Analysis of parent drug-metabolite relationship in the presence of an inducer. Application to the carbamazepine-clobazam interaction in normal man

An increase in drug metabolic clearance results in a decrease in concentration of parent drug but the effect on concentration of metabolite has been unclear. The effect of increases in the clearance of parent drug and/or metabolite upon the metabolite concentration, metabolite-to-parent drug concentration ratio, and fraction metabolized is described theoretically. It is shown that several combinations of increases in specific clearances can lead to qualitatively similar effects on steady state concentration of metabolite. The effect of increases in metabolic clearances of the clobazam-norclobazam system caused by carbamazepine treatment was studied in normal volunteers. The steady state concentration of metabolite (norclobazam) increased 1.4-fold and the ratio of metabolite to parent drug increased 4-fold. These effects of carbamazepine on clobazam-norclobazam pharmacokinetics could be a result of five theoretical cases. It is concluded that at least the formation clearance of norclobazam was increased. Carbamazepine treatment caused at least a 4-fold increase in the N-demethylation clearance of clobazam. It was also deduced that, in the baseline state, no more than 70% of the clobazam dose was metabolized to norclobazam, even though the norclobazam concentration was more than twice the clobazam concentration.

[Pharmacokinetic study of apalcillin after infusion]

Apalcillin is a new semi-synthetic penicillin of the uridino-penicillin group. The study comprises two groups of 6 subjects receiving 1 g and 2 g respectively of apalcilline by a two-hour infusion. The assays done by HPLC and microbiology show a good correlation between the two methods. The serum concentrations at the end of the infusion are: 32,2 micrograms/ml-1 (1 g) and 62,7 micrograms/ml-1 (2 g). The modelisation of the serum curves has been realized according to an open model with two compartments. A phase of rapid distribution is observed: t 1/2 alpha of 19.5 mn (1 g), 8.96 mn (2 g) followed by a phase of longer elimination: t 1/2 beta of 1.17 h (1 g), 1.15 h (2 g). The distribution volume at the steady-state is: 14.19 l (1 g), 14.76 l (2 g). This volume, much greater than the plasmatic volume, allows to suppose a good tissular diffusion of apalcilline. The urinary concentrations of the twelve first hours are: 182.64 micrograms/ml (1 g), 323 micrograms/ml (2 g). The urinary elimination during the 24 hours following the administration is: 18.58% (1 g), 16.47% (2 g).

[Is it preferable to prescribe 1 or 2 daily doses of sodium valproate?]

Enteric-coated tablets containing 1 500 mg of sodium valproate (VPA) were administered in a randomized fashion either once or three times a day for 7 days to 6 healthy adult volunteers. Plasma total VPA levels and unbound fractions of the drug were determined 2-hourly on the last day of each treatment. Peak plasma concentrations were higher, and minimum plasma concentrations lower with one single dose than with three doses. In subjects who received three doses, the concentration curves tended to plateau, with higher AUC values. However, none of the differences observed reached statistical significance. The clinical implications of these pharmacokinetic data are discussed.

[Forms of care, health evaluation at 10 months, and maternal behavior]

The purpose of this survey was the comparison of 4 forms of day care: day care center, baby minder, care at home by the mother herself or care at home by someone else. A sample of 1,010 children, born to French mothers in a public hospital in Paris, was examined at a check-up clinic organized by National Social Security for 10 months old children. Home care by the mother herself was more frequent for mothers with primary level education or for families with 2 children or more; care at home by someone else was often chosen by families with high social level. The health and psychosocial and motor development of the children were not very different according to the type of day care. There was a higher frequency of acute respiratory tract infections and a lower weight gain for children in day care centers. Mothers whose children went to a day care center were more anxious about medical symptoms and more often called for a doctor.

