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Owor M, Tierney C, Ziemba L, Browning R, Moye J, Graham B, Reding C, Costello D, Norman J, Wiesner L, Hughes E, Whalen ME, Purdue L, Mmbaga BT, Kamthunzi P, Kawalazira R, Nathoo K, Bradford S, Coletti A, Aweeka F, Musoke P. Pharmacokinetics and Safety of Zidovudine, Lamivudine, and Lopinavir/Ritonavir in HIV-infected Children With Severe Acute Malnutrition in Sub-Saharan Africa: IMPAACT Protocol P1092. Pediatr Infect Dis J 2021; 40:446-452. [PMID: 33464021 PMCID: PMC8043511 DOI: 10.1097/inf.0000000000003055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe acute malnutrition (SAM) may alter the pharmacokinetics (PK), efficacy, and safety of antiretroviral therapy. The phase IV study, IMPAACT P1092, compared PK, safety, and tolerability of zidovudine (ZDV), lamivudine (3TC), and lopinavir/ritonavir (LPV/r) in children with and without SAM. MATERIALS AND METHODS Children living with HIV 6 to <36 months of age with or without World Health Organization (WHO)-defined SAM received ZDV, 3TC, and LPV/r syrup for 48 weeks according to WHO weight band dosing. Intensive PK sampling was performed at weeks 1, 12, and 24. Plasma drug concentrations were measured using liquid chromatography tandem mass spectrometry. Steady-state mean area under the curve (AUC0-12h) and clearance (CL/F) for each drug were compared. Grade ≥3 adverse events were compared between cohorts. RESULTS Fifty-two children were enrolled across 5 sites in Africa with 44% (23/52) female, median age 19 months (Q1, Q3: 13, 25). Twenty-five children had SAM with entry median weight-for-height Z-score (WHZ) -3.4 (IQR -4.0, -3.0) and 27 non-SAM had median WHZ -1.0 (IQR -1.8, -0.1). No significant differences in mean AUC0-12h or CL/F were observed (P ≥ 0.09) except for lower 3TC AUC0-12h (GMR, 0.60; 95% CI, 0.4-1.0; P = 0.047) at week 12, higher ZDV AUC0-12h (GMR, 1.52; 1.2-2.0; P = 0.003) at week 24 in the SAM cohort compared with non-SAM cohort. Treatment-related grade ≥3 events did not differ significantly between cohorts (24.0% vs. 25.9%). CONCLUSION PK and safety findings for ZDV, 3TC, and LPV/r support current WHO weight band dosing of syrup formulations in children with SAM.
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Affiliation(s)
- Maxensia Owor
- From the Makerere University—Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Camlin Tierney
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H Chan School of Public Health, Boston, MA
| | - Lauren Ziemba
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H Chan School of Public Health, Boston, MA
| | - Renee Browning
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | | | | | | | - Diane Costello
- IMPAACT Laboratory Center, University of California, Los Angeles, CA
| | - Jennifer Norman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Emma Hughes
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Meghan E. Whalen
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | | | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute—Kilimanjaro Christian Medical Center and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Rachel Kawalazira
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Kusum Nathoo
- College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | | | | | - Francesca. Aweeka
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Philippa Musoke
- From the Makerere University—Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Chouchana L, Boujaafar S, Gana I, Preta LH, Regard L, Legendre P, Azoulay C, Canouï E, Zerbit J, Carlier N, Terrier B, Kernéis S, Batista R, Treluyer JM, Zheng Y, Benaboud S. Plasma Concentrations and Safety of Lopinavir/Ritonavir in COVID-19 Patients. Ther Drug Monit 2021; 43:131-135. [PMID: 33230045 PMCID: PMC7808275 DOI: 10.1097/ftd.0000000000000838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although the efficacy of lopinavir/ritonavir has not been proven, it has been proposed as an off-label treatment for COVID-19. Previously, it has been reported that the plasma concentrations of lopinavir significantly increase in inflammatory settings. As COVID-19 may be associated with major inflammation, assessing the plasma concentrations and safety of lopinavir in COVID-19 patients is essential. METHODS Real-world COVID-19 data based on a retrospective study. RESULTS Among the 31 COVID-19 patients treated with lopinavir/ritonavir between March 18, 2020 and April 1, 2020, higher lopinavir plasma concentrations were observed, which increased by 4.6-fold (interquartile range: 3.6-6.2), compared with the average plasma concentrations in HIV. Lopinavir concentrations in all except one patient were above the upper limit of the concentration range of HIV treatment. Approximately one to 5 patients prematurely stopped treatment mainly because of an ADR related to hepatic or gastrointestinal disorders. CONCLUSIONS Lopinavir plasma concentrations in patients with moderate-to-severe COVID-19 were higher than expected, and they were associated with the occurrence of hepatic or gastrointestinal adverse drug reactions. However, a high plasma concentration may be required for in vivo antiviral activity against SARS-CoV-2, as suggested by previous studies. Therefore, in the absence of adverse drug reaction, lopinavir dosage should not be reduced. Caution is essential because off-label use can be associated with a new drug safety profile.
