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Everts RJ, Begg R, Gardiner SJ, Zhang M, Turnidge J, Chambers ST, Begg EJ. Probenecid and food effects on flucloxacillin pharmacokinetics and pharmacodynamics in healthy volunteers. J Infect 2019; 80:42-53. [PMID: 31521742 DOI: 10.1016/j.jinf.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To measure the effect of probenecid, fasting and fed, on flucloxacillin pharmacokinetic and pharmacodynamic endpoints. METHODS Flucloxacillin 1000 mg orally was given to 11 volunteers alone while fasting ('flucloxacillin alone'), and with probenecid 500 mg orally while fasting ('probenecid fasting') and with food ('probenecid fed'). Flucloxacillin pharmacokinetic and pharmacodynamic endpoints were compared. RESULTS Probenecid, fasting and fed, increased free plasma flucloxacillin area under the concentration-time curve (zero to infinity) ∼1.65-fold (p < 0.01) versus flucloxacillin alone. Probenecid fed prolonged time to peak flucloxacillin concentrations ∼2-fold versus the other two regimens (p < 0.01). Probenecid fasting or fed increased free flucloxacillin concentrations exceeding 30%, 50% and 70% of the first 6, 8 and 12 h post-dose by 1.58- to 5.48-fold compared with flucloxacillin alone. As an example of this pharmacodynamic improvement, the probability of target attainment of free concentrations above the minimum inhibitory concentration for Staphylococcus aureus (0.5 mg/L) for 50% of a 6-hour dose interval was > 80% for flucloxacillin plus probenecid (fasting or fed) and < 20% for flucloxacillin alone. CONCLUSIONS Probenecid increased flucloxacillin exposure, with predicted pharmacodynamic effects greater than pharmacokinetic effects because of the altered shape of the concentration-time curve. Probenecid may improve the applicability of oral flucloxacillin regimens.
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Affiliation(s)
| | - Ronald Begg
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Sharon J Gardiner
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand; Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand; Pharmacy Services, Christchurch Hospital, Christchurch, New Zealand
| | - Mei Zhang
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand; Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - John Turnidge
- Departments of Pathology, Paediatrics, and Molecular and Biomedical Sciences, University of Adelaide, Australia
| | - Stephen T Chambers
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand; Department of Pathology, University of Otago-Christchurch, Christchurch, New Zealand
| | - Evan J Begg
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand; Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand
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5
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Shah NR, Bulitta JB, Kinzig M, Landersdorfer CB, Jiao Y, Sutaria DS, Tao X, Höhl R, Holzgrabe U, Kees F, Stephan U, Sörgel F. Novel Population Pharmacokinetic Approach to Explain the Differences between Cystic Fibrosis Patients and Healthy Volunteers via Protein Binding. Pharmaceutics 2019; 11:pharmaceutics11060286. [PMID: 31216743 PMCID: PMC6630667 DOI: 10.3390/pharmaceutics11060286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/16/2022] Open
Abstract
The pharmacokinetics in patients with cystic fibrosis (CF) has long been thought to differ considerably from that in healthy volunteers. For highly protein bound β-lactams, profound pharmacokinetic differences were observed between comparatively morbid patients with CF and healthy volunteers. These differences could be explained by body weight and body composition for β-lactams with low protein binding. This study aimed to develop a novel population modeling approach to describe the pharmacokinetic differences between both subject groups by estimating protein binding. Eight patients with CF (lean body mass [LBM]: 39.8 ± 5.4kg) and six healthy volunteers (LBM: 53.1 ± 9.5kg) received 1027.5 mg cefotiam intravenously. Plasma concentrations and amounts in urine were simultaneously modelled. Unscaled total clearance and volume of distribution were 3% smaller in patients with CF compared to those in healthy volunteers. After allometric scaling by LBM to account for body size and composition, the remaining pharmacokinetic differences were explained by estimating the unbound fraction of cefotiam in plasma. The latter was fixed to 50% in male and estimated as 54.5% in female healthy volunteers as well as 56.3% in male and 74.4% in female patients with CF. This novel approach holds promise for characterizing the pharmacokinetics in special patient populations with altered protein binding.
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Affiliation(s)
- Nirav R. Shah
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA; (N.R.S.); (Y.J.); (D.S.S.); (X.T.)
| | - Jürgen B. Bulitta
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA; (N.R.S.); (Y.J.); (D.S.S.); (X.T.)
