient elution mode. A PDA detector set at 210 nm was used for detection. The investigated validation elements showed the method has acceptable specificity, accuracy, linearity, precision, robustness and high sensitivity with detection limits and quantitation limits ranging from 0.028 μg/ml to 0.063 μg/ml and 0.084 μg/ml to 0.192 μg/ml respectively. The method can be used for routine quality control analysis and stability testing of lopinavir drug substance.     

Time-dependent interaction between lopinavir/ritonavir and fexofenadine

This study investigated the effect of single-dose and steady-state lopinavir/ritonavir on the exposure to fexofenadine, as a measure of P-glycoprotein activity. Sixteen volunteers (8 women) received single-dose oral fexofenadine 120 mg alone, in combination with single-dose ritonavir 100 mg or lopinavir/ritonavir 400/100 mg (randomized 1:1, stratified by sex), and in combination with steady-state lopinavir/ritonavir 400/100 mg twice daily. Single-dose ritonavir and lopinavir/ritonavir increased the area under the fexofenadine plasma concentration-time curve from 0 to infinity (AUC(infinity)) by 2.2- and 4.0-fold, respectively (P < .02). Steady-state lopinavir/ritonavir increased the fexofenadine AUC(infinity) by 2.9-fold. No changes were observed in the fexofenadine elimination half-life (P > .12). The fexofenadine AUC(infinity) was increased by lopinavir/ritonavir, likely due to increased bioavailability secondary to P-glycoprotein inhibition. After repeated administration of lopinavir/ritonavir, the interaction was attenuated compared to the single-dose effect, although a net inhibitory effect was maintained. Time-dependent inhibition of P-glycoprotein by lopinavir/ritonavir should be considered when P-glycoprotein substrates are coadministered.     

洛匹那韦/利托那韦在冠状病毒治疗中的应用

目的：近20年来全球多次发生冠状病毒导致的严重危害公众健康的公共卫生事件，其高的传播效率、严重的感染后果以及捉摸不定的流行时间对人类健康构成严重威胁，而针对冠状病毒的治疗目前暂缺乏特效药物。HIV蛋白酶抑制剂复合制剂洛匹那韦/利托那韦广泛用于HIV的治疗，而用于治疗冠状病毒感染则相对少见。本文着重介绍洛匹那韦/利托那韦的药理作用、药动学特点及在冠状病毒感染治疗中的应用。     

洛匹那韦/利托那韦临床应用概述

洛匹那韦/利托那韦是复方制剂,洛匹那韦与病毒蛋白酶催化部位结合干扰病毒装配过程,低剂量利托那韦抑制人体CYP3A介导洛匹那韦代谢,提高生物利用度,提高血浆中洛匹那韦药物浓度。本文对洛匹那韦/利托那韦在病毒感染性疾病的临床应用、不良反应、药物相互作用等进行介绍。     

洛匹那韦/利托那韦治疗冠状病毒感染的研究进展

洛匹那韦/利托那韦(LPV/r)是国家卫生健康委员会和国家中医药管理局推荐的新型冠状病毒肺炎(COVID-19)抗病毒治疗药物之一。几项体外试验研究结果显示,LPV/r有抑制SARS病毒和中东呼吸综合征(MERS)冠状病毒的作用,但也有研究并未发现其有抑制SARS病毒的活性或活性较弱。2篇文献报道了LPV/r治疗SARS有一定临床疗效,1篇文献报道了LPV/r治疗1例MERS患者取得成功。近来也有少量LPV/r治疗COVID-19的报道,但是均尚缺乏高质量的对照研究。     

Safety of lopinavir/ritonavir for the treatment of HIV-infection

Kaletra, a fixed-dose co-formulation of lopinavir/ritonavir, was the first boosted protease inhibitor developed for the treatment of HIV-infection. In September 2000, the US FDA granted Kaletra fast-track approval as data showed a higher efficacy in the treatment of HIV-infection than standard protease inhibitors of that time. Although potency was of major concern in the early years of highly active antiretroviral therapy (HAART), presently, with the perspective of HIV-infection becoming a chronic but well controllable disease, other issues begin to draw increased attention in the long-term management of HIV-infected patients. Among general health issues such as cardiovascular disease, metabolic disorders or hepatitis co-infection, the long-term toxicity and safety of HAART is an important concern when choosing antiretroviral drugs for each individual patient. In this review, the authors report on the safety of lopinavir/ritonavir in the treatment of HIV-infected patients, and focus on special patient groups and relevant safety issues.     