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Affiliation(s)
- Laurent Chouchana
- Regional Center of Pharmacovigilance, Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Sana Boujaafar
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Ines Gana
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Laure-Hélène Preta
- Regional Center of Pharmacovigilance, Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Lucile Regard
- Pneumology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Paul Legendre
- Internal Medicine Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Celia Azoulay
- Internal Medicine Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Etienne Canouï
- Antimicrobial Stewardship Team, Cochin Hospital, AP-HP Centre-Université de Paris; and
| | - Jeremie Zerbit
- Pharmacy Department, Cochin Hospital, AP-HP Centre-Université de Paris, Paris, France
| | - Nicolas Carlier
- Pneumology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Benjamin Terrier
- Internal Medicine Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Solen Kernéis
- Antimicrobial Stewardship Team, Cochin Hospital, AP-HP Centre-Université de Paris; and
| | - Rui Batista
- Pharmacy Department, Cochin Hospital, AP-HP Centre-Université de Paris, Paris, France
| | - Jean-Marc Treluyer
- Regional Center of Pharmacovigilance, Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Yi Zheng
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
| | - Sihem Benaboud
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris
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Hernández-Pineda J, Jung-Cook HH, Katende-Kyenda NL, Galindo-Sevilla N, Domínguez-Castro M, Romo-Yañéz J, Ramírez-Ramírez A, Irles C, Figueroa-Damián R. Assessment of lamivudine, zidovudine, lopinavir, and ritonavir plasma levels in HIV-positive pregnant women: Drug monitoring application to improve patient safety. Medicine (Baltimore) 2020; 99:e20487. [PMID: 32481459 DOI: 10.1097/md.0000000000020487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Simultaneous therapeutic drug monitoring (TDM) of combination antiretroviral therapy (cART) is critical during pregnancy in order to improve clinical follow-up, monitor viral load, and patient adherence to treatment.A modified simple and fast ultra-high performance liquid chromatography coupled with tandem mass spectrometry and electrospray ionization (UPLC-ESI-MS/MS) method was developed and validated according to national and international guidelines for the simultaneous determination of lamivudine (LMV), zidovudine (ZDV), lopinavir (LPV), and ritonavir (RTV) concentrations in 100-μL plasma sample of Human Immunodeficiency Virus (HIV)-positive pregnant women. Protein precipitation using 0.1% formic acid in cold acetonitrile was used for sample preparation. The chromatographic separation was achieved with a run-time of 3.0 minutes and 3-μL injection on an ethylene bridged hybrid C18 column (2.1 μm × 50 mm, 1.7 μm), under gradient conditions using acetonitrile and formic acid (0.1%).The chromatographic method was used to analyze 10 plasma samples from 8 HIV pregnant women as a clinical patient routinely follow-up by applying TDM criteria.The protonated precursor/product ion transitions for LMV (230.18/112.08), ZDV (268.22/127.10), LPV (629.55/447.35), and RTV (721.50/296.20) were recorded in multiple-reaction-monitoring (MRM) mode. The calibration curve was linear in the range of 50-3,000, 75-4,500, 250-15,000, and 25-1,500-ng/mL for LMV, ZDV, LPV, and RTV, respectively. The range of accuracy was 97.2% to 100.1% and precision 3.4% to 12.7%. The method showed specificity and matrix effect values of < 15%. Minimum absolute recovery percentages (%CV) were 90.5 (5.4), 90.8 (5.0), 95.4 (3.5), and 93.7 (6.9), for LMV, ZDV, LPV, and RTV, respectively. Drug concentrations in patient samples had high inter-individual variability with %CV of 91.98%, 77.54%, 53.80%, and 92.16% for ZDV, LMV, LPV, and RTV, respectively. Two of the 8 patients showed no adherence due to the absence of Protease Inhibitors (PIs) levels in plasma.This technique demonstrated to be effective in therapeutic drug monitoring and is intended to be used in population pharmacokinetics specifically for HIV-positive pregnant women.
