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Marino SE, Birnbaum AK, Leppik IE, Conway JM, Musib LC, Brundage RC, Ramsay RE, Pennell PB, White JR, Gross CR, Rarick JO, Mishra U, Cloyd JC. Steady-state carbamazepine pharmacokinetics following oral and stable-labeled intravenous administration in epilepsy patients: effects of race and sex. Clin Pharmacol Ther 2012; 91:483-8. [PMID: 22278332 PMCID: PMC4038037 DOI: 10.1038/clpt.2011.251] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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] [Indexed: 02/03/2023]
Abstract
Carbamazepine is a widely prescribed antiepileptic drug. Owing to the lack of an intravenous formulation, its absolute bioavailability, absolute clearance, and half-life in patients at steady state have not been determined. We developed an intravenous, stable-labeled (SL) formulation in order to characterize carbamazepine pharmacokinetics in patients. Ninety-two patients received a 100-mg infusion of SL-carbamazepine as part of their morning dose. Blood samples were collected up to 96 hours after drug administration. Plasma drug concentrations were measured with liquid chromatography-mass spectrometry, and concentration-time data were analyzed using a noncompartmental approach. Absolute clearance (l/hr/kg) was significantly lower in men (0.039 ± 0.017) than in women (0.049 ± 0.018; P = 0.007) and in African Americans (0.039 ± 0.017) when compared with Caucasians (0.048 ± 0.018; P = 0.019). Half-life was significantly longer in men than in women as well as in African Americans as compared with Caucasians. The absolute bioavailability was 0.78. Sex and racial differences in clearance may contribute to variable dosing requirements and clinical response.
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Affiliation(s)
- S E Marino
- Center for Clinical and Cognitive Neuropharmacology, University of Minnesota, Minneapolis, Minnesota, USA.
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Carducci MA, Armstrong DK, Collins C, Wang T, Schaefer S, Ermisch S, Musib LC, Nicol S, Thornton DE, Zhang Z. Phase I study of enzastaurin (ENZ) and bevacizumab (BV) in patients with advanced cancer: Safety, pharmacokinetics (PK), and response assessment. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3517 Background: ENZ, an oral kinase inhibitor, suppresses tumor growth through PKC and PI-3 kinase/AKT. BV binds VEGF and inhibits angiogenesis. Since ENZ and BV are complementary in inhibiting angiogenesis, we conducted a Phase I study of ENZ / BV. Methods: Eligible patients (pts) had advanced cancer, adequate organ function and no co-morbidities for increased risk of drug-related toxicities. Six pts were enrolled per cohort; if ≤1 DLT the next cohort opened. A loading dose of ENZ 1125 mg was given on Day 1, C1. After 1 cohort combining ENZ 500 mg/QD and BV at 5mg/kg IV q 2 wks, subsequent cohorts alternated pts between BV 10 mg/kg IV q 2 wks and BV 15 mg/kg IV q 3wks with escalating doses of ENZ (500 mg/QD, 250 mg/BID, and 375 mg/BID) for a total of 7 cohorts. DLT was defined as C1: Grade (G)4 neutropenia ≥7 days, febrile neutropenia, G3 thrombocytopenia with bleeding or G4 thrombocytopenia; G3/G4 non-hematological toxicities, and toxicities associated with BV. ENZ PK was performed at steady-state on Day 1, C2. Results: 43 pts (21 with ovarian cancer) are evaluable for toxicity. Two DLTs (G3 elevated aminotransferase and intraparenchymal hemorrhage) occurred at different dose levels. No apparent increase in ENZ or BV toxicity was seen. Two SAEs (DVT and myocardial ischemia) in two pts occurred at DL 3 after 3 cycles and 13 cycles, respectively. Common toxicities included fatigue, chromaturia, dry/sore mouth, nausea and diarrhea. Nine of 43 pts (21%) had a response (CR, PR), 6 responses were in the ovarian subset (29%). Median time to progression was 3.9 mos (range 0–19.2 mos) and 7.7 mos for ovarian pts (range 0.3–19.2 mos). Overall, 43% remained on study without disease progression for >6 mos (51% of ovarian pts remained on study for >6 mos). Mean steady-state ENZ concentrations (%CV) at 500 mg/QD, 250mg/BID and 375mg/BID were 1080 nmol/L (82.8 %), 516 nmol/L (102%) and 1120 nmol/L (93.3%), respectively. Conclusions: The addition of ENZ to BV in any of the currently approved BV dosing schedules is well tolerated and clinically active in advanced cancer pts. ENZ exposures are highly variable and comparable across the three dose groups. The combination of ENZ / BV demonstrates encouraging activity, specifically in our population of ovarian cancer pts. [Table: see text]
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Affiliation(s)
- M. A. Carducci
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - D. K. Armstrong
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - C. Collins
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - T. Wang
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - S. Schaefer
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - S. Ermisch
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - L. C. Musib
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - S. Nicol
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - D. E. Thornton
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - Z. Zhang
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
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Ahn JE, Cloyd JC, Brundage RC, Marino SE, Conway JM, Ramsay RE, White JR, Musib LC, Rarick JO, Birnbaum AK, Leppik IE. Phenytoin half-life and clearance during maintenance therapy in adults and elderly patients with epilepsy. Neurology 2008; 71:38-43. [DOI: 10.1212/01.wnl.0000316392.55784.57] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rademaker-Lakhai JM, Beereport L, Witteveen EO, Radema SA, Visseren-Grul CM, Musib LC, Van Hal G, Beijnen JH, Schellens JHM, Voest EE. Phase I and pharmacologic study of enzastaurin HCl, gemcitabine and cisplatin. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. M. Rademaker-Lakhai
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - L. Beereport
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - E. O. Witteveen
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - S. A. Radema
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - C. M. Visseren-Grul
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - L. C. Musib
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - G. Van Hal
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - J. H. Beijnen
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - J. H. M. Schellens
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
| | - E. E. Voest
- Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands; University Medical Center, Utrecht, Netherlands; Eli Lilly International Corp, Indianapolis, IN; Eli Lilly International Corp., Indianapolis, IN
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