Diurnal variations in steady-state plasma concentrations of valproic acid in epileptic patients

Patients on long term valproate treatment exhibit unusual fluctuations in steady-state plasma levels of valproic acid. In order to delineate the underlying mechanisms of these fluctuations, 2 studies were undertaken. In the oral study, 6 epileptic patients received enteric-coated sodium valproate tablets (on a bid regimen for at least 1 month) and plasma levels were monitored on an hourly basis during 24 hours. In the intravenous study, 5 patients received first an intravenous bolus dose (800mg) of sodium valproate followed a week later by a combination intravenous loading dose/constant rate infusion for 36 hours. Plasma valproic acid concentrations were monitored hourly during the infusion study. In the oral study, valproic acid concentrations in all subjects continued to decay for 5 to 6 hours following the 8pm dose. The mean fluctuation in concentrations during 24 hours was 112.8 +/- 31.6%. Consecutive fasting levels were not reproducible. In the intravenous study, small but significant oscillations were present at steady-state; fluctuations ranged from 22 to 34%. However, no circadian rhythm was apparent. On the basis of these findings, it appears that the value of a single fasting sample during therapeutic monitoring of valproic acid is questionable. For an accurate evaluation of valproic acid plasma levels, an average concentration based upon several daily determinations should be performed.

Liquid chromatography determination of clobazam and its major metabolite N-desmethylclobazam in human plasma

A specific procedure for the analysis of clobazam and N-desmethylclobazam in plasma is described. Reversed-phase liquid chromatography was performed on a Radial-pak cartridge using a mixture of 45% acetonitrile and 55% buffer solution (pH 7); the ultraviolet detector was set at 254 nm. The method used diazepam as internal standard and diethylether as extraction solvent. The calibration curves are linear between 50 and 500 ng/ml for clobazam and between 100 and 1000 ng/ml for N-desmethylclobazam. The day-to-day precision of the procedure at clobazam plasma concentrations of 50, 250, and 500 ng/ml generated coefficients of variation of 2.2, 6.6, and 11.3%, respectively. No interference occurred in plasma from patients treated with various drugs. The method has been used to study the pharmacokinetics of clobazam and N-desmethylclobazam in patients receiving oral clobazam.

Meal-dependent absorption of enteric-coated sodium valproate

The effect of meals on valproic acid (VPA) absorption from an enteric coated (EC) formulation was investigated. In study I, six adult normal volunteers received a single 500 mg dose of sodium valproate in randomized treatments: fasting (A), with a meal (B) or 3 hours after a meal (C). There were significant differences between treatments in the latency period (Lp) defined as the time during which measured concentrations of VPA were less than 1 microgram/ml. Lp values for treatments A, B and C were: 1.67 +/- 1.25 hr, 6.75 +/- 3.98 hr and 7.63 +/- 3.15 hr respectively. In study II, six subjects (five from study I) received in a randomized fashion a 400 mg intravenous bolus dose of VPA and a 500 mg EC VPA tablet, 3 hours after a meal. The mean Lp value was 8.1 +/- 1.6 hr and the mean bioavailability was 100%. Clearance, volume of distribution and half-life values obtained after intravenous dosing were comparable to literature values. These results indicate that food intake delays but does not decrease the extent of absorption of VPA from an enteric coated formulation.

Intestinal calcium-binding protein 3 months after massive small bowel resection in the piglet

Changes in intestinal calcium-binding protein and calcium binding activity were studied at resection and 3 months after 90% small bowel resection in piglets and one adult pig. A calcium-binding protein (MW congruent to 11.000) with calcium-dependent eletrophoretic mobility was partially purified from mucosal extract of proximal jejunum, mid-gut, and ileum. The concentration of calcium-binding protein and the calcium-binding activity of the intact animals were found highest in the proximal jejunal segment, lowest in the ileal segment. After resection in the four surviving animals out of nine, a significant increase in calcium-binding activity was observed in the proximal jejunum and in the distal ileal segment. The change in calcium-binding activity was much more marked in the ileum than the jejunum. These data demonstrate that pig intestinal mucosa possesses an adaptive capacity to increase the synthesis of calcium-binding protein after massive small bowel resection.