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Affiliation(s)
| | | | - Norah Lucky Katende-Kyenda
- Department of Internal Medicine and Pharmacology, Walter Sisulu University, School of Medicine, Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
| | | | | | - José Romo-Yañéz
- Coordinación de Endocrinología Ginecológica y Perinatal. Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | - Claudine Irles
- Departamento de Fisiología y Desarrollo Celular. Instituto Nacional de Perinatología
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Oumar AA, Bagayoko-Maiga K, Bahachimi A, Maiga M, Cere MC, Diarra Z, Chatelut E, Sylla M, Murphy RL, Dao S, Gandia P. Efavirenz and Lopinavir Levels in HIV-Infected Women and Their Nursing Infants, in Mali. J Pharmacol Exp Ther 2018; 366:479-484. [PMID: 29986950 PMCID: PMC11056435 DOI: 10.1124/jpet.118.249938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022] Open
Abstract
Limited data are currently available on antiretroviral pharmacokinetics in breast milk (BM) and in breastfed infants' blood. To explore these parameters in patients in Mali, we measured plasma antiretroviral levels in human immunodeficiency virus (HIV)-infected mothers and their breastfed infants over 6 months. We specifically analyzed the concentrations of efavirenz (EFV) and lopinavir (LPV) in the plasma of mothers living with HIV and their breastfed infants. Blood samples were collected at delivery and at month 1, 3, and 6 postpartum. EFV and LPV concentrations were measured by liquid chromatography-tandem mass spectrometry. HIV-1 RNA load was measured by Abbott M2000RT RealTime System at delivery and 6 months postpartum for mothers, and at 3 and 6 months postbirth for infants. The median duration of antiretroviral therapy at study inclusion was 57 months [interquartile range (IQR), 0-168 months]. The median EFV ratios of infant plasma/maternal plasma (MP) were 0.057 at month 1, 0.072 at month 3, and 0.048 at month 6. During the study period, the median BM/MP ratio of EFV was 1.16 (IQR, 0.96-20.62), which corresponds to a relative infant dose of 2.46% of the recommended weight-adjusted pediatric EFV dose at month 6. The apparent infant clearance of EFV was 0.146 l/h per kilogram at month 6. The LPV concentrations in the plasma of all infants were undetectable. No drug-related adverse reaction or toxicity was observed in any of the infants. The two women who presented a viral load of >50 copies/ml at month 6 had undetectable plasma drug concentrations at the same period. This study showed that breastfed infants received a low level of EFV but not LPV from their treated mothers.
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Affiliation(s)
- Aboubacar Alassane Oumar
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Kadiatou Bagayoko-Maiga
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Aliou Bahachimi
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Mamoudou Maiga
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Marie-Christine Cere
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Zoumana Diarra
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Etienne Chatelut
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Mariam Sylla
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Robert Leo Murphy
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Sounkalo Dao
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
| | - Peggy Gandia
- Pharmacokinetics and Toxicology Laboratory, Federative Institute of Biology, Purpan Hospital University, Toulouse, France (A.A.O., M.-C.C., P.G.); Institut National de la Sante et de la Recherche Medicale, Unité Mixte de Recherche 1037, Pharmacology and Pharmacogenetics Laboratory, University Institute of Cancer Oncopôle, Toulouse, France (A.A.O., E.C.); HIV/Tuberculosis Research and Training Center, University of Science, Techniques and Technologies, Bamako, Mali (A.A.O., A.B., M.M., S.D.); Center for Global Health, Northwestern University, Chicago, Illinois (M.M., R.L.M.); Department of Pediatric, University Hospital of Gabriel Touré, Bamako, Mali (K.B.-M., M.S.); Referral Health Center V, Bamako, Mali (Z.D.); and Institut National de la Recherche Agronomique Unité Mixte de Recherche 1331-TOXALIM, Veterinary School of Toulouse, Toulouse, France (P.G.)
