The Journal of Clinical Pharmacology最新文献

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Back Pedaling on Baclofen: Highlighting Concerns Surrounding Baclofen use in Phenibut Withdrawal 巴氯芬的倒退:强调在菲尼布特戒断期使用巴氯芬的担忧。
The Journal of Clinical Pharmacology Pub Date : 2024-05-16 DOI: 10.1002/jcph.2463
Ryan Feldman PharmD
{"title":"Back Pedaling on Baclofen: Highlighting Concerns Surrounding Baclofen use in Phenibut Withdrawal","authors":"Ryan Feldman PharmD","doi":"10.1002/jcph.2463","DOIUrl":"10.1002/jcph.2463","url":null,"abstract":"<p>To the Editor:</p><p>I applaud Drs. Penzak and Bulloch for attempting to organize the sparse phenibut literature into usable clinical information.<span><sup>1</sup></span> However, some case information reported within this article requires correction. Additionally, important considerations for baclofen use in withdrawal need to be emphasized.</p><p>In the authors' discussion of baclofen use for withdrawal, they state: “This approach has been questioned, especially in patients who may be at risk of seizures. Fortunately, there were no reported seizures in any of the published cases after baclofen initiation.”</p><p>This statement is incorrect. It cites a case report, published by our author group, in which a patient has a seizure after being sent home on baclofen for phenibut withdrawal.<span><sup>2</sup></span> Later in the discussion, they do accurately describe our case report, contradicting their own statement.</p><p>Next, in the authors' discussion of pharmacotherapy for withdrawal management they comment in table 1 that baclofen “Has been used successfully alone and in combination (usually with a benzodiazepine) for the treatment of phenibut withdrawal.” However, withdrawal management entails various strategies. Some patients may taper from phenibut, while others will undergo abstinence, the two may require different treatment strategies. Those undergoing abstinence may experience more severe acute withdrawal syndromes. In our review, 100% of patients undergoing abstinence were managed inpatient and nearly all required multiple medications to stabilize symptoms.<span><sup>3</sup></span> The monotherapy use of baclofens in the published literature has only been for aiding a phenibut taper, or after the acute stabilization phase in abstinence (e.g., maintenance).<span><sup>3</sup></span> The phrasing in this table could be interpreted to suggest baclofen as a monotherapy for patients admitted to handle acute withdrawal during the initial phases of abstinence. Given the risk for severe outcomes in these patients (seizure in 9.1%, intubation in 27.7%), it is important to point out baclofen has no data to support its use as a single agent in this setting.<span><sup>3</sup></span></p><p>Finally, the authors discuss baclofen dosing and highlight a previously suggested dosing regimen of 8-10 mg of baclofen per 1 g of phenibut. This recommendation stems from a single case with no comparator.<span><sup>4</sup></span> Every other case report, which utilized baclofen successfully, is just as valid. The only difference is that these authors proposed a dosing strategy in their text. Despite a total lack of scientific rationale, it has unfortunately become a prevalent discussion point in other texts. This suggested dosing implies baclofen is 100 times more potent than phenibut. However, in vitro data demonstrates baclofen has a 28-fold higher affinity for the gamma amino butyric acid-B receptor than phenibut.<span><sup>5</sup></span> Many patients in t","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 9","pages":"1181-1182"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcph.2463","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pharmacokinetics and Safety of Intramuscular Injectable Benzathine Penicillin G in Japanese Healthy Participants 日本健康参与者肌肉注射苄星青霉素 G 的药代动力学和安全性。
The Journal of Clinical Pharmacology Pub Date : 2024-05-12 DOI: 10.1002/jcph.2454
Yinhua Li PhD, Akifumi Okayama MS, Toshiaki Hagi MS, Chieko Muto PhD, Susan Raber PharmD, MPH, Masahito Nagashima BS
