Serum theophylline levels in asthmatic children receiving sustained-release theophylline tablets

Serum theophylline levels produced in asthmatic children by sustained-release theophylline tablets (TheoDur) were studied. Nineteen patients received for 14 days a dose of 5.5 to 13.1 mg/kg (mean 9.1 mg/kg) of amhydrous theophylline (as sustained-release TheoDur tablets) every 12 hours. Theophylline serum levels were assayed, by cation-exchange high-performance liquid chromatography, immediately before and at 4, 6 and 10 hours after the first day-five dose. Symptoms of asthma and theophylline toxicity were recorded. Mean peak-trough difference for the 6-to-10-years age group (4.5 +/- 1.6 microgram/ml) was not significantly different than that of the 11-to-17-year age group (5.2 +/- 3.2 micrograms/ml) (p greater than 0.1). Therapeutic serum theophylline levels (8 to 20 micrograms/ml) were maintained throughout a 12-hour period in 12 patients. Two patients had side effects possibly attributable to theophylline. Four patients reported asthamtic symptoms on two or more evenings; none required emergency treatment. The study suggests that sustained-release theophylline tablets administered every 12 hours can maintain therapeutic serum levels in children.     

Pharmacokinetics of a sustained-release theophylline formulation.

1 Plasma theophylline concentrations following administration of sustained-release (SR) theophylline tablets were determined in ten healthy volunteers using a dose of 190 mg or 380 mg 12 hourly. 2 The plasma theophylline levels during the first 12 h period confirmed the sustained-release formulation characteristics, with the plasma drug concentrations reaching a plateau for the last 6 hours. 3 During the fifth 12 h dosing period the mean maximum and minimum plasma theophylline concentrations were 7.25 and 4.30 microgram/ml after 190 mg SR theophylline 12 hourly (n = 6) and 12.96 and 7.36 microgram/ml after 380 mg 12 hourly (n = 5), although there was marked between-subject variation in plasma theophylline concentrations. 4 One subject withdrew from the study due to side effects, which were more common when the higher dose of SR theophylline was given.     

Conversion from intravenous to sustained-release oral theophylline in pediatric patients with asthma

A method for converting pediatric patients from intravenous aminophylline to sustained-release oral theophylline was evaluated in eight asthmatic children. The administration of Theo-Dur tablets two hours before discontinuation of a continuous intravenous aminophylline infusion resulted in a peak rise of 5.6 +/- 3.0 micrograms/ml over steady-state serum theophylline concentrations. This method of conversion is acceptable in children with equivalent oral and intravenous doses of theophylline and serum theophylline concentrations less than 15 micrograms/ml. Children with steady-state theophylline concentrations greater than 15 micrograms/ml are likely to develop concentrations exceeding the therapeutic range using this conversion method.     

Comparison of the plasma concentrations and efficacy of mexiletine and of a slow-release preparation of mexiletine in patients admitted to a coronary care unit

We determined if therapeutic plasma concentrations of mexiletine (0.75-2.0 microgram/ml) could be maintained in patients admitted to a coronary care unit by twice daily dosing of a new slow-release (S.R.) formulation of mexiletine. Twenty patients, 14 with acute myocardial infarction, entered the first study and received either 250 mg conventional mexiletine at 0.8, and 14 h or 360 mg S.R. mexiletine at 0 and 12 h each day for 7 days. Blood samples were taken daily for measurement of plasma mexiletine concentrations. A continuous 24 -h ECG recording was obtained in all patients between days 3 and 6. The mean plasma concentration was greater on all days in the group that received conventional mexiletine; these differences were most marked during the first 15 h on day 1. The mean trough values on days 2-7 were in the range 0.73-1.22 microgram/ml after mexiletine and 0.63-1.17 microgram/ml after S.R. mexiletine. The incidence of ventricular arrhythmias was the same in the two groups; side effects were less common in the group receiving S.R mexiletine. Since the plasma concentration increased slowly during day 1 with S.R. mexiletine, a second study was carried out in 19 similar patients who received 360 mg S.R. mexiletine, 720 mg S.R. mexiletine, or 360 mg S.R. mexiletine and 250 mg conventional mexiletine and 12 h later 360 mg S.R. mexiletine. The plasma concentration increased most rapidly after the third regime, reaching 0.97 +/- 0.09 microgram/ml at 3 hours. These results show that therapeutic plasma concentrations of mexiletine can be maintained by the 12-hourly administration of 360 mg S.R. mexiletine, but that an additional loading dose of 250 mg mexiletine increases the plasma concentration more rapidly.     