- Correspondence: (J.B.B.); (F.S.); Tel.: +1-407-313-7010 (J.B.B.); +49-911-518-290 (F.S.)
| | - Martina Kinzig
- IBMP—Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg 90562, Germany;
| | - Cornelia B. Landersdorfer
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia;
| | - Yuanyuan Jiao
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA; (N.R.S.); (Y.J.); (D.S.S.); (X.T.)
| | - Dhruvitkumar S. Sutaria
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA; (N.R.S.); (Y.J.); (D.S.S.); (X.T.)
| | - Xun Tao
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA; (N.R.S.); (Y.J.); (D.S.S.); (X.T.)
| | - Rainer Höhl
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg 90419, Germany;
| | - Ulrike Holzgrabe
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Würzburg 97074, Germany;
| | - Frieder Kees
- Department of Pharmacology, University of Regensburg, Regensburg 93053, Germany;
| | - Ulrich Stephan
- IBMP—Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg 90562, Germany;
- Department of Pharmacology, University of Duisburg, Essen 47057, Germany
| | - Fritz Sörgel
- IBMP—Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg 90562, Germany;
- Department of Pharmacology, University of Duisburg, Essen 47057, Germany
- Correspondence: (J.B.B.); (F.S.); Tel.: +1-407-313-7010 (J.B.B.); +49-911-518-290 (F.S.)
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6
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Shen H, Holenarsipur VK, Mariappan TT, Drexler DM, Cantone JL, Rajanna P, Singh Gautam S, Zhang Y, Gan J, Shipkova PA, Marathe P, Humphreys WG. Evidence for the Validity of Pyridoxic Acid (PDA) as a Plasma-Based Endogenous Probe for OAT1 and OAT3 Function in Healthy Subjects. J Pharmacol Exp Ther 2018; 368:136-145. [PMID: 30361237 DOI: 10.1124/jpet.118.252643] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/23/2018] [Indexed: 12/24/2022] Open
Abstract
Plasma pyridoxic acid (PDA) and homovanillic acid (HVA) were recently identified as novel endogenous biomarkers of organic anion transporter (OAT) 1/3 function in monkeys. Consequently, this clinical study assessed the dynamic changes and utility of plasma PDA and HVA as an initial evaluation of OAT1/3 inhibition in early-phase drug development. The study was designed as a single-dose randomized, three-phase, crossover study; 14 Indian healthy volunteers received probenecid (PROB) (1000 mg orally) alone, furosemide (FSM) (40 mg orally) alone, or FSM 1 hour after receiving PROB (40 and 1000 mg orally) on days 1, 8, and 15, respectively. PDA and HVA plasma concentrations remained stable over time in the prestudy and FSM groups. Administration of PROB significantly increased the area under the plasma concentration-time curve (AUC) of PDA by 3.1-fold (dosed alone; P < 0.05), and 3.2-fold (coadministered with FSM; P < 0.01), compared with the prestudy and FSM groups, respectively. The corresponding increase in HVA AUC was 1.8-fold (P > 0.05) and 2.1-fold (P < 0.05), respectively. The increases in PDA AUC are similar to those in FSM AUC, whereas those of HVA are smaller (3.1-3.2 and 1.8-2.1 vs. 3.3, respectively). PDA and HVA renal clearance (CL R) values were decreased by PROB to smaller extents compared with FSM (0.35-0.37 and 0.67-0.73 vs. 0.23, respectively). These data demonstrate that plasma PDA is a promising endogenous biomarker for OAT1/3 function and that its plasma exposure responds in a similar fashion to FSM upon OAT1/3 inhibition by PROB. The magnitude and variability of response in PDA AUC and CL R values between subjects is more favorable relative to HVA.
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Affiliation(s)
- Hong Shen
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Vinay K Holenarsipur
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - T Thanga Mariappan
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Dieter M Drexler
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Joseph L Cantone
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Prabhakar Rajanna
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Shashyendra Singh Gautam
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Yueping Zhang
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Jinping Gan
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Petia A Shipkova
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - Punit Marathe
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
| | - W Griffith Humphreys
- Metabolism and Pharmacokinetics Department (H.S., Y.Z., J.G., P.M., W.G.H.) and Bioanalytical and Discovery Analytical Sciences Department (P.A.S.), Bristol-Myers Squibb Company, Princeton, New Jersey; Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre (BBRC), Syngene International Ltd., Biocon Park, Bangalore, India (V.K.H., T.T.M., P.R., S.S.G.); and Bioanalytical and Discovery Analytical Sciences Department, Bristol-Myers Squibb Company, Wallingford, Connecticut (D.M.D., J.L.C.)
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