{"title":"Pharmacokinetics and Safety of Intramuscular Injectable Benzathine Penicillin G in Japanese Healthy Participants","authors":"Yinhua Li PhD,&nbsp;Akifumi Okayama MS,&nbsp;Toshiaki Hagi MS,&nbsp;Chieko Muto PhD,&nbsp;Susan Raber PharmD, MPH,&nbsp;Masahito Nagashima BS","doi":"10.1002/jcph.2454","DOIUrl":"10.1002/jcph.2454","url":null,"abstract":"<p>An intramuscular (IM) suspension of benzathine penicillin G (BPG) has been used as first-line therapy for the treatment of syphilis worldwide since its approval in the 1950s. However, there are limited reports about the pharmacokinetics of BPG. A Phase 1 study was conducted on eight Japanese healthy participants to investigate the pharmacokinetics (samples collected predose to 648 h post-dose) and safety of 2.4 million units of BPG after a single IM injection. Following administration, penicillin G, the active moiety of BPG, was absorbed slowly from the injection site with a median time to C<sub>max</sub> (t<sub>max</sub>) of 48 h post-dose. After the achievement of C<sub>max</sub>, concentrations of penicillin G declined slowly in a monophasic fashion with a mean apparent terminal half-life of 189 h. Geometric mean AUC<sub>inf</sub> and C<sub>max</sub> were 50770 ng•h/mL and 259 ng/mL, respectively. Median time (range) above the well-accepted therapeutic concentration (18 ng/mL) for syphilis treatment was 561 h (439-608 h [18-25 days]), which reached and exceeded the necessary duration of 7-10 days for syphilis treatment. Two participants were underdosed with residual drug left in the syringe due to the high viscosity of the drug product. Only one (12.5%) participant reported a mild adverse event of nasopharyngitis, which was considered not related to the study treatment. The study results supported BPG approval in Japan as an option for syphilis treatment.</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 10","pages":"1259-1266"},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcph.2454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transfer of the Dual Orexin Receptor Antagonist Daridorexant into Breast Milk of Healthy Lactating Women 健康哺乳期妇女的母乳中转入双重奥列克素受体拮抗剂 Daridorexant。
The Journal of Clinical Pharmacology Pub Date : 2024-05-12 DOI: 10.1002/jcph.2455
Priska Kaufmann PhD, Clemens Muehlan PhD, Marion Anliker-Ort PhD, Giancarlo Sabattini MSc, Nicholas Siebers MD, Jasper Dingemanse PhD
{"title":"Transfer of the Dual Orexin Receptor Antagonist Daridorexant into Breast Milk of Healthy Lactating Women","authors":"Priska Kaufmann PhD,&nbsp;Clemens Muehlan PhD,&nbsp;Marion Anliker-Ort PhD,&nbsp;Giancarlo Sabattini MSc,&nbsp;Nicholas Siebers MD,&nbsp;Jasper Dingemanse PhD","doi":"10.1002/jcph.2455","DOIUrl":"10.1002/jcph.2455","url":null,"abstract":"<p>The novel dual orexin receptor antagonist daridorexant was approved in 2022 for the treatment of adult patients with insomnia. The aim of this post-marketing study was to measure daridorexant and its major metabolites in breast milk and plasma of 10 healthy lactating subjects.</p><p>This single-center, open-label study evaluated the transfer of the analytes into breast milk. A single dose of 50 mg was orally administered in the morning. Milk and blood samples were collected pre-dose and over a period of 72 h after dosing. The pharmacokinetics of daridorexant in milk and plasma were assessed including the cumulative amount and fraction of dose excreted, daily infant dose, and relative infant dose. Safety and tolerability were also investigated.</p><p>All subjects completed the study. Daridorexant was rapidly absorbed into and distributed from plasma. Daridorexant and its major metabolites were measurable in breast milk. The cumulative total amount of daridorexant excreted over 72 h was 0.010 mg, which corresponds to 0.02% of the maternal dose. This corresponds to a mean daily infant dose of 0.009 mg/day and a relative infant dose of less than 0.22% over 24 h. The maternal safety profile was similar to that observed in previous studies.</p><p>Low amounts of daridorexant and its metabolites were detected in the breast milk of healthy lactating women. Since the exposure and potential effects on the breastfed infant are unknown, a risk of somnolence or other depressant effects cannot be excluded.</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 10","pages":"1278-1287"},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcph.2455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pooled Population Pharmacokinetic Analysis and Dose Recommendations for Ciprofloxacin in Intensive Care Unit Patients with Obesity 重症监护室肥胖患者使用环丙沙星的人群药代动力学分析和剂量建议。