Investigation of diurnal changes in the disposition of theophylline

The mechanism of observed temporal variations in plasma theophylline concentrations has been investigated. Eight healthy volunteers were given both oral and intravenous doses of theophylline (5 mg/kg) at 09.00 h and 21.00 h under controlled conditions. Regular plasma concentration measurements were made following each dose in order to determine the diurnal and nocturnal disposition of the drug. Plasma theophylline concentrations at 0.5 h following each oral dose were 6.9 +/- 0.8 micrograms/ml, a.m., and 3.9 +/- 0.6 microgram/ml, p.m. (P less than 0.05). Time to peak concentration was 1.69 +/- 0.28 h, a.m.; 2.13 +/- 0.23 h, p.m. (P less than 0.05). Values for ka were not significantly different, however. Overall bioavailability, volume of distribution and systemic clearances, calculated for the 12 h period after each dose, did not differ significantly between day and night. Diurnal variations in theophylline disposition do not appear to be the result of changes in metabolism or excretion, but may reflect minor differences in absorption.     

Plasma concentrations of isosorbide dinitrate after oral administration of a sustained-release formulation to human subjects

1. A peak of mean plasma concentrations of isosorbide dinitrate of 5.8 ng/ml was reached at 0.5 h after a single oral dose of 5 mg in a standard tablet formulation. Thereafter mean concentrations declined with a half-life of about 48 min. 2. A peak of mean concentrations of isosorbide dinitrate of 3.2 ng/ml was reached at 2--4 h after a single oral dose of 20mg in a sustained-realease capsule formulation (Iso Mack Retard). Thereafter mean concentrations declined by about twofold during 6 h and were still detectable at 12 h after dosing. 3. When corrected by dose/bodyweight variations, the mean area under the isosorbide dinitrate plasma concentration curve from the sustained-release capule was 76% of that from the standard tablet and this formulation-related difference in bioavailability was statistically significant (p less than 0.05). 4. The results showed that sustained-release formulation is a useful way to maintain plasma concentrations of isosorbide dinitrate for several hours.     

A new sustained-release theophylline suspension for asthmatic children: evaluation of serum theophylline concentrations

Theophylline level variability obtained with standard slow-release theophylline tablets was compared to that obtained with a new sustained-release theophylline suspension in asthmatic children. The sustained-release preparations were administered every 12 hours and serum samples were collected after ten days of treatment during the steady-state period. In this crossover study, the sequence of the two regimens (slow-release tablets versus slow-release suspension) was selected at random. Both preparations of theophylline were administered at a mean dosage (+/- s.d.) of 19.3 +/- 1 mg/kg/day. The results of our study demonstrated that theophylline serum levels remain within the therapeutic range for both preparations, but there was a greater fluctuation with theophylline suspension compared to the tablets. The tolerability of the two drugs was satisfactory.     

Evaluation of the absorption from three ibuprofen formulations

The pharmacokinetic differences between two sustained-release 300 mg (A) and 400 mg (B) formulations and a rapid-release 400 mg ibuprofen conventional sugar-coated formulation (C) were compared after a single dose. Mean peak levels of 25.1 micrograms/ml for preparation A (2 X 300 mg), 31.3 micrograms/ml for preparation B (2 X 400 mg) and 68.5 micrograms/ml for preparation C (2 X 400 mg) were reached at 5.3, 3 and 2 hours respectively, after ingestion of the drugs. The individual plasma-level time-profiles for the majority of doses suggested prolonged absorption of product A and B. The absorption from formulations A and B was significantly slower (p less than 0.001 and p less than 0.05 respectively) than that from the conventional tablets. The bioavailability of ibuprofen from sustained-release capsules, was not found to differ significantly from that of ibuprofen from conventional tablets. The relative bioavailability was very close to 100% in almost all subjects (coefficient of variation 14% and 17%). Projections of plasma concentrations upon multiple dosing were made from single dose data. The dosage interval concentration ratio which reflects both the frequency and the entry of the drug into and from the body was much lower for sustained-release formulations (A: 3.0; B: 3.7; C: 12.9).     

