伏立康唑的药动学/药效学及其药物监测

伏立康唑为新一代三唑类抗真菌药,抗菌谱广,抗菌作用强,主要用于治疗患有进展性、可能威胁生命的真菌感染的患者。其药动学呈非线性,个体差异大。本文对伏立康唑药动学影响因素,药动学/药效学特性,血药浓度与治疗效果、不良反应间关系以及不同类患者伏立康唑药物监测作一综述,以指导临床制定个性化给药方案,提高药物治疗效果。     

伏立康唑在肾移植患者中的群体药动学研究

目的：建立肾移植患者服用伏立康唑的群体药动学（PopPK）特征,探究影响伏立康唑药动学参数的因素,为临床个体化给药提供依据。方法：回顾性收集84例肾移植患者进行治疗药物监测的谷浓度和生理病理资料,利用Phoenix NLME软件建模,并用VPC法和Bootstrap法进行内部验证。结果：肾移植患者的伏立康唑的药动学特征符合一级消除一室模型,最终PopPK模型为：表观分布容积V（L）=183.69×[1+（HGB-98）×0.016]×exp（η_V）,清除率CL（L·h^-1）=7.24×[1+（ALB-36）×0.037]×exp（η_CL）。结论：血红蛋白（HGB）对V有显著影响,白蛋白（ALB）对CL有显著影响,所建PopPK模型较稳定,可以较好地描述肾移植患者伏立康唑的药动学特征。     

伏立康唑的体外及体内药动学研究进展

目的:为伏立康唑的临床应用提供理论依据和指导。方法:采用文献综述法,对伏立康唑临床前和临床药动学研究所涉及的生物样品预处理技术、动物和人体内分析方法、临床前和临床药动学予以综述。结果与结论:样品预处理与体内分析的新方法、新技术联用,提高了伏立康唑体内定性、定量分析和检测的灵敏度、选择性,确保了药动学参数的准确性和可靠性,对设计更合理的给药途径、给药剂量和临床应用具有指导意义。     

伏立康唑个体化给药研究进展

伏立康唑是目前临床用于治疗一些真菌感染的首选药物,其药动学复杂多变且受多种因素的影响。本文阐述了影响伏立康唑代谢的重要因素,包括药物相互作用、CYP2C19的基因多态性、炎症状态;总结了各国指南中对伏立康唑TDM指征、有效浓度范围、剂量调整等方面的推荐;并对不同人群中伏立康唑应用的研究进行了探讨。本文旨在推进伏立康唑个体化给药。     

利奈唑胺群体药动学的文献分析

利奈唑胺是临床常用的抗革兰氏阳性菌感染药物,其个体间药动学差异大。本文通过查阅当前发表的利奈唑胺群体药动学文献,提取建模相关信息并进行分析归纳与综述,以期为利奈唑胺的临床用药提供参考。相关文献表明利奈唑胺代谢的主要影响因素为体重、年龄、肌酐清除率和肾小球滤过率,临床制订给药方案时应优先考虑这些因素。     

质子泵抑制药药动学的研究进展

质子泵抑制药(PPIs)是临床中主要的抑酸药,奥美拉唑、埃索美拉唑、兰索拉唑、泮托拉唑、雷贝拉唑等PPIs在药动学方面存在很大的差异(如生物利用度、代谢型、药物的相互作用、生物特异性等方面)。近年来,有很多文献报道了P450酶(CYP)代谢对PPIs的药动学影响。临床证据证明PPIs安全有效,但仍有很多患者对PPIs耐药,所以在实践中应该选择性应用PPIs。     

中药药动学研究进展

中药药动学是近10余年才迅速发展起来的药学新领域,主要研究中药单体、单方、复方在体内过程动态变化的规律,并将研究结果用数学方程和相关药动学参数来表达,反映了药物在体内的吸收、分布、代谢和排泄过程,具有整体、综合、动态和定量的特点。影响其特征的主要因素包括个体差异、年龄、疾病和生理等方面。其研究对阐明中药的药效物质基础、组方原理、作用机制,指导中药新制剂的研究和促进临床合理用药等方面都具有重要意义。目前,中药药动学研究方法主要有体内药物浓度法和生物效应法两大类。体内药物浓度法主要适用于有效成分明确的中药;…     

伏立康唑及其临床应用

伏立康唑是最新上市的第2代三唑类广谱抗真菌药物,能有效抑制真菌羊毛甾醇14α去甲基化酶,阻断麦角甾醇生物合成,从而影响细胞膜的流动性、通透性,在体内、外具有广泛的抗真菌活性临床研究结果表明,伏立康唑可用于念珠菌感染和其他药物治疗无效的克柔念珠菌及烟曲菌感染。本文综述了伏立康唑的药效学、药动学特性及临床应用等研究进展。     

