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Tay E, Sotiriou A, Graham GG, Wilhelm K, Snowden L, Day RO. Restarting antidepressant and antipsychotic medication after intentional overdoses: need for evidence-based guidance. Ther Adv Psychopharmacol 2019; 9:2045125319836889. [PMID: 30956788 PMCID: PMC6444415 DOI: 10.1177/2045125319836889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 02/13/2019] [Indexed: 11/16/2022] Open
Abstract
Intentional drug overdoses with antidepressant and antipsychotic medications are an increasingly common problem. Currently, there is little guidance with regard to reintroduction of these medications after intentional overdoses. We have used published toxicological and pharmacokinetic data to obtain factors which control the recovery from overdoses. From such data, we have proposed guidance regarding their reintroduction, provided there are no adverse effects or contraindications. Tentatively, we suggest that when adverse effects from the overdose are lost, treatment could recommence after a further mean half-life of elimination. Most antidepressant and antipsychotic drugs are metabolized by cytochrome P450 enzymes and, where cytochrome P450 inhibitors are co-ingested, serial plasma concentrations should optimally be obtained in order to assess a suitable time for reintroduction of the psychoactive drugs. We hope the proposals presented will stimulate research and discussion that lead to better guidance for clinicians concerning reintroduction of psychoactive medication after intentional overdose.
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Affiliation(s)
- Emma Tay
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
| | - Andreas Sotiriou
- University College London Medical School, University College London, London, UK
| | - Garry G Graham
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia Department of Pharmacology, University of New South Wales, Sydney, Australia
| | - Kay Wilhelm
- Department of Liaison Psychiatry, St Vincent's Hospital, Sydney, Australia Department of Psychiatry, University of New South Wales, Sydney, Australia
| | - Leone Snowden
- NSW Medicines Information Centre, Darlinghurst, NSW, Australia
| | - Richard O Day
- Department of Pharmacology, University of New South Wales, Sydney, Australia
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Polasek TM, Tucker GT, Sorich MJ, Wiese MD, Mohan T, Rostami‐Hodjegan A, Korprasertthaworn P, Perera V, Rowland A. Prediction of olanzapine exposure in individual patients using physiologically based pharmacokinetic modelling and simulation. Br J Clin Pharmacol 2018; 84:462-476. [PMID: 29194718 PMCID: PMC5809347 DOI: 10.1111/bcp.13480] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
AIM The aim of the present study was to predict olanzapine (OLZ) exposure in individual patients using physiologically based pharmacokinetic modelling and simulation (PBPK M&S). METHODS A 'bottom-up' PBPK model for OLZ was constructed in Simcyp® (V14.1) and validated against pharmacokinetic studies and data from therapeutic drug monitoring (TDM). The physiological, demographic and genetic attributes of the 'healthy volunteer population' file in Simcyp® were then individualized to create 'virtual twins' of 14 patients. The predicted systemic exposure of OLZ in virtual twins was compared with measured concentration in corresponding patients. Predicted exposures were used to calculate a hypothetical decrease in exposure variability after OLZ dose adjustment. RESULTS The pharmacokinetic parameters of OLZ from single-dose studies were accurately predicted in healthy Caucasians [mean-fold errors (MFEs) ranged from 0.68 to 1.14], healthy Chinese (MFEs 0.82 to 1.18) and geriatric Caucasians (MFEs 0.55 to 1.30). Cumulative frequency plots of trough OLZ concentration were comparable between the virtual population and patients in a TDM database. After creating virtual twins in Simcyp®, the R2 values for predicted vs. observed trough OLZ concentrations were 0.833 for the full cohort of 14 patients and 0.884 for the 7 patients who had additional cytochrome P450 2C8 genotyping. The variability in OLZ exposure following hypothetical dose adjustment guided by PBPK M&S was twofold lower compared with a fixed-dose regimen - coefficient of variation values were 0.18 and 0.37, respectively. CONCLUSIONS Olanzapine exposure in individual patients was predicted using PBPK M&S. Repurposing of available PBPK M&S platforms is an option for model-informed precision dosing and requires further study to examine clinical potential.
