Effect of age and gender on the pharmacokinetics of grepafloxacin

Gender-based personalized pharmacotherapy: a systematic review

PURPOSE

In general, male and female are prescribed the same amount of dosage even if most of the cases female required less dosage than male. Physicians are often facing problem on appropriate drug dosing, efficient treatment, and drug safety for a female in general. To identify and synthesize evidence about the effectiveness of gender-based therapy; provide the information to patients, providers, and health system intervention to ensure safety treatment; and minimize adverse effects.

METHODS

We performed a systematic review to evaluate the effect of gender difference on pharmacotherapy. Published articles from January 1990 to December 2015 were identified using specific term in MEDLINE (PubMed), EMBASE, and the Cochrane library according to search strategies that strengthen the reporting of observational and clinical studies.

RESULTS

Twenty-six studies fulfilled the inclusion criteria for this systematic review, yielding a total of 6309 subjects. We observed that female generally has a lower the gastric emptying time, gastric PH, lean body mass, and higher plasma volume, BMI, body fat, as well as reduce hepatic clearance, difference in activity of Cytochrome P450 enzyme, and metabolize drugs at different rate compared with male. Other significant factors such as conjugation, protein binding, absorption, and the renal elimination could not be ignored. However, these differences can lead to adverse effects in female especially for the pregnant, post-menopausal, and elderly women.

CONCLUSION

This systematic review provides an evidence for the effectiveness of dosage difference to ensure safety and efficient treatment. Future studies on the current topic are, therefore, recommended to reduce the adverse effect of therapy.

Influence of Sex on the Pharmacokinetics of Ciprofloxacin and Ofloxacin

The pharmacokinetics of orally administered ciprofloxacin and ofloxacin were studied in healthy volunteers to assess the influence of sex on drug bioavailability. The first group of subjects (9 males and 9 females) received a single oral dose of 200 mg ofloxacin, and the second group of volunteers included 24 subjects (12 males and 12 females) treated with a single oral dose of 100 mg ciprofloxacin. Blood samples (3 ml) were collected and investigated in this parallel design study in both groups, and ciprofloxacin and ofloxacin concentrations were determined. These experimental data, which had not been changed by any mathematical operation, were collected and used to determine the effect of sex on the pharmacokinetic profile using parametric and non-parametric tests as well as multivariate classification tools like cluster analysis (CA) and principal component analysis (PCA). The following variables demonstrated significant differences (p < 0.05) in c(0.5), c(1.5), c(2.0), c(4.0), c(10), c(12.0), c(24) and c(6.0), c(8.0), c(10.0) for ofloxacin and ciprofloxacin, respectively, using Student's t test and ANOVA. Therefore the alternative hypothesis about sex differences between males and females was accepted. The CA and PCA plot separated females from males and allowed to select subjects accounting for differences between males and females. Data on the whole pharmacokinetic profile enabled to determine subtle sex differences between males and females.

Pharmacokinetics of Intravenously Administered Levofloxacin in Men and Women

STUDY OBJECTIVE

To characterize and compare the pharmacokinetics of levofloxacin in men and women after systemic administration.

DESIGN

Prospective, open-label, parallel group pharmacokinetic study.

SETTING

University research center.

SUBJECTS

Eleven healthy men and nine healthy women stratified by body mass index.

INTERVENTION

Subjects received levofloxacin as a single 500-mg intravenous dose. Serum and urine were collected over 36 hours.

MEASUREMENTS AND MAIN RESULTS

Levofloxacin concentrations were determined by high-performance liquid chromatography with ultraviolet detection. Pharmacokinetic analysis was performed with ADAPT II software (University of Southern California, Los Angeles, CA). Median (range) body mass index was 23.2 kg/m2 (19.9-28.3 kg/m2) for men and 23.6 kg/m2 (16.0-32.4 kg/m2) for women (p = 0.67). A two-compartment model best fit the pharmacokinetic data: median (range) R2 was 0.996 (0.990-0.999). Women had a 24% greater exposure to levofloxacin, with a significantly smaller steady-state volume of distribution (p < 0.01) and a slower clearance (p < 0.01).

CONCLUSIONS

Differences exist in the disposition of levofloxacin between healthy men and women after systemic administration. Fixed intravenous doses of levofloxacin will lead to greater drug exposure in women. Thus, women may have more of an increased risk of fluoroquinolone toxicity than men, and men may need higher doses to achieve similar drug efficacy than women. Levofloxacin dosage adjustments based on sex should be considered on an individual basis.

Sex-related differences in the pharmacokinetics of oral ciprofloxacin

The oral pharmacokinetics of ciprofloxacin were studied in healthy volunteers to assess the influence of sex on its disposition. Subjects (8 males, 7 females) received a single oral dose of ciprofloxacin 750 mg, blood and urine samples were collected, and ciprofloxacin concentrations were determined. A two-compartment open-model with two or three absorption phases, each one having a fitted independent lag time, best fit the data using a weighted least squares estimator. Univariate and multivariate regression analyses were performed to determine the influence of renal function, weight, and subject sex on the oral clearance (CL(S)/F) and apparent steady-state volume of distribution (V(ss)/F) of ciprofloxacin. Females had a median C(max) of ciprofloxacin that was 30% greater than males and a significantly smaller median (range) V(ss)/F: 81.1 (44.8-111.6) versus 170.9 (140.9-213.4), respectively (p < 0.01). In addition, females had increased exposure to ciprofloxacin, with a slower median (range) CL(S)/F of 28.3 L/h (24.5-33.4) compared to 44.4 L/h (41.4-53.7) for males (p < 0.01). Regression analyses revealed that subject sex was the only significant predictor of CL(S)/F (p < 0.001), but both body weight (p = 0.04) and subject sex (p < 0.005) were significant predictors of V(ss)/F. Fixed oral doses of ciprofloxacin will lead to higher maximum concentration and total drug exposure in females compared to males and do not appear to be solely related to weight-based differences.