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Giardiello M, Liptrott NJ, McDonald TO, Moss D, Siccardi M, Martin P, Smith D, Gurjar R, Rannard SP, Owen A. Accelerated oral nanomedicine discovery from miniaturized screening to clinical production exemplified by paediatric HIV nanotherapies. Nat Commun 2016; 7:13184. [PMID: 27767027 PMCID: PMC5078733 DOI: 10.1038/ncomms13184] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/08/2016] [Indexed: 12/13/2022] Open
Abstract
Considerable scope exists to vary the physical and chemical properties of nanoparticles, with subsequent impact on biological interactions; however, no accelerated process to access large nanoparticle material space is currently available, hampering the development of new nanomedicines. In particular, no clinically available nanotherapies exist for HIV populations and conventional paediatric HIV medicines are poorly available; one current paediatric formulation utilizes high ethanol concentrations to solubilize lopinavir, a poorly soluble antiretroviral. Here we apply accelerated nanomedicine discovery to generate a potential aqueous paediatric HIV nanotherapy, with clinical translation and regulatory approval for human evaluation. Our rapid small-scale screening approach yields large libraries of solid drug nanoparticles (160 individual components) targeting oral dose. Screening uses 1 mg of drug compound per library member and iterative pharmacological and chemical evaluation establishes potential candidates for progression through to clinical manufacture. The wide applicability of our strategy has implications for multiple therapy development programmes.
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Affiliation(s)
- Marco Giardiello
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool L69 7ZD, UK
| | - Neill J. Liptrott
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Tom O. McDonald
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool L69 7ZD, UK
| | - Darren Moss
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Marco Siccardi
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Phil Martin
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Darren Smith
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Rohan Gurjar
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
| | - Steve P. Rannard
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool L69 7ZD, UK
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool L69 3GF, UK
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6
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Pham K, Li D, Guo S, Penzak S, Dong X. Development and in vivo evaluation of child-friendly lopinavir/ritonavir pediatric granules utilizing novel in situ self-assembly nanoparticles. J Control Release 2016; 226:88-97. [PMID: 26849919 DOI: 10.1016/j.jconrel.2016.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 11/18/2022]
Abstract
The aim of this study was to develop a nanotechnology to formulate a fixed-dose combination of poorly water-soluble drugs in a children-friendly, flexible solid dosage form. For diseases like HIV, pediatric patients are taking multiple drugs for effective treatments. Fixed-dose combinations could reduce pill burdens and costs as well as improving patient adherence. However, development of fixed-dose combinations of poorly water-soluble drugs for pediatric formulations is very challenging. We discovered a novel nanotechnology that produced in situ self-assembly nanoparticles (ISNPs) when the ISNP granules were introduced to water. In this study, antiretroviral drug granules, including lopinavir (LPV) ISNP granules and a fixed-dose combination of LPV/ritonavir (RTV) ISNP granules, were prepared using the ISNP nanotechnology, which spontaneously produced drug-loaded ISNPs in contact with water. Drug-loaded ISNPs had particle size less than 158nm with mono-dispersed distribution, over 95% entrapment efficiency for both LPV and RTV and stability over 8h in simulated physiological conditions. Drug-loaded ISNP granules with about 16% of LPV and 4% of RTV were palatable and stable at room temperature over 6months. Furthermore, LPV/RTV ISNP granules displayed a 2.56-fold increase in bioavailability and significantly increased LPV concentrations in tested tissues, especially in HIV sanctuary sites, as compared to the commercial LPV/RTV tablet (Kaletra®) in rats. Overall, the results demonstrated that the novel ISNP nanotechnology is a promising platform to manufacture palatable, "heat" stable, and flexible pediatric granules for fixed-dose combinations that can be used as sachets and sprinkles. To the best of our knowledge, this is the first report on this kind of novel nanotechnology for pediatric fixed-dose combinations of poorly water-soluble drugs.
