Patients with Kidney Transplant: Maximizing Mycophenolic Acid Submission with Target Dose Intervention

2021 ◽  
Vol 15 (11) ◽  
pp. 2996-2998
Author(s):  
Mujtaba Ali Hasnain ◽  
Samrah Mujtaba ◽  
Iqra Javed ◽  
Saima Abdul Waheed ◽  
Muhammad Shahzad Gul ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Drug Exposure ◽  
Optimization Procedure ◽  
Maintenance Phase ◽  
Immunosuppressive Agent ◽  
Fixed Dose ◽  
Dose Optimization ◽  
Target Dose ◽  
Target Concentration ◽  
Time Curve

Background: Mycophenolate, an immunosuppressive agent choice. It is used readily in the transplantation of kidneys. Aim: To find out utilization of this drug is considered safe but the exact dosage of this drug varies according to the choice. Methods: It alters from fixed-dose to the dose optimization to the drug exposure target. It is the area under the concentration and time curve graph. This graph gives inconsistent results of concentration-controlled dosing in prospective studies. In this research paper, the evidence helping mycophenolate has been analyzed. The research includes finding out the pharmacological features, toxicities, and efficacy of this chemical ingredient. Randomized controlled trials along with dose optimization procedure and exposure have also been achieved. Results: A fixed dose of mycophenolate continuously leads to either less exposure associated with unapproved strategy or over-exposure leading to toxicity. When concentration controlled dosing is measured via pharmacokinetic measurement to target concentration intervention, mycophenolate exposure is controlled successfully and clinical benefits are visible. There is a need for agreement on practical aspects of drug-target concentration intervention in normal tacrolimus containing dosage and research to find maintenance phase subjection targets. Conclusion: More preference should be given to the effects of over suppression and under suppression in transplantation of kidney affecting short term as well as long term benefits. A single dose should be given to the mycophenolate target concentration intervention. Keywords: Mycophenolate, immunosuppressive agent, kidney transplant, target dose intervention

scholarly journals Voriconazole Pharmacokinetics in Liver Transplant Recipients

2009 ◽  
Vol 54 (2) ◽  
pp. 852-859 ◽  
Author(s):  
H. J. Johnson ◽  
K. Han ◽  
B. Capitano ◽  
D. Blisard ◽  
S. Husain ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Drug Exposure ◽  
Plasma Concentrations ◽  
Fixed Dose ◽  
Pharmacokinetic Analysis ◽  
Pharmacokinetic Parameters ◽  
Prophylactic Regimen ◽  
Time Curve ◽  
Transplant Patients ◽  
Concentration Time

ABSTRACT The objective of this study was to evaluate the pharmacokinetics of voriconazole and the potential correlations between pharmacokinetic parameters and patient variables in liver transplant patients on a fixed-dose prophylactic regimen. Multiple blood samples were collected within one dosing interval from 15 patients who were initiated on a prophylactic regimen of voriconazole at 200 mg enterally (tablets) twice daily starting immediately posttransplant. Voriconazole plasma concentrations were measured using high-pressure liquid chromatography (HPLC). Noncompartmental pharmacokinetic analysis was performed to estimate pharmacokinetic parameters. The mean apparent systemic clearance over bioavailability (CL/F), apparent steady-state volume of distribution over bioavailability (V ss/F), and half-life (t 1/2) were 5.8 ± 5.5 liters/h, 94.5 ± 54.9 liters, and 15.7 ± 7.0 h, respectively. There was a good correlation between the area under the concentration-time curve from 0 h to infinity (AUC0-∞) and trough voriconazole plasma concentrations. t 1/2, maximum drug concentration in plasma (C max), trough level, AUC0-∞, area under the first moment of the concentration-time curve from 0 h to infinity (AUMC0-∞), and mean residence time from 0 h to infinity (MRT0-∞) were significantly correlated with postoperative time. t 1/2, λ, AUC0-∞, and CL/F were significantly correlated with indices of liver function (aspartate transaminase [AST], total bilirubin, and international normalized ratio [INR]). The C max, last concentration in plasma at 12 h (C last), AUMC0-∞, and MRT0-∞ were significantly lower in the presence of deficient CYP2C19*2 alleles. Donor characteristics had no significant correlation with any of the pharmacokinetic parameters estimated. A fixed dosing regimen of voriconazole results in a highly variable exposure of voriconazole in liver transplant patients. Given that trough voriconazole concentration is a good measure of drug exposure (AUC), the voriconazole dose can be individualized based on trough concentration measurements in liver transplant patients.