How important are gender differences in pharmacokinetics?

Gender-related differences in pharmacokinetics have frequently been considered as potentially important determinants for the clinical effectiveness of drug therapy. The mechanistic processes underlying gender-specific pharmacokinetics can be divided into molecular and physiological factors. Major molecular factors involved in drug disposition include drug transporters and drug-metabolising enzymes. Men seem to have a higher activity relative to women for the cytochrome P450 (CYP) isoenzymes CYP1A2 and potentially CYP2E1, for the drug efflux transporter P-glycoprotein, and for some isoforms of glucuronosyltransferases and sulfotransferases. Women were suggested to have a higher CYP2D6 activity. No major gender-specific differences seem to exist for CYP2C19 and CYP3A. The often-described higher hepatic clearance in women compared with men for substrates of CYP3A and P-glycoprotein, such as erythromycin and verapamil, may be explained by increased intrahepatocellular substrate availability due to lower hepatic P-glycoprotein activity in women relative to men. Physiological factors resulting in gender-related pharmacokinetic differences include the generally lower bodyweight and organ size, higher percentage of body fat, lower glomerular filtration rate and different gastric motility in women compared with men. Although gender disparity in pharmacokinetics has been identified for numerous drugs, differences are generally only subtle. For a few drugs, e.g. verapamil, beta-blockers and selective serotonin reuptake inhibitors, gender-related differences in pharmacokinetics have been shown to result in different pharmacological responses, but their clinical relevance remains unproven. In contrast, gender differences of clinical importance have clearly been identified for pharmacodynamic processes such as QTc prolongation, and intensive future research efforts are needed to assess the full scope and impact of pharmacodynamic gender disparity on applied pharmacotherapy.

Comparison of the fluoroquinolones based on pharmacokinetic and pharmacodynamic parameters

Assessment of pharmacodynamic activity from standard in vitro minimum inhibitory concentrations (MICs) alone is insufficient to predict in vivo potency. Achievable serum and tissue concentrations as well as pharmacokinetic characteristics must be considered. When pharmacokinetic and pharmacodynamic values are combined, the area under the inhibitory curve (AUIC) and peak concentration:MIC ratio predict clinical cure for fluoroquinolones. Clinical data and animal models indicate that a peak:MIC of 10:1 and above and an AUIC of 125 and above are predictive of a clinical cure for this class of antimicrobials against gram-negative organisms. The values may be used to compare and contrast fluoroquinolones to determine which would be best for treating a specific microorganism. Pharmacodynamic data also can be used to design regimens that minimize the risk of suboptimal drug levels. Ensuring the optimal fluoroquinolone dosage based on pharmacodynamic principles would diminish the emergence of resistant organisms and prevent treatment failures.

Quinolones in the aged

Pharmacokinetic studies of fluoroquinolone antibacterials generally demonstrate some quantitative alterations in elderly compared with younger populations. The most common observations are an increased maximal plasma drug concentration and area under the concentration-time curve, which are primarily attributable to the 10 to 15% decrease in lean body mass in the elderly. For quinolones excreted primarily by the renal route, there is a prolongation in elimination half-life correlated with the aging-associated decline in creatinine clearance. Quinolones with major routes of nonrenal clearance will not usually show a prolongation in half-life because of compensatory relative increases in nonrenal mechanisms. Alterations directly attributable to aging alone, however, are minor, and vary between different quinolones. They do not justify a consistent need for dosage alterations on the basis of age alone. Agents with primarily renal excretion, such as ofloxacin or levofloxacin, may require dosage adjustment in the very elderly or the frail elderly, if significant decreases in creatinine clearance are present. No age-related differences in adverse effects of fluoroquinolones have been reported. Studies in both community-dwelling and institutionalised elderly populations have consistently shown quinolones to be as effective as comparative parenteral or oral therapy. While elderly populations may be at greater risk of adverse effects because of comorbidities and concurrent therapies, an increased occurrence of adverse events in elderly populations receiving quinolone antimicrobials relative to younger populations has not been reported.

Effect of gender on the pharmacokinetics of ofloxacin

STUDY OBJECTIVES

To assess the influence of gender on the pharmacokinetics of ofloxacin.

DESIGN

Open-label study.

SETTING

Academic medical center.

PATIENTS

Five healthy men and seven healthy women volunteers.

INTERVENTIONS

Subjects received a single oral dose of ofloxacin 400 mg, and serial blood samples were collected for 24 hours. Plasma concentrations of ofloxacin were determined by high-performance liquid chromatography and pharmacokinetic parameters were determined. Statistical comparisons between genders were made with the Wilcoxon rank sum test.

MEASUREMENTS AND MAIN RESULTS

Median volume of distribution at steady state/systemic bioavailability (V(ss)/F) was significantly smaller in women than in men, although when normalized for total body weight there were no differences. Except for terminal elimination half-life, which was 10% shorter in women, no other pharmacokinetic values were significantly different between genders. Median peak concentrations, although not statistically different, were 28% higher in women.

CONCLUSION

Ofloxacin V(ss)/F values were smaller in women than in men, explained by gender-related differences in weight.