Bayesian反馈法估算静脉输注伏立康唑的群体药动学参数

目的用Bayesian反馈法估算临床患者静脉输注伏立康唑的群体药动学(PPK)参数。方法收集静脉输注给药不同时间后的血样,采用HPLC法测定伏立康唑血药浓度,用Bayesian反馈法估算PPK参数。结果以二室模型拟合伏立康唑的药动学过程,得PPK参数为Vss为(46.58±19.35)L,CL为(4.76±2.64)L/h,k10为(0.187±0.006)h-1k,12为(4.97±0.02)h-1,k21为(0.895±0.308)h-1。结论此PPK模型能够较准确地描述伏立康唑在临床患者静脉输注的药动学特征,其预测能力尚待进一步评估。     

伏立康唑白蛋白纳米粒大鼠体内药动学与组织分布

摘 要 目的：制备伏立康唑白蛋白纳米粒,并考察其在大鼠体内药动学与及组织分布。 方法: 采用超高压微射流技术制备伏立康唑白蛋白纳米粒,并评价了白蛋白纳米粒的粒径分布、Zeta电位、外观形态以及体外释药行为;考察了伏立康唑白蛋白纳米粒在大鼠体内的药动学与组织分布特征。 结果: 本研究制备的伏立康唑白蛋白纳米粒平均粒径为（121.9±41.6）nm,PdI为0.197,Zeta电位为（-42.1±0.9）mV,呈球形或类球形分布;伏立康唑白蛋白纳米粒在0.5%吐温80磷酸盐缓冲液（pH 7.4）中24 h累积释放67.5%;大鼠体内药动学研究表明,伏立康唑白蛋白纳米粒和伏立康唑注射剂的AUC0-24分别为（98.27±1.42）和（105.32±1.45）g?h?L^-1,MRT0-24分别为（4.48±0.38）和（4.86±0.51）h;伏立康唑白蛋白纳米粒能增加药物在大鼠肝、脾、脑中的靶向性。 结论:伏立康唑白蛋白纳米粒在大鼠体内具有良好的肝、脾、脑中靶向性,可以提高药物治疗疗效。     

Quantitative clinical pharmacology practice for optimal use of antibiotics during the neonatal period

Introduction: For safe and effective neonatal antibiotic therapy, knowledge of the pharmacokinetic parameters of antibacterial agents in neonates is a prerequisite. Fast maturational changes during the neonatal period influence pharmacokinetic and pharmacodynamic parameters and their variability. Consequently, the need for applying quantitative clinical pharmacology and determining optimal drug dosing regimens in neonates has become increasingly recognized.

Areas covered: Modern quantitative approaches, such as pharmacometrics, are increasingly utilized to characterize, understand and predict the pharmacokinetics of a drug and its effect, and to quantify the variability in the neonatal population. Individual factors, called covariates in modeling, are integrated in such approaches to explain inter-individual pharmacokinetic variability. Pharmacometrics has been shown to be a relevant tool to evaluate, optimize and individualize drug dosing regimens.

Expert opinion: Challenges for optimal use of antibiotics in neonates can largely be overcome with quantitative clinical pharmacology practice. Clinicians should be aware that there is a next step to support the clinical decision-making based on clinical characteristics and therapeutic drug monitoring, through Bayesian-based modeling and simulation methods. Pharmacometric modeling and simulation approaches permit us to characterize population average, inter-subject and intra-subject variability of pharmacokinetic parameters such as clearance and volume of distribution, and to identify and quantify key factors that influence the pharmacokinetic behavior of antibiotics during the neonatal period.     

Epidemiology and characteristics of adverse drug reactions caused by drug–drug interactions

Introduction: Drug–drug interactions (DDIs) arise in numerous different ways, involving pharmacokinetic or pharmacodynamic mechanisms. Adverse drug reactions are a possible consequence of DDIs and health operators are often unaware of the clinical risks of certain drug combinations. Many papers on drug interactions have been published in recent years, but most of them focused on potential DDIs while few studies have been conducted on actual interactions.

Areas covered: This paper reviews the epidemiology of actual DDIs in outpatients as well as in hospital settings and in spontaneous reporting databases. The incidence of actual DDIs is consistently lower than that of potential DDIs. However, the absolute number of patients involved is high, representing a significant proportion of adverse drug reactions. The importance of risk factors such as age, polypharmacy and genetic polymorphisms is also evaluated. The relevance and efficacy of tools for recognizing and preventing DDIs are discussed.