scholarly journals Fulvestrant-3-Boronic Acid (ZB716) Demonstrates Oral Bioavailability and Favorable Pharmacokinetic Profile in Preclinical ADME Studies

2021 ◽  
Vol 14 (8) ◽  
pp. 719
Author(s):  
Jiawang Liu ◽  
Nirmal Rajasekaran ◽  
Ahamed Hossain ◽  
Changde Zhang ◽  
Shanchun Guo ◽  
...  
Keyword(s):  
Boronic Acid ◽  
Oral Bioavailability ◽  
Drug Exposure ◽  
Liver Microsomes ◽  
Pharmacokinetic Profile ◽  
Pharmacokinetic Studies ◽  
Dependent Manner ◽  
Mucosal Permeability ◽  
Time Curve ◽  
Concentration Dependent Manner

Fulvestrant-3-boronic acid (ZB716), an oral selective estrogen receptor degrader (SERD) under clinical development, has been investigated in ADME studies to characterize its absorption, metabolism, and pharmacokinetics. ZB716 was found to have high plasma protein binding in human and animal plasma, and low intestinal mucosal permeability. ZB716 had high clearance in hepatocytes of all species tested. ZB716 was metabolized primarily by CYP2D6 and CYP3A. In human liver microsomes, ZB716 demonstrated relatively low inhibition of CYP1A2, 2C8, 2C9, 2C19, 2D6, and 3A4 (when testosterone was used as the substrate), and no inhibition of CYP2B6 and 3A4 (when midazolam was used as the substrate). In assays for enzyme activity, ZB716 induced CYP1A2, 2B6, and 3A4 in a concentration-dependent manner. Single-dose and repeated-dose pharmacokinetic studies in rats and dogs showed oral bioavailability, dose-proportional drug exposure, and drug accumulation as measured by maximum concentration and area under the concentration–time curve (AUC).

scholarly journals MILLIGRAM TO MILLIGRAM CONVERSION OF TWICE DAILY TO ONCE DAILY TACROLIMUS PROVIDES EQUIVALENT DRUG EXPOSURE IN ADULT KIDNEY TRANSPLANT

2020 ◽  
Vol 104 (S3) ◽  
pp. S625-S625
Author(s):  
Kanitha Tiankanon ◽  
Natavudh Townamchai ◽  
Stephen Kerr ◽  
Siriwan Thongthip ◽  
Suwasin Udomkarnjananun ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Drug Exposure ◽  
Once Daily ◽  
Adult Kidney

Evaluation of an Alternate Dosing Strategy for Cisplatin in Patients With Extreme Body Surface Area Values

2006 ◽  
Vol 24 (10) ◽  
pp. 1499-1506 ◽  
Author(s):  
Walter J. Loos ◽  
Felix E. de Jongh ◽  
Alex Sparreboom ◽  
Ronald de Wit ◽  
Desiree M. van Boven-van Zomeren ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Drug Exposure ◽  
Normal Population ◽  
Fixed Dose ◽  
Interpatient Variability ◽  
Average Patient ◽  
Dosing Strategy ◽  
Adjusted Dose

Purpose The majority of cytotoxic drugs for adults are dosed based on body surface area (BSA), aiming to reduce interpatient variability in drug exposure. We prospectively studied the usefulness of BSA-based dosing of cisplatin in patients at extremes of BSA values. Patients and Methods Patients were randomly assigned to receive a fixed dose of cisplatin in course 1, and a BSA-adjusted dose in course 2, or vice versa. The fixed dose was based on the average BSA for males and females, while extremes were set at BSA values exceeding the average ± 1 standard deviation. Subsequently, we retrospectively analyzed data from a normal population. Results In 25 patients assessable for both courses, the use of a fixed dose of cisplatin resulted in reduced exposure to unbound platinum in patients at the upper extremes of BSA (P = .003) and higher exposures in patients at the lower extremes (P = .009), as compared with exposures following the BSA-adjusted dose. Although clearance was related to BSA (R2 = 0.44; P < .001), only a small reduction in interpatient variability in clearance after correction for BSA was achieved (20.8% v 17.1%). In the retrospective analysis, compared with the average patient, the clearance of unbound platinum in patients with a BSA value ≤ 1.65 m2 was 16% slower (P < .001), while an 18% faster clearance (P < .001) was observed in patients with a BSA value ≥ 2.05 m2. Conclusion Unless better predictors for platinum clearance are identified, fixed-dose regimens per BSA cluster (≤ 1.65 m2; 1.66 m2 to 2.04 m2; ≥ 2.05 m2) are recommended.