The Journal of Clinical Pharmacology Pub Date : 2024-05-12 DOI: 10.1002/jcph.2450
Koen P. van Rhee PharmD, Roger J.M. Brüggemann PharmD, PhD, Jason A. Roberts PharmD, PhD, Fredrik Sjövall MD, PhD, Reinier M. van Hest PharmD, PhD, Paul W.G. Elbers MD, PhD, Alan Abdulla PharmD, PhD, Paul D. van der Linden PharmD, PhD, Catherijne A.J. Knibbe PharmD, PhD
{"title":"Pooled Population Pharmacokinetic Analysis and Dose Recommendations for Ciprofloxacin in Intensive Care Unit Patients with Obesity","authors":"Koen P. van Rhee PharmD,&nbsp;Roger J.M. Brüggemann PharmD, PhD,&nbsp;Jason A. Roberts PharmD, PhD,&nbsp;Fredrik Sjövall MD, PhD,&nbsp;Reinier M. van Hest PharmD, PhD,&nbsp;Paul W.G. Elbers MD, PhD,&nbsp;Alan Abdulla PharmD, PhD,&nbsp;Paul D. van der Linden PharmD, PhD,&nbsp;Catherijne A.J. Knibbe PharmD, PhD","doi":"10.1002/jcph.2450","DOIUrl":"10.1002/jcph.2450","url":null,"abstract":"<p>Recent studies have explored the influence of obesity and critical illness on ciprofloxacin pharmacokinetics. However, variation across the subpopulation of individuals with obesity admitted to the intensive care unit (ICU) with varying renal function remains unexamined. This study aims to characterize ciprofloxacin pharmacokinetics in ICU patients with obesity and provide dose recommendations for this special population. Individual patient data of 34 ICU patients with obesity (BMI &gt;30 kg/m<sup>2</sup>) from four studies evaluating ciprofloxacin pharmacokinetics in ICU patients were pooled and combined with data from a study involving 10 individuals with obesity undergoing bariatric surgery. All samples were collected after intravenous administration. Non-linear mixed effects modeling and simulation were used to develop a population pharmacokinetic model and describe ciprofloxacin exposure in plasma. Model-based dose evaluations were performed using a pharmacokinetic/pharmacodynamic target of AUC/MIC &gt;125. The data from patients with BMI ranging from 30.2 to 58.1 were best described by a two-compartment model with first-order elimination and a proportional error model. The inclusion of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) as a covariate on clearance reduced inter-individual variability from 57.3% to 38.5% (<i>P</i> &lt; .001). Neither body weight nor ICU admission significantly influenced clearance or volume of distribution. Renal function is a viable predictor for ciprofloxacin clearance in ICU patients with obesity, while critical illness and body weight do not significantly alter clearance. As such, body weight and critical illness do not need to be accounted for when dosing ciprofloxacin in ICU patients with obesity. Individuals with CKD-EPI &gt;60 mL/min/1.73 m<sup>2</sup> may require higher dosages for the treatment of pathogens with minimal inhibitory concentration ≥0.25 mg/L.</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 9","pages":"1165-1172"},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcph.2450","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Guiding Dyslipidemia Treatment: A Population Pharmacokinetic–Pharmacodynamic Framework for Obicetrapib 指导血脂异常治疗:奥比曲匹的群体药代动力学-药效学框架。
The Journal of Clinical Pharmacology Pub Date : 2024-05-08 DOI: 10.1002/jcph.2448
Allison Dunn PharmD, MS, Marc Ditmarsch MD, John J. P. Kastelein MD, PhD, Douglas Kling BS, Annie Neild PhD, Michael H. Davidson MD, Joga Gobburu PhD
