Further considerations on model-independent bioavailability estimation

Linear and nonlinear system approaches in pharmacokinetics: how much do they have to offer? I. General considerations

System approaches in pharmacokinetics are defined as generalizing and simplifying modeling approaches that mathematically model a general property of the pharmacokinetic system without modeling specifically the individual kinetic processes responsible for the general property considered. The rationale for the use of system approaches is discussed and the kinetic basis of some of the approaches is presented. An overview of the approaches is presented together with a comparison to classical approaches involving specific pharmacokinetic models. Examples are given from different application areas involving problems in linear and nonlinear pharmacokinetics and in pharmacodynamics. The advantages, disadvantages, and limitations of the system approaches are discussed. In several application areas the system approach offers some rational methods and procedures with distinct advantages over more traditional approaches.

Drug absorption evaluation in the presence of changes in clearance: an algorithm and computer program for deconvolution with exact clearance correction

Most commonly drug absorption is evaluated with a reference dosing given on separate occasions. The assumption that no change in drug disposition is taking place between the drug administrations is often violated resulting in errors in the calculations. A novel deconvolution method is presented which exactly compensates for a change in drug clearance. The method is based on a model independent disposition decomposition-recomposition technique. The distribution function is obtained from an i.v. administration by disposition decomposition. This distribution function is assembled together with the elimination kinetics containing the perturbed clearance to construct the perturbed disposition function in the subsequent disposition recomposition operation. The perturbed absorption response is finally deconvolved using the corresponding perturbed disposition function. It is shown that the perturbed clearance can be obtained from the log-linear terminal disposition phase once the distribution function has been obtained from an i.v. administration. The proposed method is implemented in an algorithm and computer program DCONB and demonstrated using human cimetidine drug level data from an i.v. and oral administration. The usage of DCONB is identical to DECONV previously published. It requires only regular sums of exponentials to be fitted to drug level data. Such fittings are routinely done in pharmacokinetics thereby enabling DCONB to be implemented very simply.

Oral cyclacillin interacts with the absorption of oral ampicillin, amoxycillin, and bacampicillin

The relative bioavailabilities of single oral doses of ampicillin, amoxycillin, and bacampicillin were compared with and without concomitant administration of a six-times higher molar dose of cyclacillin. As the absorption of cyclacillin has been shown to involve a capacity-limited transport system in animals, it was selected as the reference compound for the study. The treatments were given to 14 fasting volunteers using a randomized, complete crossover design. The drugs in plasma and urine were determined by liquid chromatography. Renal clearance was 17%, 10% and 19% lower when ampicillin, amoxycillin, and bacampicillin were given together with cyclacillin. Consequently, differences in the relative bioavailability were based on urinary recoveries assuming constant non-renal clearance. When amoxycillin was given with cyclacillin there was a 67% delay in the time of the plasma peak concentration, and an 8% lower urinary recovery than when it was given alone. There was a 50% and 33% delay in the tmax of ampicillin and bacampicillin when combined with cyclacillin; the urinary recovery of ampicillin in the combination was 10% lower but that of bacampicillin was similar. There was also a 20% delay in the tmax of cyclacillin when combined with amoxycillin. The differences in renal clearance indicate an interaction in the renal elimination of the drugs, but the effect was probably not the explanation for the marked shift in time of the absorption of these rapidly absorbed drugs. The results support the existence of a capacity-limited transport system for aminopenicillins in the human gut.