Plasma level and broncholytic effect of choline theophyllinate after a single dose of a press- coated tablet formulation

Summary The broncholytic effect and plasma concentrations of theophylline in 10 asthmatic patients were studied for 8 hours after a single dose of 600 mg choline theophyllinate in press-coated 200 mg tablets. Therapeutic concentrations of theophylline were rapidly achieved and the plasma peak averaged 10.4 µg/ml after 2 hours. The broncholytic effect was closely related to the plasma level of theophylline. The largest change was in FEV₁, which was significantly increased 1 to 6 hours after the dose. No patient complained of adverse effects. A theophylline concentration of 7 µg/ml plasma was adequate for a broncholytic effect, but a higher level was required for a maximal response. The results provide a basis for further studies to establish a dosage schedule suitable for prolonged therapy.     

Studies of rokitamycin in pediatrics

Pharmacokinetic, bacteriological and clinical studies on a new macrolide antibiotic, rokitamycin (RKM) dry syrup for pediatric use, were done, and results as summarized below were observed: 1. Five children with ages between 6 and 10 years were administered orally with RKM at a dose level of 10 mg/kg either at 30 minutes before or 30 minutes after meal on a crossover design, and plasma concentrations and urinary excretion rates of the drug were measured. Plasma concentrations of RKM following the administration before meal were 0.50 microgram/ml at 1/2 hour, 0.43 microgram/ml at 1 hour, 0.15 microgram/ml at 2 hours, 0.03 microgram/ml at 4 hours, and not detectable at 6 hours. Plasma concentrations following the administration after meal were 0.11 microgram/ml at 1/2 hour, 0.15 microgram/ml at 1 hour, 0.09 microgram/ml at 2 hours, 0.03 microgram/ml at 4 hours, and not detectable at 6 hours. The 0-6 hour urinary recovery rates were 1.41% following the administration before meal, and 0.93% following the administration after meal. These results suggested that the drug might be absorbed more rapidly, giving a higher plasma concentration, when administered before meal than when administered after meal. Changes in plasma concentrations of RKM following the administration of 10 mg/kg before meal were similar to those of two 100 mg RKM tablets (TMS-19-Q.GC tablets) to adult patients. Therefore, it seemed optimal to administer 10 mg/kg 3 times daily at fasting to children as a rule.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of methods for determining unbound theophylline concentrations

In order to determine the suitability of using tears and saliva to estimate theophylline concentrations, simultaneous plasma, tear, and saliva samples were obtained in 22 adult male patients taking theophylline. Unbound theophylline concentrations were determined by equilibrium dialysis for nine of the subjects and compared with the concentrations determined in saliva and tears. The mean tear/unbound and saliva/unbound ratios were 0.94 +/- 0.12, r = 0.88, and 1.25 +/- 0.14, r = 0.91, respectively. Tear/plasma ratios ranged from 0.36 to 0.76 (mean 0.58 +/- 0.11), and tear concentrations correlated well with plasma concentrations (r = 0.94). Saliva/plasma ratios ranged from 0.52 to 1.16 (mean 0.79 +/- 0.19), and there was a positive correlation between plasma and saliva concentrations (r = 0.84). The mean tear/unbound and saliva/unbound ratio predicted the unbound concentration within 1 microgram/ml in 50 and 78% of the cases, respectively. Saliva and tears have limited clinical value in estimating the unbound concentration of theophylline.     

Naloxone pharmacokinetics in the newborn.