洛匹那韦逆转LLC/cMOAT细胞多药耐药的作用

目的研究洛匹那韦对LLC/cMOAT细胞株多药耐药的逆转作用及其可能机制。方法采用四甲基偶氮唑盐方法（MTT）检测洛匹那韦对细胞株LLC/CMV和LLC/cMOAT细胞生存的影响,并检测阿霉素（ADM）、长春新碱（VCR）、环磷酰胺（CTX）、顺铂（DDP）对上述细胞株的半数抑制浓度（IC50）。应用流式细胞术检测洛匹那韦处理后细胞内化疗药物阿霉素相关的荧光强度变化。结果 LLC/cMOAT细胞对ADM、VCR、DDP有不同程度的耐药,对CTX未产生耐药;洛匹那韦在浓度小于10.0μmol·L^-1,对LLC/cMOAT细胞无明显细胞毒性作用;用2.5μmol·L^-1洛匹那韦处理后,LLC/cMOAT细胞对VCR和DDP的敏感性增高,浓度提高至5.0μmol·L^-1,敏感性明显提高;用洛匹那韦处理后LLC/cMOAT细胞内ADM的蓄积增加,并表现为浓度依赖;细胞周期检测分析显示,使用洛匹那韦处理0、4、8、16 h后,G1期细胞百分比由（42.65±3.75）%分别增至（56.77±2.37）%、（68.13±4.30）%、（70.25±5.12）%,与0 h G1期细胞数比较差异显著（P〈0.05）;使用洛匹那韦处理细胞48 h后,凋亡率增高且呈时间和浓度依赖性。结论洛匹那韦可以部分逆转LLC-cMOAT的多药耐药,这种逆转可能与增加细胞内化疗药物蓄积,诱导细胞G1期阻滞,增强细胞凋亡有关。     

Alopecia induced by lopinavir plus ritonavir therapy in an HIV patient

The most commonly reported side effects related to lopinavir/ritonavir are diarrhea, vomiting, headache, nausea, and increased serum triglycerides and cholesterol levels. About 4% of the patients prescribed lopinavir/ritonavir stop taking it because of side effects. Alopecia, generally involving the scalp, has been reported in patients with HIV infection treated with indinavir but not with lopinavir/ritonavir. We present a 62-year-old man with HIV infection, stage B2, who experienced alopecia totalis of his scalp, eyebrows, and eyelashes beginning 18 months after initiating antiretroviral treatment including lopinavir/ritonavir. No hair loss on the arms, legs, and pubic area was observed. Our patient's drug regimen consisted of lopinavir/ritonavir, efavirenz, and stavudine; in addition, the patient was receiving treatment for diabetes with glivenclamide and metformin for the last 3 years. These drugs have not been shown to cause alopecia. Alopecia reversed completely 2 months after substituting nelfinavir for lopinavir/ritonavir without any other change of treatment and his eyelashes and eyebrows grew back as well. To our knowledge, this is the second case of lopinavir/ritonavir-associated alopecia totalis reported in the international literature.     

洛匹那韦/利托那韦的不良反应及其机制研究进展

洛匹那韦/利托那韦主要用于人类免疫缺陷（艾滋病）病毒感染的治疗,临床上超说明书用于新型冠状病毒感染的治疗。临床发现使用该药后易引发多种不良反应,主要包括胃肠道反应、肝损伤、代谢紊乱、心血管和神经毒性不良反应。洛匹那韦/利托那韦不良反应机制可能与内质网应激、氧化应激、线粒体应激、细胞凋亡等有关,具有剂量相关性,剂量越高则不良反应越大,主要由肝脏CYP3A代谢,当其与某些具有较强CYP3A4抑制作用的药物共同使用时,往往会加重其不良反应。综述了洛匹那韦/利托那韦片的不良反应及其发生机制,为临床安全、合理用药提供参考。     

Pharmacokinetics of lopinavir after administration of Kaletra in healthy Japanese volunteers

The pharmacokinetic parameters of lopinavir (LPV) were examined by administering Kaletra (LPV+ritonavir) to 8 healthy Japanese volunteers both in the fasting and postprandial conditions. LPV showed a biphasic decline, which was slower in the initial phase and became more rapid in the later phase. The behavior of LPV in the initial phase could be modeled using a one-compartment model with first-order absorption. In the fasting study, calculations based on the pharmacokinetic model revealed that the time to reach the maximum concentration (T(max)), maximum concentration (C(max)), half-life (T(1/2)), lag time, apparent volume of distribution (Vd/F) and oral clearance (Cl/F) were 3.2+/-1.0 h, 6.9+/-1.9 microg/ml, 10.0+/-3.7 h, 0.71+/-0.32 h, 51.0+/-12.4 l and 4.2+/-2.6 l/h, respectively. On the other hand, in the postprandial study, the calculated T(max), C(max), T(1/2), lag time, Vd/F and Cl/F were 5.6+/-2.0 h, 7.6+/-1.8 microg/ml, 16.7+/-7.0 h, 2.35+/-0.78 h, 48.0+/-15.9 l and 2.1+/-0.6 l/h, respectively. The values for the area under the curve for data collected over a 24-h period (AUC(24 h)) in the fasting and postprandial studies were 86.0+/-27.7 and 102.1+/-31.0 microg.h/ml, respectively. The T(1/2) had a tendency to be prolonged after food intake, but there were 2 cases with shortened T(1/2). Food intake prolonged the lag time 3-fold and as a result, the postprandial T(max) was 2 times longer.     