Expert opinion: Potential DDIs far outnumber actual drug interactions. The potential for an adverse interaction to occur is often theoretical, and clinically important adverse effects occur only in the presence of specific risk factors. Several studies have shown the efficacy of computers in early detection of DDIs. However, a correct risk–benefit evaluation by the prescribing physician, together with a careful clinical, physiological and biochemical monitoring of patients, is essential. Future directions of drug interaction research include the increasing importance of pharmacogenetics in preventing DDIs and the evaluation of interactions with biological drugs.     

Recent advances of siRNA delivery by nanoparticles

Introduction: The field of RNA interference technology has been researched extensively in recent years. However, the development of clinically suitable, safe and effective drug delivery vehicles is still required.

Areas covered: This paper reviews the recent advances of non-viral delivery of small interfering RNA (siRNA) by nanoparticles, including biodegradable nanoparticles, liposomes, polyplex, lipoplex and dendrimers. The characteristics, composition, preparation, applications and advantages of different nanoparticle delivery strategies are also discussed in detail, along with the recent progress of non-viral nanoparticle carrier systems for siRNA delivery in preclinical and clinical studies.

Expert opinion: Non-viral carrier systems, especially nanoparticles, have been investigated extensively for siRNA delivery, and may be utilized in clinical applications in the future. So far, a few preliminary clinical trials of nanoparticles have produced promising results. However, further research is still required to pave the way to successful clinical applications. The most important issues that need to be focused on include encapsulation efficiency, formulation stability of siRNA, degradation in circulation, endosomal escape and delivery efficiency, targeting, toxicity and off-target effects. Pharmacology and pharmacokinetic studies also present another great challenge for nanoparticle delivery systems, owing to the unique nature of siRNA oligonucleotides compared with small molecules.     

Pharmacotherapy of the third-generation AEDs: lacosamide,retigabine and eslicarbazepine acetate

Introduction: The search for new, more effective antiepileptic drugs (AEDs) continues. The three most recently approved drugs, the so-called third-generation AEDs, include lacosamide, retigabine and eslicarbazepine acetate and are licensed as adjunctive treatment of partial epilepsy in adults.

Areas covered: For the above three AEDs, their mechanisms of action, pharmacokinetic characteristics, drug–drug interactions, pharmacotherapeutics, dose and administration and therapeutic drug monitoring are reviewed in this paper.

Expert opinion: Lacosamide and retigabine act through novel mechanisms, while eslicarbazepine acetate, a pro-drug for eslicarbazepine, acts in a similar manner to several other AEDs. All three AEDs are associated with linear pharmacokinetic and rapid absorption and undergo metabolism. Their drug–drug interaction profile is low (lacosamide and retigabine) to modest (eslicarbazepine) in propensity. At the highest approved doses for the three AEDs, responder rates were similar. The most commonly observed adverse effects compared with placebo were dizziness, headache, diplopia and nausea for lacosamide; dizziness, somnolence and fatigue for retigabine and dizziness and somnolence for eslicarbazepine acetate. The precise role that these new AEDs will have in the treatment of epilepsy and whether they will make a significant impact on the prognosis of intractable epilepsy is not yet known and will have to await further clinical experience.     

Role of transport proteins in drug discovery and development: a pharmaceutical perspective

1.?This review will explore, from a pharmaceutical industry perspective, the evidence and consequences of transport protein involvement in pharmacokinetic variability and safety of drugs in humans. With the preclinical and clinical evidence available, the transport proteins that are considered to be the most important in respect of pharmacokinetic variability and safety in humans will be highlighted.

2.?A large number of transport proteins have been identified, at both the genetic and the cellular level, which have been suggested to play some role in the absorption, distribution or elimination of endogenous, xenobiotic or drug substrates.

3.?The weight of evidence suggests that only a small number of transport proteins need to be routinely considered in the drug-discovery setting driven by the magnitude of their impact on tissue distribution, pharmacokinetic variability and drug–drug interactions.

4.?For the majority of candidate drugs, an assessment of the role of transporter proteins in their disposition and safety need only be assessed if in vivo properties suggest that active transport is likely to be a significant factor, if transport proteins are implicated in a particular therapeutic target area or if the disposition and safety of a likely co-medication are known to be significantly modulated by transport proteins.     

卡培他滨在结直肠癌患者中的群体药动学研究

目的评价卡培他滨在肠癌患者的群体药动学特征及可能的影响因素。方法选取56例肠癌(包括结肠癌及直肠癌)患者为研究对象,餐后单次口服卡培他滨0.6g(0.15g×4片)后进行多点采集血样,以高效液相色谱-质谱联用法(HPLC-MS/MS)检测受试者给药后血浆中的卡培他滨的血药浓度,以非线性混合效应模型及程序(NONMEM)对检测数据进行分析,建立卡培他滨群体药动学模型并获得其群体药动学参数。结果最终模型为一级吸收和消除的一室模型,模型的药动学参数群体典型值为:清除率(CL)为265 L/h,表观分布容积(V)为329 L,吸收速率常数(Ka)为2.15 h~(-1)。人口统计学因素(年龄、性别、体质量等)及肝肾清除相关因素(肌酐清除率、胆红素及白蛋白等)对卡培他滨的清除均无显著性影响。结论所得模型稳定,能较好地拟合卡培他滨在肠癌患者的的群体药动学特征,可用于临床个体化给药方案的制订。     