{"title":"Guiding Dyslipidemia Treatment: A Population Pharmacokinetic–Pharmacodynamic Framework for Obicetrapib","authors":"Allison Dunn PharmD, MS,&nbsp;Marc Ditmarsch MD,&nbsp;John J. P. Kastelein MD, PhD,&nbsp;Douglas Kling BS,&nbsp;Annie Neild PhD,&nbsp;Michael H. Davidson MD,&nbsp;Joga Gobburu PhD","doi":"10.1002/jcph.2448","DOIUrl":"10.1002/jcph.2448","url":null,"abstract":"<p>Obicetrapib is a selective inhibitor of cholesteryl ester transfer protein that is currently in phase 3 of development for the treatment of dyslipidemia as adjunct therapy. The purpose of this study was to comprehensively characterize the pharmacokinetic (PK) and pharmacodynamic (PD) disposition of obicetrapib. Data from 7 clinical trials conducted in healthy adults and those with varying degrees of dyslipidemia were included for model development. The structural model that best described obicetrapib PK was a 3-compartment model with 4-compartment transit absorption and first-order elimination. Body weight was the only covariate found to significantly explain observed variability and was therefore included using allometric scaling on all disposition parameters. For a typical patient weighing 75 kg, the estimated apparent total body clearance and apparent volume of distribution of the central compartment was 0.81 L/h and 36.1 L, respectively. The final PK model parameters were estimated with good precision and were ultimately leveraged to sequentially inform 2 turnover models that describe obicetrapib's effect on low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) concentrations. The maximum stimulatory effect of obicetrapib on LDL-C loss was estimated to be 1.046, while the maximum inhibitory effect of obicetrapib on HDL-C loss was 0.691. This corresponds to a predicted typical maximum percent change from baseline LDL-C and HDL-C of 51.1% and 224%, respectively. The final sequential model described obicetrapib PKPD well and was ultimately able to both demonstrate evidence of internal consistency and support decision-making throughout the development lifecycle.</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 9","pages":"1150-1164"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Population Pharmacokinetics of Sertraline in Psychiatric and Substance Use Disorders 舍曲林在精神病和药物使用失调人群中的药代动力学。
The Journal of Clinical Pharmacology Pub Date : 2024-05-08 DOI: 10.1002/jcph.2457
Cinthya Eloisa Chávez Castillo MSc, Susanna Edith Medellín Garibay PhD, Rosa del Carmen Milán Segovia PhD, Sergio Zarazúa Guzmán PhD, Helgi Jung Cook PhD, Marisol Orocio Contreras MD, Silvia Romano Moreno PhD
{"title":"Population Pharmacokinetics of Sertraline in Psychiatric and Substance Use Disorders","authors":"Cinthya Eloisa Chávez Castillo MSc,&nbsp;Susanna Edith Medellín Garibay PhD,&nbsp;Rosa del Carmen Milán Segovia PhD,&nbsp;Sergio Zarazúa Guzmán PhD,&nbsp;Helgi Jung Cook PhD,&nbsp;Marisol Orocio Contreras MD,&nbsp;Silvia Romano Moreno PhD","doi":"10.1002/jcph.2457","DOIUrl":"10.1002/jcph.2457","url":null,"abstract":"<p>This study aimed to characterize the population pharmacokinetics of sertraline in Mexican patients with psychiatric and substance use disorders. Fifty-nine patients (13 to 76 years old) treated with doses of sertraline between 12.5 and 100 mg/day were included. Plasma sertraline concentrations were determined in blood samples and five of the main substances of abuse were determined by rapid tests in urine samples. Demographic, clinical, and pharmacogenetic factors were also evaluated. Population pharmacokinetic analysis was performed using NONMEM software with first-order conditional estimation method. A one-compartment model with proportional residual error adequately described the sertraline concentrations versus time. CYP2D6*2 polymorphism and CYP2C19 phenotypes significantly influenced sertraline clearance, which had a population mean value of 66 L/h in the final model. The absorption constant and volume of distribution were fixed at 0.855 1/h and 20.2 L/kg, respectively. The model explained 11.3% of the interindividual variability in sertraline clearance. The presence of the CYP2D6*2 polymorphism caused a 23.1% decrease in sertraline clearance, whereas patients with intermediate and poor phenotype of CYP2C19 showed 19.06% and 48.26% decreases in sertraline clearance, respectively. The model was internally validated by bootstrap and visual predictive check. Finally, stochastic simulations were performed to propose dosing regimens to achieve therapeutic levels that contribute to improving treatment response.</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 10","pages":"1267-1277"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Food Effect in Pediatric Populations: Current Practice, Challenges, and Future Potential for Use of Physiologically Based Biopharmaceutics Modeling 儿科人群的食物效应:基于生理学的生物药剂学建模的当前实践、挑战和未来应用潜力》(Current Practice, Challenges, and Future Potential for Use of Physiologically Based Biopharmaceutics Modeling)。
