Population Pharmacokinetics of Risperidone and 9-Hydroxyrisperidone in Patients with Acute Episodes Associated with Bipolar I Disorder |
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Authors: | An Vermeulen Vladimir Piotrovsky Elizabeth A Ludwig |
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Institution: | (1) a Division of Janssen Pharmaceutica N.V., Johnson & Johnson Pharmaceutical Research & Development, 2340 Beerse, Belgium;(2) Cognigen Corporation, Buffalo, New York, USA |
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Abstract: | A population model was developed with the aim to simultaneously describe risperidone and 9-hydroxyrisperidone pharmacokinetics;
to obtain estimates for pharmacokinetic parameters and associated inter- and intra-individual variability of risperidone and
9-hydroxyrisperidone; and to evaluate the influence of patient demographic characteristics and other factors on risperidone,
9-hydroxyrisperidone, and active moiety pharmacokinetics. Data were obtained from 407 patients enrolled in four Phase 1 (serial
blood sampling) and three Phase 3 trials (sparse sampling), representing dosage regimens ranging from 4 mg single dose to
flexible 1–6 mg once daily. A pharmacokinetic model with two-compartment submodels for risperidone and 9-hydroxyrisperidone
disposition and a sequential zero- and first-order absorption pathway was selected based on prior knowledge. A mixture model
was incorporated due to CYP2D6 polymorphism of risperidone conversion to 9-hydroxyrisperidone. Patient characteristics tested
as potential covariates were: age, sex, race, body weight, lean body mass, body mass index, creatinine clearance, liver function
laboratory parameters, study, and carbamazepine comedication. The quasi-clearance of active moiety (the sum of risperidone
and 9-hydroxyrisperidone) was simulated and linear regression performed to identify significant covariates. The selected pharmacokinetic
model described the plasma concentration-time profiles for risperidone and 9-hydroxyrisperidone quite well and was able to
determine each patient’s phenotype. Covariates significantly affecting the pharmacokinetics were carbamazepine comedication,
and study because the proportion of patients assigned to the intermediate metabolizer status decreased from single to multiple
dosing while the proportion assigned to extensive metabolizer status increased. Covariates with limited and clinically irrelevant
effects on active moiety concentrations were patient phenotype, race, and total protein. Carbamazepine also decreased active
moiety concentrations. |
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Keywords: | risperidone 9-hydroxyrisperidone population pharmacokinetics |
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