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Affiliation(s)
- Kevin Pham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Diana Li
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Shujie Guo
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Scott Penzak
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Xiaowei Dong
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA.
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Kitidee K, Khamaikawin W, Thongkum W, Tawon Y, Cressey TR, Jevprasesphant R, Kasinrerk W, Tayapiwatana C. Expedient screening for HIV-1 protease inhibitors using a simplified immunochromatographic assay. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 1021:153-158. [PMID: 26490422 DOI: 10.1016/j.jchromb.2015.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022]
Abstract
A colloidal gold-based immunochromatographic (IC) strip test was developed and validated for the detection of HIV-1 protease (HIV-PR) activity and inhibitory effect of HIV-PR inhibitors (PIs). It is a unique 'two-step' process requiring the combination of proteolysis of HIV-PR and an immunochromatographic reaction. Monoclonal antibodies to the free C-terminus of HIV matrix protein (HIV-MA) conjugated to gold particles and a monoclonal antibody against intact and cleaved forms of the HIV-MA are immobilized on the 'Test'-line of the IC strip. Using lopinavir, a potent HIV protease inhibitor, the IC-strip was optimized to detect inhibitory activity against HIV-protease. At a lopinavir concentration of 1000ng/mL (its suggested minimum effective concentration), a HIV-PRH6 concentration of 6mg/mL and incubation period of 60min were the optimal conditions. A preliminary comparison between a validated high-performance liquid chromatography assay and the IC-strip to semi-quantify HIV protease inhibitor concentrations (lopinavir and atazanavir) demonstrated good agreement. This simplified method is suitable for the rapid screening of novel protease inhibitors for future therapeutic use. Moreover, the IC strip could also be optimized to semi-quantify PIs concentrations in plasma samples.
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Affiliation(s)
- Kuntida Kitidee
- Center for Research and Innovation, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Wannisa Khamaikawin
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Weeraya Thongkum
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; i+MED Laboratories Company Limited, Bangkok, Thailand
| | - Yardpiroon Tawon
- Program for HIV Prevention and Treatment (PHPT/IRD 174), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Tim R Cressey
- Program for HIV Prevention and Treatment (PHPT/IRD 174), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; Harvard T.H Chan School of Public Health, Boston, MA 02115, USA
| | | | - Watchara Kasinrerk
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; Biomedical Technology Research Unit, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency at the Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chatchai Tayapiwatana
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Biomolecular Therapy and Diagnostic, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand.
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Naiker S, Connolly C, Wiesner L, Kellerman T, Reddy T, Harries A, McIlleron H, Lienhardt C, Pym A. Randomized pharmacokinetic evaluation of different rifabutin doses in African HIV- infected tuberculosis patients on lopinavir/ritonavir-based antiretroviral therapy. BMC Pharmacol Toxicol 2014; 15:61. [PMID: 25406657 PMCID: PMC4277828 DOI: 10.1186/2050-6511-15-61] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pharmacokinetic interactions between rifampicin and protease inhibitors (PIs) complicate the management of HIV-associated tuberculosis. Rifabutin is an alternative rifamycin, for patients requiring PIs. Recently some international guidelines have recommended a higher dose of rifabutin (150 mg daily) in combination with boosted lopinavir (LPV/r), than the previous dose of rifabutin (150 mg three times weekly {tiw}). But there are limited pharmacokinetic data evaluating the higher dose of rifabutin in combination with LPV/r. Sub-optimal dosing can lead to acquired rifamycin resistance (ARR). The plasma concentration of 25-O-desacetylrifabutin (d-RBT), the metabolite of rifabutin, increases in the presence