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Affiliation(s)
- Thomas M. Polasek
- Department of Clinical PharmacologyFlinders UniversityAdelaideSAAustralia
- d3 MedicineA Certara CompanyMelbourneVICAustralia
| | - Geoffrey T. Tucker
- Medicine and Biomedical Sciences (Emeritus)University of SheffieldSheffieldUK
| | - Michael J. Sorich
- Department of Clinical PharmacologyFlinders UniversityAdelaideSAAustralia
- Flinders Centre for Innovation in CancerFlinders UniversityAdelaideSAAustralia
| | - Michael D. Wiese
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Titus Mohan
- Department of PsychiatryFlinders Medical CentreAdelaideSAAustralia
| | - Amin Rostami‐Hodjegan
- Certara, Blades Enterprise CentreSheffieldUK
- Centre for Applied Pharmacokinetic ResearchUniversity of ManchesterManchesterUK
| | | | - Vidya Perera
- Clinical Pharmacology and Pharmacometrics, Early Clinical and Translational ResearchBristol Myers SquibbPrincetonNJUSA
| | - Andrew Rowland
- Department of Clinical PharmacologyFlinders UniversityAdelaideSAAustralia
- Flinders Centre for Innovation in CancerFlinders UniversityAdelaideSAAustralia
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Yin A, Shang D, Wen Y, Li L, Zhou T, Lu W. Population pharmacokinetics analysis of olanzapine for Chinese psychotic patients based on clinical therapeutic drug monitoring data with assistance of meta-analysis. Eur J Clin Pharmacol 2016; 72:933-44. [PMID: 27117554 DOI: 10.1007/s00228-016-2040-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/02/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to build an eligible population pharmacokinetic (PK) model for olanzapine in Chinese psychotic patients based on therapeutic drug monitoring (TDM) data, with assistance of meta-analysis, to facilitate individualized therapy. METHODS Population PK analysis for olanzapine was performed using NONMEM software (version 7.3.0). TDM data were collected from Guangzhou Brain Hospital (China). Because of the limitations of TDM data, model-based meta-analysis was performed to construct a structural model to assist the modeling of TDM data as prior estimates. After analyzing related covariates, a simulation was performed to predict concentrations for different types of patients under common dose regimens. RESULTS A two-compartment model with first-order absorption and elimination was developed for olanzapine oral tablets, based on 23 articles with 390 data points. The model was then applied to the TDM data. Gender and smoking habits were found to be significant covariates that influence the clearance of olanzapine. To achieve a blood concentration of 20 ng/mL (the lower boundary of the recommended therapeutic range), simulation results indicated that the dose regimen of olanzapine should be 5 mg BID (twice a day), ≥ 5 mg QD (every day) plus 10 mg QN (every night), or >10 mg BID for female nonsmokers, male nonsmokers and male smokers, respectively. CONCLUSION The population PK model, built using meta-analysis, could facilitate the modeling of TDM data collected from Chinese psychotic patients. The factors that significantly influence olanzapine disposition were determined and the final model could be used for individualized treatment.
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Affiliation(s)
- Anyue Yin
- School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.,Peking University/Pfizer Pharmacometrics Education Center, Peking University Health Science Center, Beijing, 100191, China.,State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Dewei Shang
- Guangzhou Brain Hospital (Guangzhou Huiai Hospital, the Affiliated Brain Hospital of Guangzhou Medical University), Guangzhou, 510370, China
| | - Yuguan Wen
- Guangzhou Brain Hospital (Guangzhou Huiai Hospital, the Affiliated Brain Hospital of Guangzhou Medical University), Guangzhou, 510370, China
| | - Liang Li
- School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.,Peking University/Pfizer Pharmacometrics Education Center, Peking University Health Science Center, Beijing, 100191, China.,State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Tianyan Zhou
- School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.,Peking University/Pfizer Pharmacometrics Education Center, Peking University Health Science Center, Beijing, 100191, China.,State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Wei Lu
- School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China. .,Peking University/Pfizer Pharmacometrics Education Center, Peking University Health Science Center, Beijing, 100191, China. .,State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China. .,Beijing Institute for Brain Disorders, Beijing, 100088, China.
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