Impact of preformulation on drug development

Introduction: Preformulation assists scientists in screening lead candidates based on their physicochemical and biopharmaceutical properties. This data is useful for selection of new chemical entities (NCEs) for preclinical efficacy/toxicity studies which is a major section under investigational new drug application. A strong collaboration between discovery and formulation group is essential for selecting right NCEs in order to reduce attrition rate in the late stage development.

Areas covered: This article describes the significance of preformulation research in drug discovery and development. Various crucial preformulation parameters with case studies have been discussed.

Expert opinion: Physicochemical and biopharmaceutical characterization of NCEs is a decisive parameter during product development. Early prediction of these properties helps in selecting suitable physical form (salt, polymorph, etc.) of the candidate. Based on pharmacokinetic and efficacy/toxicity studies, suitable formulation for Phase I clinical studies can be developed. Overall these activities contribute in streamlining efficacy/toxicology evaluation, allowing pharmacologically effective and developable molecules to reach the clinic and eventually to the market. In this review, the magnitude of understanding preformulation properties of NCEs and their utility in product development has been elaborated with case studies.     

Pharmacokinetic consequences of time-dependent inhibition using the isolated perfused rat liver model

Mathematical models exist to describe the pharmacokinetic changes caused by time-dependent inhibition (TDI) and these have been reported to predict accurately for several marketed drugs. However, their robustness using in-depth, carefully controlled pre-clinical studies has yet to be established. In the current study, the isolated perfused rat liver was employed to investigate the effects of TDI under carefully controlled conditions. A five-compartmental model was used to describe the observed data and bring context to in vitro TDI data (k_inact and K_I). Co-administration of midazolam with troleandomycin, mifepristone, erythromycin and the discovery compound, AZ-X, increased midazolam area under the curve (AUC) 3.2-, 2.5-, 1.6- and 1.0-fold, respectively, compared with AUC increases of 1.8-, 1.4-, 1.2- and 1.1-fold predicted by the model. These experimental findings, whilst modest in overall effect, support the use of this model in the rat and it is proposed that projections can be made for the likely clinical impact of novel time-dependent inhibitors in man based on predicted human pharmacokinetics and TDI potency determined in vitro.     

Clinical pharmacokinetics of panobinostat,a novel histone deacetylase (HDAC) inhibitor: review and perspectives

1.?Panobinostat is a recently approved histone deacetylase (HDAC) inhibitor.

2.?The pharmacokinetic data of panobinostat in patients with hematologic malignancies and advanced solid tumors have been collated and reviewed from the various published clinical studies for over a decade. Further perspectives and anticipated challenges in the clinical therapy with panobinostat are discussed in the review.

3.?Regardless of intravenous or oral dosing, panobinostat showed a high degree of inter-patient variability in the pharmacokinetics. After oral administration, most of the administered dose is extensively metabolized and the metabolites are either fecally or renally excreted with trace amount of intact panobinostat. Both cytochrome p450 (CYP) 3A4 and non-CYP mechanisms govern the clearance of panobinostat. CYP3A4-related drug–drug interactions with panobinostat have been documented with ketoconazole (inhibitor) and dexamethasone (inducer).

4.?In summary, the clinical pharmacokinetic data of panobinostat, a promising HDAC inhibitor, obtained from various clinical studies do not appear to limit the utility of panobinostat in the clinic.     

The effect of antibiotics on bone healing: current evidence

Introduction: Bone healing is a complex cascade of events that involves the proliferation and differentiation of osteoblastic cells under the influence of signals from growth factors, cytokines and mechanical loading. Several medications have been found to interact negatively with this process including cytostatics, NSAIDs and corticosteroids; however, the effect of antibiotics on bone repair processes remains obscure.

Areas covered: The authors offer a comprehensive review of the existing literature on the in vivo and in vitro effect of antibiotics on bone, bone cells and fracture healing. The authors describe the pharmacokinetic characteristics of antibiotics after parenteral administration as well as their levels when applied locally together with a delivery vehicle.

Expert opinion: The available experimental data and clinical evidence are rather limited to allow safe conclusions. In vitro studies indicate that high doses administered after systemic administration have little or no direct effect on bone cells. Further studies are desirable to define the effect of higher or prolonged concentrations on bone biology and especially that of high concentrations released by locally implanted antibiotic-delivery systems, that is, bone cement, spacers and beads.