of PIs and may lead to toxicity. METHODS AND RESULTS Sixteen patients with TB-HIV co-infection received rifabutin 300 mg QD in combination with tuberculosis chemotherapy (initially pyrazinamide, isoniazid and ethambutol then only isoniazid), and were then randomized to receive isoniazid and LPV/r based ART with rifabutin 150 mg tiw or rifabutin 150 mg daily. The rifabutin dose with ART was switched after 1 month. Serial rifabutin and d-RBT concentrations were measured after 4 weeks of each treatment. The median AUC0-48 and Cmax of rifabutin in patients taking 150 mg rifabutin tiw was significantly reduced compared to the other treatment arms. Geometric mean ratio (90% CI) for AUC0-48 and Cmax was 0.6 (0.5-0.7) and 0.5 (0.4-0.6) for RBT 150 mg tiw compared with RBT 300 mg and 0.4 (0.4-0.4) and 0.5 (0.5-0.6) for RBT 150 mg tiw compared with 150 mg daily. 86% of patients on the tiw rifabutin arm had an AUC0-24 < 4.5 μg.h/mL, which has previously been associated with acquired rifamycin resistance (ARR). Plasma d-RBT concentrations increased 5-fold with tiw rifabutin dosing and 15-fold with daily doses of rifabutin. Rifabutin was well tolerated at all doses and there were no grade 4 laboratory toxicities. One case of uveitis (grade 4), occurred in a patient taking rifabutin 300 mg daily prior to starting ART, and grade 3 neutropenia (asymptomatic) was reported in 4 patients. These events were not associated with increases in rifabutin or metabolite concentrations. CONCLUSIONS A daily 150 mg dose of rifabutin in combination with LPV/r safely maintained rifabutin plasma concentrations in line with those shown to prevent ARR. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00640887.
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Affiliation(s)
- Suhashni Naiker
- />TB Research Unit, Medical Research Council, Durban, South Africa
| | - Cathy Connolly
- />Biostatistics Unit, Medical Research Council, Durban, South Africa
| | - Lubbe Wiesner
- />Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tracey Kellerman
- />Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tarylee Reddy
- />Biostatistics Unit, Medical Research Council, Durban, South Africa
| | - Anthony Harries
- />International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Helen McIlleron
- />Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Alexander Pym
- />TB Research Unit, Medical Research Council, Durban, South Africa
- />KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), University of KwaZulu-Natal, Durban, South Africa
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Camara S, Zucman D, Vasse M, Goudjo A, Guillard E, Peytavin G. [Lack of bioavailability of generic lopinavir/ritonavir not prequalified by WHO marketed in Africa (Congo Brazzaville)]. ACTA ACUST UNITED AC 2014; 108:46-8. [PMID: 25256250 DOI: 10.1007/s13149-014-0389-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/11/2014] [Indexed: 11/27/2022]
Abstract
Although second-line generic antiretroviral drugs are of great value in developing countries there are concerns regarding their quality and safety. This study is a case report and pharmacological study in healthy volunteers. A French subject of sub-saharan origin who visited Republic of Congo received a post-exposure treatment with AZT+3TC and LPV/r (200/50 mg, Arga-L®, India) following unprotected sexual intercourse. Two days later, in France, tests showed that plasma concentrations of lopinavir and ritonavir were undetectable. The WHO prequalification list showed Arga-L® was not prequalified. A pharmacological study in healthy volunteers evaluated oral bioavailability: plasma concentrations of generic LPV/r Arga-L® and LPV/r Kaletra® (400/100 mg) were measured after one single dose at 7 days apart in four healthy volunteers. Concentrations of Arga-L® at 12 h after intake were considerably lower than those of Kaletra®, revealing very low oral bioavailability of generic lopinavir and ritonavir (<10%) compared to the brand-name drug. We found that Arga-L®, despite having adequate qualitative and quantitative drug contents, had very poor bio availability compared to Kaletra®. In order to avoid the selection and the spread of drug-resistant HIV strains, rigorous pharmacological monitoring of generic antiretroviral drugs that are not pre-qualified by WHO, but are marketed in Africa, must be a priority for health authorities.