The Journal of Clinical Pharmacology Pub Date : 2024-05-08 DOI: 10.1002/jcph.2456
Neil Parrott MSc
{"title":"Food Effect in Pediatric Populations: Current Practice, Challenges, and Future Potential for Use of Physiologically Based Biopharmaceutics Modeling","authors":"Neil Parrott MSc","doi":"10.1002/jcph.2456","DOIUrl":"10.1002/jcph.2456","url":null,"abstract":"<p>In drug development, the effects of food on oral pharmacokinetics are usually assessed by performing a clinical study in adults where a single dose of the drug is given in a crossover design, and pharmacokinetic parameters derived after dosing in the fasted state are statistically compared to those obtained after a high-calorie meal.<span><sup>1</sup></span> When it comes to children, ethical concerns limit the conduct of such studies and current regulatory guidance recommends that new pediatric formulations should be assessed for their food effect in adults to guide dosing in children.<span><sup>1</sup></span> However, the validity of this practice can be questioned. For instance, food effects might differ between children and adults because many of the determining physiological factors, such as stomach volume, gastrointestinal pH, gastric emptying time, intestinal bile salt concentrations, and liver blood flow are age-dependent.<span><sup>2, 3</sup></span> Furthermore, meal types and feeding patterns in children are quite different from those in adults, and the high-fat and high-calorie meal used in adult food effect studies can be inappropriate to project effects in young children. For example, a study was performed where adults were dosed with pediatric formulations of paracetamol and ibuprofen in fasted and fed states in a crossover design.<span><sup>4</sup></span> In one arm, the fed state was represented by a 990 kcal standard adult meal whereas an infant 520 kcal formula meal was used in a second arm. Quite distinct fed-state pharmacokinetic profiles were seen for these different meal types. Although the extent of absorption was comparable, the pediatric meal caused slower absorption than the standard adult meal showing that, even for BCS1 drugs, the impact of the meal type should be considered and a pediatric meal may result in different absorption. Further doubts on the validity of the direct transfer of food effects between adults and children were raised by clinical food effects collected for a set of antibiotic suspensions.<span><sup>4</sup></span> Only one out of seven drugs shows a food effect that is qualitatively similar in adults and children (Table 1).</p><p>Additional evidence that the current approach for the prediction of pediatric food effects is not optimal was provided in a recent report from Tunehag and colleagues at the FDA.<span><sup>5</sup></span> They analyzed pediatric drug development studies submitted from 2012 to 2022. In that 10-year period, 102 drug products were approved for use in children &lt;6, and 43 drug labels give dosing recommendations regarding food directly transferred from adult findings. Fourteen products are recommended to be taken without food in infants aged less than 2, which is problematic considering that children of this age feed more frequently than adults, typically every 2–3 h, and tend to remain in a semi-fed state. On the other hand, for the drug products that were recommended to be ","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 8","pages":"1044-1047"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcph.2456","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Simulation-Based Assessment of Levetiracetam Concentrations Following Fixed and Weight-Based Loading Doses: A Meta-Regression and Pharmacokinetic Modeling Analysis 基于模拟的左乙拉西坦固定剂量和基于体重的负荷剂量浓度评估:元回归和药代动力学模型分析。
The Journal of Clinical Pharmacology Pub Date : 2024-05-06 DOI: 10.1002/jcph.2449
Anthony Lau BSc(Pharm), PharmD, ACPR, Hans Haag BSc(Pharm), PharmD, ACPR, Anil Maharaj BSc(Pharm), PhD