1 Plasma naloxone levels were determined by RIA over a period of 6--36 h in three groups of neonates, (1) those given 35 microgram i.v. (n = 6), (2) those given 70 microgram i.v. (n = 6) and (3) those given 200 microgram i.m. (n = 17) naloxone HCl within 1 min of birth. 2 After intravenous administration of 35 and 70 microgram of naloxone peak levels of 4--15 ng/ml and 9--20 ng/ml respectively were reached in 5--40 min and the mean plasma half-life after both doses was 3.1 +/- 0.5 h. 3 Peak levels of 7--35 ng/ml were reached 0.5 to 2 h after intramuscular administration of 200 microgram. The fall in concentration after this was consistently biphasic with the levels declining rapidly between one and four hours and then slowly from four hours onwards. 4 Plasma levels at 24--36 h after i.m. administration were as high as they were 4 h after i.v. administration of 35 microgram and this may account for the prolonged duration of action when this route is used.     

Plasma theophylline concentrations following the oral administration of microcrystalline theophylline and a new sustained-release theophylline preparation to normal subjects

Summary Plasma theophylline concentrations have been measured in 14 normal subjects following the oral administration of a microcrystalline theophylline preparation (MT) 187.5 mg every 6 h and a sustained-release theophylline preparation (SRT) 375 mg every 12 h for 5 days. During the 5 days, blood samples were drawn before and 2 h after each morning dose with MT, and before and 4.5 h after each morning dose of SRT. On days 1 and 5, more frequent samples were taken during the dose interval. With both preparations, steady-state plasma concentrations were achieved by the third day. The trough levels were significantly higher with SRT than with MT on days 3 and 4, and the levels at 4.5 h after SRT were significantly higher than those measured 2 h after MT on days 3, 4 and 5. Over the terminal 3 days of the study, mean theophylline concentrations with SRT ranged between 11.2 and 15.5 µg/ml at measured trough and peak times, whereas the mean trough levels with MT were always below 10 µg/ml. With adjustment for the dosage differences, the mean ratio of the areas under the plasma concentration/time curves for the final dosage interval for the two formulations (AUC_SRT/AUC_MT) was 1.29±0.56, suggesting that the SRT preparation was well absorbed. The mean steady-state plasma theophylline concentrations (AUC/dose interval) on day 5 were 11.5±4.7 µg/ml with MT and 13.7±5.7 µg/ml with SRT. Nine subjects experienced a total of 35 side-effects whilst taking MT, compared with 10 subjects complaining of 23 side-effects on SRT. These results indicate that, in normal subjects, SRT 375 mg every 12 h exhibited satisfactory sustained-release properties and achieved adequate mean plasma theophylline concentrations during chronic administration. It produced higher plasma levels and a lower incidence of side-effects than the same daily dose of MT.     

Oral forms of the oxime HI-6: a study of pharmacokinetics and tolerance after administration to healthy volunteers

New pharmaceutical formulations of the oxime HI-6 as sustained-release and conventional tablets were studied in healthy volunteers. Twenty-six subjects, divided into 3 groups, received 3784 mg or 7568 mg doses of HI-6 conventional tablets or 4027 mg of the oxime in the form of sustained-release tablets. Peak plasma concentrations of HI-6 were reached within 0.6 h (10.2 mumol/l) and 1.6 h (21.4 mumol/l) following the ingestion of conventional tablets. Elimination half-lives were similar (1.7 h and 1.3 h) and the respective urinary recoveries amounted to 3.2% and 2.9%. After the administration of sustained-release tablets of HI-6, maximal concentration (8.8 mumol/l) was attained in 2.2 h, elimination half-life was 1.9 h and 4.2% of the dose was excreted unchanged in urine. Undesirable side effects were not reported by the subjects or revealed by clinical or laboratory tests. The results indicate low bioavailability of the oral formulations of HI-6 in man.     

Quinidine dosage, with special reference to an oral loading dose schedule.