scholarly journals Pharmacokinetics of Telavancin at Fixed Doses in Normal-Body-Weight and Obese (Classes I, II, and III) Adult Subjects

2018 ◽  
Vol 62 (4) ◽  
Author(s):  
Kristen L. Bunnell ◽  
Manjunath P. Pai ◽  
Monica Sikka ◽  
Susan C. Bleasdale ◽  
Eric Wenzler ◽  
...  
Keyword(s):  
Body Weight ◽  
Time Profile ◽  
Primary Objective ◽  
Fixed Dose ◽  
Target Area ◽  
Obese Patients ◽  
Time Curve ◽  
Content Type ◽  
Time Zero ◽  
Concentration Time

ABSTRACT A recommended total-body-weight (TBW) dosing strategy for telavancin may not be optimal in obese patients. The primary objective of this study was to characterize and compare the pharmacokinetics (PK) of telavancin across four body size groups: normal to overweight and obese classes I, II, and III. Healthy adult subjects ( n = 32) received a single, weight-stratified, fixed dose of 500 mg ( n = 4), 750 mg ( n = 8), or 1,000 mg ( n = 20) of telavancin. Noncompartmental PK analyses revealed that subjects with a body mass index (BMI) of ≥40 kg/m 2 had a higher volume of distribution (16.24 ± 2.7 liters) than subjects with a BMI of <30 kg/m 2 (11.71 ± 2.6 liters). The observed area under the concentration-time curve from time zero to infinity (AUC 0–∞ ) ranged from 338.1 to 867.3 mg · h/liter, with the lowest exposures being in subjects who received 500 mg. AUC 0–∞ values were similar among obese subjects who received 1,000 mg. A two-compartment population PK model best described the plasma concentration-time profile of telavancin when adjusted body weight (ABW) was included as a predictive covariate. Fixed doses of 750 mg and 1,000 mg had similar target attainment probabilities for efficacy as doses of 10 mg/kg of body weight based on ABW and TBW, respectively. However, the probability of achieving a target area under the concentration-time curve from time zero to 24 h of ≥763 mg · h/liter in association with acute kidney injury was highest (19.7%) with TBW-simulated dosing and lowest (0.4%) at the 750-mg dose. These results suggest that a fixed dose of 750 mg is a safe and effective alternative to telavancin doses based on TBW or ABW for the treatment of obese patients with normal renal function and Staphylococcus aureus infections. (This study has been registered at ClinicalTrials.gov under identifier NCT02753855.)

scholarly journals 1379. Determination of the Arbekacin Exposure Required to Prevent Amplification of Resistant Subpopulations Using Patient Pharmacokinetics Simulated in a Hollow-Fiber Infection Model (HFIM)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S422-S423 ◽  
Author(s):  
Brian D VanScoy ◽  
Elizabeth A Lakota ◽  
Sujata M Bhavnani ◽  
Greg Giesel ◽  
Ana I Carranco ◽  
...  
Keyword(s):  
Drug Exposure ◽  
Antimicrobial Agents ◽  
Therapy Resistance ◽  
Step Function ◽  
Infection Model ◽  
Drug Resistant ◽  
Total Drug ◽  
Research Support ◽  
Time Curve ◽  
Concentration Time