{"title":"A Simulation-Based Assessment of Levetiracetam Concentrations Following Fixed and Weight-Based Loading Doses: A Meta-Regression and Pharmacokinetic Modeling Analysis","authors":"Anthony Lau BSc(Pharm), PharmD, ACPR,&nbsp;Hans Haag BSc(Pharm), PharmD, ACPR,&nbsp;Anil Maharaj BSc(Pharm), PhD","doi":"10.1002/jcph.2449","DOIUrl":"10.1002/jcph.2449","url":null,"abstract":"<p>Current recommendations for refractory status epilepticus (SE) unresponsive to benzodiazepines suggest a loading dose of levetiracetam (LEV) of 60 mg/kg to a maximum of 4500 mg. LEV therapeutic drug monitoring can help guide therapy and is garnering increasing attention. The objective of this study is to simulate the probability of target attainment (PTA) of fixed dose and weight-based loading doses of LEV with respect to established therapeutic target concentrations. Meta-regression of the current literature was performed to evaluate the relationship between intravenous LEV loading dose and seizure cessation in refractory SE patients. A previously published pharmacokinetic model was used to simulate the PTA capacity of competing single intravenous dosing schemes (fixed vs weight-based dosing) to achieve maximum (C<sub>peak</sub>) and 12-h (C<sub>12h</sub>) plasma concentrations that exceed 12 mg/L. The meta-regression indicated that dosage was not a statistically significant modulator of seizure control at dosages between 20 and 60 mg/kg. Stochastic simulations showed all dosing schemes achieved plasma C<sub>peak</sub> &gt;12 mg/L, but C<sub>12h</sub> levels were &lt;12 mg/L in subjects over 60 kg with a fixed dose ≤2000 mg or in subjects &lt;60 kg with a weight-based dose &lt;30 mg/kg. Dosages of 40 and 60 mg/kg provided ≥90% PTAs across all weights. Using a weight-based loading dose of 40 mg/kg, up to a suggested maximum of 4500 mg, improves the likelihood of achieving a sustained therapeutic drug concentration after the initial LEV dose, whereas fixed &lt;3000 mg may not achieve the desired concentration before maintenance dosing.</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 9","pages":"1173-1180"},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcph.2449","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ocular Pharmacology 眼科药理学。
The Journal of Clinical Pharmacology Pub Date : 2024-05-06 DOI: 10.1002/jcph.2451
Gary D. Novack PhD, Alan L. Robin MD
{"title":"Ocular Pharmacology","authors":"Gary D. Novack PhD,&nbsp;Alan L. Robin MD","doi":"10.1002/jcph.2451","DOIUrl":"10.1002/jcph.2451","url":null,"abstract":"<p>Treatment of ocular diseases presents unique challenges and opportunities for the clinician and for the clinical pharmacologist. Ophthalmic pharmaceuticals, typically given as liquids, require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Ocular tissue levels are challenging to obtain in humans, and the clinical pharmacokinetics is typically blood levels, which are primarily related to safety, rather than efficacy. The eye is a closed compartment with multiple physiological barriers with esterases and transporters, but relatively little cytochrome oxidases. Delivery routes include topical, intravitreal, and systemic. Patient dosing involves not only adherence issues common to all chronic diseases, but also performance requirements on eye drop instillation. Therapeutically, ocular diseases and their pharmacological treatments include both those analogous to systemic diseases (e.g., inflammation, infection, and neuronal degeneration) and those unique to the eye (e.g., cataract and myopia).</p>","PeriodicalId":22751,"journal":{"name":"The Journal of Clinical Pharmacology","volume":"64 9","pages":"1068-1082"},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In-Depth Analysis of the Selection of PBPK Modeling Tools: Bibliometric and Social Network Analysis of the Open Systems Pharmacology Community 深入分析 PBPK 建模工具的选择:开放系统药理学社区的文献计量和社会网络分析。
The Journal of Clinical Pharmacology Pub Date : 2024-05-06 DOI: 10.1002/jcph.2453
André Dallmann PhD, Donato Teutonico PhD, Stephan Schaller PhD, Rolf Burghaus PhD, Sebastian Frechen MD
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