1 Plasma concentrations of quinidine were analyzed in 52 cardiac patients after different oral loading doses and during different maintenance dosage intervals using both conventional and sustained release preparations of quinidine. 2 The majority of patients reached therapeutic plasma concentrations in the order of 2--4 microgram/ml within 3 h after the loading dose of 600--800 mg of rapidly absorbed ordinary quinidine sulphate tablets and institution of maintenance therapy with sustained release tablets 1 h after the loading dose. 3 The dosage interval of 12 h during maintenance therapy with sustained release tablets gave as acceptable plasma drug fluctuations as an 8 h interval. 4 A large individual variation in plasma concentrations was noticed. Thus monitoring of therapy by plasma concentration analyses is desirable.     

Plasma nitrazepam concentrations after an acute intake and their correlation to sedation and serum growth hormone levels.

Concentrations of nitrazepam in plasma were determined by gas chromatography in healthy volunteers after an acute peroral administration of nitrazepam (5 and 10 mg). Placebo tablets were also used, and an assessement of subjective drug effects was made during each medication. In addition serum growth hormone levels were determined. The peak plasma nitrazepam concentration was achieved at 120 minutes (46.9 +/- 3.2 ng/ml, mean +/- S.E.M.) after 5 mg of nitrazepam and at 180 minutes (82.8 +/- 10.5 ng/ml) after the dose of 10 mg. The half-life of nitrazepam in plasma ranged from 16.5 to 48.3 (mean 28.8) hours. A significant positive correlation was seen between the subjective sedative effects and the magnitude of the peak nitrazepam concentrations in plasma. This drug effect was highly significant when the plasma levels of nitrazepam were rising. The subjective sedative effects were more prominent after 10 mg than after 5 mg dose of nitrazepam. The plasma nitrazepam concentration was not significantly correlated with the subjective sedative effect the next morning, 12 hours after the drug intake. Serum growth hormone levels rose significantly during the study both after 5 mg and 10 mg nitrazepam doses (peak levels 16.3 +/- 4.0 and 12.7 +/- 3.1 ng/ml) and were significantly higher than after placebo administration (3.7 +/- 0.7 ng/ml).     

Effect of cimetidine on the absorption of orally administered tetracycline.

1 Six healthy female subjects received orally two 250 mg tetracycline tablets either with 400 mg cimetidine or placebo. In a separate experiment six healthy female volunteers received 500 mg tetracycline as a suspension on the fifth day of a 6 day regime of 400 mg cimetidine or placebo, 8 hourly and at bedtime. 500 mg tetracycline as tablets was also given with cimetidine only. 2 Following a single dose of cimetidine the mean peak tetracycline plasma concentration was significantly reduced by 1.2 microgram/ml and the area under the plasma concentration, time curve was decreased by 40%. The 72 h urinary tetracycline excretion was diminished by approximately 30%. 3 Tetracycline had no effect on the plasma concentration, time profile of cimetidine. 4 Administration of 400 mg cimetidine 8 hourly and at night for 6 days and dosing with 500 mg tetracycline as tablets or suspension on the fifth day produced no alteration in tetracycline kinetics. 5 It was concluded that under clinical circumstances it is unlikely that cimetidine produces a clinically significant alteration in tetracycline absorption or disposition. 6 The bioavailability of tetracycline from tablets and suspension was found to be similar (31.2% and 36.9% of the dose excreted in the urine over 72 h). 7 The mean renal clearance of tetracycline was 83.8 ml/min (95% confidence interval +/- 9.2 ml/min) and was unaltered by cimetidine treatment.     

Pharmacokinetics and therapeutic efficacy of metronidazole at different dosages.