Abstract Background ME1100 (arbekacin inhalational solution) is an aminoglycoside in clinical development for the treatment of patients with hospital-acquired and ventilator-associated bacterial pneumonia (HABP and VABP, respectively). Due to the increase in resistance of Staphylococcus aureus and Pseudomonas aeruginosa to many antimicrobial agents, it is important to understand the relationships between amplification of drug resistance and each of drug exposure and therapy duration. The objective of the studies described herein was to utilize the HFIM to determine the arbekacin exposure after ME1100 administration required to prevent the emergence of drug-resistant subpopulations. Methods Duplicate 10-day HFIM assays were completed in which arbekacin total-drug epithelial lining fluid (ELF) concentration–time profiles following inhalational administration of ME1100 every 12 hours were simulated. Four isolates, two methicillin-resistant S. aureus (Arbekacin MIC = 1 mg/L), and two P. aeruginosa (Arbekacin MIC = 4 mg/L), were exposed to total-drug ELF area under the concentration–time curve (AUC) values ranging from 217 to 25,053 mg hour/L, which were simulated using two different half-lives, 1 hour (α) and 6.93 hours (β). The initial bacterial burden was 1.0 × 108 CFU/mL. Samples were collected for enumeration of both the total and drug-resistant bacterial burdens and evaluation of pharmacokinetic samples using LC/MS–MS. Results Total-drug ELF AUC:MIC ratios required to prevent amplification of MRSA and P. aeruginosa resistance in the HFIM over 10 days were 1,512 and 2,942, respectively. The higher AUC:MIC ratio required to prevent resistance for P. aeruginosa was most likely due to the presence of a small colony variant population. The relationship between total-drug ELF AUC:MIC ratio and change in log10 CFU from baseline of the drug-resistant sub-populations found on agar plates on Day 10 took the form of an inverted-U for three pathogens and a step-function for one (Figure 1). Conclusion These data, which address the goal of considering arbekacin exposures that prevent the development of on-therapy resistance in a clinical setting, will help to provide guidance for future ME1100 dose selection for the treatment of patients with HABP/VABP. Disclosures B. D. VanScoy, Meiji Seika Pharma Co. Ltd.: Research Contractor, Research support. E. A. Lakota, Meiji Seika Pharma Co. Ltd.: Research Contractor, Research support. S. M. Bhavnani, Meiji Seika Pharma Co. Ltd.: Research Contractor, Research support. G. Giesel, Meiji Seika Pharma Co. Ltd.: Research Contractor, Research support. A. I. Carranco, Meiji Seika Pharma Co. Ltd.: Research Contractor, Research support. Y. Nagira, Meiji Seika Pharma Co. Ltd.: Employee, Salary. S. Ouchi, Meiji Seika Pharma Co. Ltd.: Employee, Salary. K. Kondo, Meiji Seika Pharma Co. Ltd.: Employee, Salary. P. G. Ambrose, Meiji Seika Pharma Co. Ltd.: Research Contractor, Research support.

scholarly journals Pharmacokinetics of Daptomycin in Critically Ill Pediatric Patients

2018 ◽  
Vol 62 (6) ◽  
Author(s):  
Charalampos Antachopoulos ◽  
Stavroula Ilia ◽  
Paschalis Kadiltzoglou ◽  
Eirini Baira ◽  
Aristides Dokoumetzidis ◽  
...  
Keyword(s):  
Critically Ill ◽  
Drug Exposure ◽  
Pediatric Patients ◽  
Plasma Concentrations ◽  
Therapeutic Drug ◽  
Burn Patients ◽  
Time Curve ◽  
Once Daily ◽  
Concentration Time ◽  
Optimal Drug

ABSTRACT The pharmacokinetics of daptomycin (10 mg/kg once daily) was studied in 4 critically ill pediatric patients aged 8 to 14 yrs. The area under the concentration-time curve from time zero to infinity (AUC 0–∞ ) of plasma concentrations on day 1 ranged between 123.8 to 663.9 μg · h/ml, with lower values observed in septic and burn patients; clearance ranged from 15.1 to 80.7 ml/h/kg. Higher-than-recommended doses of daptomycin may be needed in septic children to ensure optimal drug exposure. Interpatient variability may suggest a role for therapeutic drug monitoring.

scholarly journals Eravacycline Pharmacokinetics and Challenges in Defining Humanized ExposureIn Vivo

2016 ◽  
Vol 60 (8) ◽  
pp. 5072-5075 ◽  
Author(s):  
Abrar K. Thabit ◽  
Marguerite L. Monogue ◽  
David P. Nicolau
Keyword(s):  
Human Exposure ◽  
Drug Exposure ◽  
Pharmacokinetic Profile ◽  
Free Drug ◽  
Infection Model ◽  
Exposure Level ◽  
Time Curve ◽  
Unbound Fraction ◽  
Binding Profile ◽  
Concentration Time

ABSTRACTWe assessed the pharmacokinetic profile of eravacycline, a novel antibiotic of the tetracycline class, and determined the dose in an immunocompetent murine thigh infection model that would provide free-drug exposure similar to that observed in humans after the administration of 1 mg/kg intravenously (i.v.) every 12 h (q12h). Eravacycline demonstrated a nonlinear protein-binding profile. The 2.5-mg/kg i.v. q12h dose in mice resulted in an area under the concentration-time curve for the free, unbound fraction of the drug of 1.64 mg · h/liter, which closely resembles the human exposure level.

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