A bioequivalence study comparing two formulations of lopinavir/ritonavir capsules

This investigation was carried out to evaluate the bioavailability of a new single fixed-dose combination formulation of lopinavir and ritonavir, relative to reference product, Kaletra (133.3 mg lopinavir/33.3 mg ritonavir) capsules, manufactured by Abbott Laboratories, Chicago, IL, USA. The bioavailability study was carried out on 72 healthy male and female volunteers who received a single dose of 3 capsules (133.3 mg lopinavir/33.3 mg ritonavir) of the test (T) and the reference (R) products in the fasting state, in a randomized, balanced, 2-way crossover design. After dosing, serial blood samples were collected for a period of 72 hours. Plasma harvested from blood was analyzed for lopinavir and ritonavir by a sensitive and validated simultaneous liquid-chromatographic and mass-spectrometric (LC-MS/MS) assay. Mean oral clearance (Cl/F) values of the FDC were 4.92 and 23.54 l/h for lopinavir and ritonavir, respectively, the maximum plasma concentrations (C(max)), area under the plasma concentration-time curve up to the last measurable concentration (AUC(0-t)), and to infinity (AUC(0-infinity)), were analyzed statistically under the assumption of a multiplicative model. The time to maximum concentration (t(max)) was analyzed assuming an additive model. The parametric confidence intervals (90%) were calculated by Schuirmann's two 1-sided t-test criteria. It was found that the test/reference (T/R) ratios for the pharmacokinetic parameters AUC(0-t), AUC(0-infinity) and C(max) (after initial log transformation) were well within the bioequivalence acceptance range of 80-125% as per international regulatory guidelines. Therefore, the two formulations were considered to be bioequivalent [Food and Drug Administration 2003].     

Apparent mechanism-based inhibition of human CYP3A in-vitro by lopinavir

The influence of the viral protease inhibitor lopinavir on the activity of six human cytochrome P450 (CYP) enzymes was evaluated in a model system using human liver microsomes. Column chromatography methodology was developed to separate lopinavir from ritonavir starting from the commercially available lopinavir-ritonavir combination dosage form. Lopinavir produced negligible or weak inhibition of human CYP1A2, 2B6, 2C9, 2C19 and 2D6. However, lopinavir was an inhibitor of CYP3A. At 250 microM triazolam (the CYP3A index substrate), the mean (+/- s.e., n = 4) IC50 versus triazolam alpha-hydroxylation (where IC50 is the concentration producing a 50% decrement in reaction velocity) was 7.3 (+/- 0.5) microM. Pre-incubation of lopinavir with microsomes prior to addition of triazolam yielded a significantly lower IC50 of 4.1 (+/- 0.5) microM. This is consistent with mechanism-based inhibition of human CYP3A by lopinavir. Although lopinavir is less potent than ritonavir as an inhibitor of CYP3A, lopinavir is nonetheless likely to contribute to net CYP3A inhibition in-vivo during treatment with the lopinavir-ritonavir combination.     

唐草片对洛匹那韦在大鼠体内药代动力学的影响

本研究利用大鼠模型探索抗艾滋病辅助治疗中成药唐草片对抗病毒药洛匹那韦药代动力学的影响。大鼠随机分为洛匹那韦组（36 mg/kg）和唐草片联用洛匹那韦组（LPV：36 mg/kg,Tang herb：864 mg/kg）,灌胃给药,高效液相色谱法测定给药前后0,0.5,1,2,4,8,10,12,14,16,22小时的血药浓度,计算药动学参数。结果显示：唐草片与洛匹那韦合并用药后,洛匹那韦的峰浓度Cmax和曲线下峰面积AUC显著提高（P〈0.05）、半衰期t1/2z和达峰时间Tmax延长（P〉0.05）。本研究提示唐草片可延迟洛匹那韦的吸收、推迟达峰时间、提高生物利用度,具体作用机制需要深入研究,临床用药需要考虑相互作用。