Metronidazole, a drug effective against certain protozoal and anaerobic infections, was given female patients with Trichomoniasis urogenitalis. Group I received twice daily 250 mg of metronidazole (supplied as 250 mg tablets Vagimid). Group II received in a single dose 1.0 g (4 tablets); and group III, 2.0 g (8 tablets). Serum and urine metronidazole levels were measured polarographically. Kinetic parameters were determined from the measured values of the concentration time curve by a computing program. An exact control of the therapeutic result was carried out. In all patients peak serum levels occurred within 1-3 hr and averaged 5.1 +/- 1.7 microgram/ml after 250 mg doses, 19.6 +/- 3.8 microgram/ml after 1.0 g doses and 40.6 +/- 9.3 microgram/ml after 2.0 g doses. About 35% of the administered dose was recovered in the urine in 12 hr and about 50% in 24 hr. Metronidazole shows protein binding of 10-20% equally in vivo and in vitro. Minimum trichomonacidic concentrations of nearly 1 microgram/ml were still present 12 hr after oral application of 250 mg metronidazole, and 24 hr to 36 hr, respectively after 1.0 g and 2.0 g daily doses. The cure rate was 100%. No serious side effects ocurred in any of the patients.     

Laboratory and clinical studies of cefuzonam in pediatric field

We have carried out laboratory and clinical studies of cefuzonam. The results were summarized as follows: The effectiveness of cefuzonam was estimated by a plate dilution method on 26 strains each of S. aureus, E. coli, K. pneumoniae, Salmonella spp. and P. aeruginosa and 27 strains of S. marcescens isolated from patients. The distribution of MIC's of cefuzonam against S. aureus was 0.39 approximately 1.56 micrograms/ml and the peak of the distribution was 0.39 microgram/ml. Strains of 96.2% of E. coli and Salmonella spp. were inhibited at cefuzonam concentrations less than 0.39 microgram/ml. Strains of 92.3% of K. pneumoniae were inhibited at drug concentrations less than 0.20 microgram/ml. The distribution of MIC's of cefuzonam against S. marcescens was less than or equal to 0.025 approximately 12.5 micrograms/ml and the peak of the distribution was 0.2 microgram/ml and 1.56 microgram/ml. MIC's against P. aeruginosa was 12.5 approximately greater than 100 micrograms/ml. Cefuzonam was given by 5-minute intravenous administration to 4 children and 1-hour drip infusion to 1 child at a single dose of 20 mg/kg. After the intravenous administration, mean serum levels of cefuzonam were 30.8 +/- 4.55 microgram/ml at 30 minutes, 13.8 +/- 1.83 micrograms/ml at 1 hour, 0.4 +/- 0.159 microgram/ml at 6 hours. The half-life was 1.12 +/- 0.198 hours. After the drip infusion, the serum levels of the drug were 38.7 micrograms/ml at 1 hour, 5.25 micrograms/ml at 2 hours and 0.087 microgram/ml at 7 hours. The half-life was 0.93 hour. The mean urinary excretion rate was 58.1% and 33.4% up to 6 hours after the intravenous administration and the drip infusion, respectively. Cefuzoname was effective in 4 out of 5 cases with bacterial infections. No side effect due to the drug was observed in any case.     

The bioavailability of griseofulvin from microsized and ultramicrosized tablets in nonfasting volunteers

Tablets of either microsized or ultramicrosized griseofulvin (2 x 125 mg), were administered to 6 healthy volunteers of either sex just before a breakfast containing 4o g. of butter. The plasma concentration of griseofulvin were determined 1, 3, 5, 7, 9, 24, and 32 h. after dosing using a spectrofluorometric method, and pharmacokinetic parameters (Cp max, t max, AUC 0 - greater than 32) were calculated. These parameters were found to be; Cp max = 0.0.681 +/- 0.1 mu/ml, t max. = 2.51 +/- 0.33 h. and AUC = 14.14 +/- 2.33 micrograms h/ml for microsized tablets and Cp max = 0.80 +/- 0.08 +/- g/ml, t max = 2.44 +/- 0.54 and AUC = 16.25 +/- 1.16 microgram h/ml for ultramicrosized tablets. Our results show that mean peak plasma level and AUC (0 - greater than 32) are only slightly higher for the ultramicrosized preparation and the time to peak plasma level is similar in two preparations. Therefore, it is concluded that coadministration of griseofulvin with food will tend to reduce the difference between the bioavailability of the two type of preparations.