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Affiliation(s)
- S Camara
- Hôpital Foch, 40 rue Worth, 92151, Suresnes cedex, France.
| | - D Zucman
- Hôpital Foch, 40 rue Worth, 92151, Suresnes cedex, France
| | - M Vasse
- Hôpital Foch, 40 rue Worth, 92151, Suresnes cedex, France
| | - A Goudjo
- France Expertise Internationale, 1, quai de Grenelle, 75015, Paris, France
| | - E Guillard
- Solthis, 58A, rue du Dessous des Berges, 75013, Paris, France
| | - G Peytavin
- Hôpital Bichat-Claude Bernard laboratoire pharmaco-toxicologie, 46 rue Henri Huchard, 75877, Paris cedex 18, France
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van Hoog S, Boer K, Nellen J, Scherpbier H, Godfried MH. Transplacental passage of nevirapine, nelfinavir and lopinavir. Neth J Med 2012; 70:102-103. [PMID: 22418759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Umeh OC, Currier JS, Park JG, Cramer Y, Hermes AE, Fletcher CV. Sex differences in lopinavir and ritonavir pharmacokinetics among HIV-infected women and men. J Clin Pharmacol 2011; 51:1665-73. [PMID: 21233301 DOI: 10.1177/0091270010388650] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors compared the pharmacokinetics of lopinavir (LPV) and ritonavir (RTV) between women and men. This 2-step, multicenter, pharmacokinetic study enrolled human immunodeficiency virus (HIV)-infected adults on lopinavir/ritonavir (LPV/r) capsules (400/100 mg bid) plus 1 or more nucleoside reverse transcriptase inhibitors. All participants underwent 12-hour pharmacokinetic sampling. The pharmacokinetic sampling was repeated in participants receiving the LPV/r tablet formulation. Step 1 enrolled 37 women and 40 men; step 2 included 42 participants from step 1 plus 35 new participants (39 women and 38 men). LPV pharmacokinetics in women and men were not significantly different with either formulation. Women had significantly higher median RTV AUC(0-12 h) with both the soft-gel capsule (SGC) and tablet formulations (SGC: 5395 vs 4119 ng·h/mL, P = .026; tablet: 5310 vs 3941 ng·h/mL, P = .012), higher median C(max) (SGC: 802 vs 635 ng/mL, P = .032; tablet: 773 vs 570 ng/mL, P = .006), and lower median CL/F (SGC: 18.54 vs 24.31 L/h, P = .026; tablet: 18.83 vs 25.37 L/h, P = .012). RTV CL/F was slower in women after weight adjustment with both formulations. The pharmacokinetics of LPV in the SGC and tablet formulations are comparable in HIV-infected patients. Women had higher RTV AUC(0-12 h) and lower CL/F with both formulations. The mechanism of the sex difference in RTV CL/F warrants elucidation.
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Affiliation(s)
- Obi C Umeh
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Yao YM, Sun JJ, Chen J, Liu XQ, Lu HZ, Zhang LJ. [LC-MS/MS method for simultaneous quantification of lopinavir and ritonavir in human plasma]. Yao Xue Xue Bao 2010; 45:279-282. [PMID: 21351441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method was developed for the determination of lopinavir and ritonavir in human plasma. Analytes were separated from plasma by a combination of alkalinized protein precipitation and liquid-liquid extraction with ethyl acetate. Chromatographic separation was performed on a Agilent ZORBAX Eclipse XDB-C18 column with the mobile phase consisted of methanol-0.1% formic acid in water (80:20). A tandem mass spectrometer equipped with electrospray ionization source was used as detector and operated in the positive ion mode. Quantification was performed using multiple reaction monitoring (MRM) of the transitions m/z 629.6 --> 155.2, m/z 721.4 --> 268.2, and m/z 515.2 --> 276.2 for lopinavir, ritonavir and telmisartan (internal standard), respectively. The method showed a good linearity in a concentration range of 62.5 - 10000 ng mL(-1) for lopinavir, and 12.5 - 2000 ng mL(-1) for ritonavir. The lower limits of quantification were 15 pg mL(-1) and 8 pg mL(-1) for lopinavir and ritonavir, respectively. The intra- and inter-day precision was less than 15% and the absolute recovery was above 75%. This method was selective and rapid, sensitive for investigating blood drug concentrations in clinics.
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Affiliation(s)
- Ya-min Yao
- Shanghai Public Health Clinical Center, Shanghai 201508, China
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