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Homma M, Kokubun H, Okuwaki K, Katada C, Hayashi N, Kanai A, Koizumi W, Atsuda K. Pharmacokinetic Analysis, Analgesic Effects, and Adverse Effects of Tapentadol in Cancer Patients with Pain. Biol Pharm Bull 2020; 43:1000-1006. [PMID: 32475909 DOI: 10.1248/bpb.b20-00084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, we conducted a pharmacokinetic analysis of tapentadol (TP) in Japanese patients with cancer pain and identified covariates influencing pharmacokinetic parameters. In addition, the analgesic effects and adverse effects of TP were investigated. Data were collected from in-patients with cancer pain who had been administered TP as an extended-release formula. The median (range) estimated clearance (CL/F) and distribution volume (Vd/F) of TP were 86.7 (31.3-213.7) L/h and 1288 (189-6736) L, respectively. There was a strong negative correlation between CL/F and age, Child-Pugh score, and albumin-bilirubin (ALBI) score. The subjects were further divided into two groups according to the factors highly correlated with CL/F. The CL/F of patients in the Child-Pugh B group was 0.46-times that of patients in the Child-Pugh A group. In addition, the CL/F of patients with an ALBI score > -2.40 was 0.56-times that of patients with ALBI scores ≤-2.40, and both differences were statistically significant (p < 0.05). The mean intensity of pain over 24 h was investigated daily from before starting TP for the first 7 d of the treatment. TP reduced pain in six of nine patients; the mean pain visual analogue scale score decreased significantly from 59.2 mm before administration to 42.5 mm at days 5-7. Overall, the Child-Pugh and ALBI scores significantly affected the clearance of TP, which was reduced in patients with impaired liver function. These results suggest that TP is an opioid with a sufficient analgesic effect for cancer patients.
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Affiliation(s)
- Masashi Homma
- Department of Pharmacy, Kitasato University Hospital
| | - Hideya Kokubun
- Center for Experiential Pharmacy Practice, Tokyo University of Pharmacy and Life Sciences
| | - Kosuke Okuwaki
- Department of Gastroenterology, Kitasato University School of Medicine
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine
| | - Norihito Hayashi
- Department of Anesthesiology, Kitasato University School of Medicine
| | - Akifumi Kanai
- Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine
| | - Koichiro Atsuda
- Department of Pharmacy, Kitasato University Hospital.,Kitasato University School of Pharmacy
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Abstract
Tapentadol prolonged release (tapentadol PR) [Palexia® SR in EU] is a long-acting tablet formulation of the strong central analgesic tapentadol, which acts as both a μ-opioid receptor (MOR) agonist and a noradrenaline reuptake inhibitor. Tapentadol PR is approved for chronic pain in various countries, with its EU indication (severe chronic pain manageable only with opioid analgesics) being the focus here. Well-designed trials and clinical practice data support tapentadol PR use in this setting. Short term, tapentadol PR was an effective and generally well tolerated analgesic for moderate to severe pain of varying aetiologies, including neuropathic pain. It provided analgesia at least as good as that of conventional strong opioids and appeared more favourable in terms of gastrointestinal tolerability, likely due to less potent MOR binding. Severe back pain with a neuropathic component responded well to moderate-dose tapentadol PR in some patients, while for others, an increase to the maximum recommended tapentadol PR dosage provided analgesia at least as good as that of moderate-dose tapentadol PR plus pregabalin and appeared to have some CNS tolerability benefits. Data also support the use of tapentadol PR in opioid rotation, including when conventional opioids are intolerable. Longer-term data in musculoskeletal pain conditions indicate continued benefit over up to 2 years' treatment with tapentadol PR with no evidence of tolerance. Thus, tapentadol PR is a useful option for the management of severe chronic pain.
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Affiliation(s)
- Emma D Deeks
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Tedeschi A, De Bellis A, Francia P, Bernini A, Perini M, Salutini E, Anichini R. Tapentadol Prolonged Release Reduces the Severe Chronic Ischaemic Pain and Improves the Quality of Life in Patients with Type 2 Diabetes. J Diabetes Res 2018; 2018:1081792. [PMID: 29675431 PMCID: PMC5838502 DOI: 10.1155/2018/1081792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/15/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023] Open
Abstract
This study has been performed in diabetic type 2 patients with pain due to peripheral artery disease (PAD) in order to evaluate the efficacy and tolerability of tapentadol prolonged release (PR). Methods. 25 patients with type 2 diabetes (13 F and 12 M) were admitted in the study. The evaluation of the analgesic efficacy of tapentadol PR was based on both the assessment of the intensity of the pain (NRS scale from 0 to 10) and the nature of the pain (DN4 questionnaire) and on assessment of the patient's quality of life and state of health (SF-12 Health Survey). Study duration was 3 months: a baseline visit and follow-up included visits after 1 week, 1 month, 2 months, and 3 months. Results. At the beginning of the study, the mean intensity of the pain was 7.88 ± 1.17 on the NRS scale and at visit 2 it reduced in a statistically significant way; at the end of the treatment with tapentadol PR, the mean intensity was 2.84 points on the NRS scale. Conclusion. In type 2 diabetic patients with chronic severe pain due to PAD, tapentadol PR reduced pain intensity, improving the quality of life.
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Affiliation(s)
- Anna Tedeschi
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, Pistoia, Italy
| | | | - Piergiorgio Francia
- Department of Clinical and Experimental Medicine, School of Human Health Sciences, Florence, Italy
| | - Arianna Bernini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, Pistoia, Italy
| | - Marco Perini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, Pistoia, Italy
| | | | - Roberto Anichini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, Pistoia, Italy
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Population pharmacokinetic modeling of furosemide in patients with hypertension and fluid overload conditions. Pharmacol Rep 2017; 69:492-496. [DOI: 10.1016/j.pharep.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
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Pergolizzi JV, Breve F, Taylor R, Raffa RB, Strasburger SE, LeQuang JA. Considering tapentadol as a first-line analgesic: 14 questions. Pain Manag 2017; 7:331-339. [PMID: 28434283 DOI: 10.2217/pmt-2016-0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Tapentadol is the newest centrally acting analgesic to be approved by the US FDA and regulatory bodies in other countries. It has been called the first-in-class of a novel-acting analgesic mechanism of action that combines µ-opioid receptor agonist activity with neuronal norepinephrine-reuptake inhibition in a single molecule. This duality of action should combine inhibition of ascending (afferent) pain-transmitting signals with activation of descending (efferent) pain-attenuating systems (e.g., diffuse noxious inhibitory controls). However, not all novel mechanisms of action impart the characteristics needed for an analgesic to be considered for first-line therapy. These key questions may help inform clinical decision making.
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Affiliation(s)
| | - Frank Breve
- Mid-Atlantic PharmaTech Consultants LLC, Ventnor City, NJ, USA.,School of Pharmacy, Temple University, Philadelphia, PA, USA
| | | | - Robert B Raffa
- Professor Emeritus, Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA.,Adjunct Professor, Department of Pharmacology & Toxicology, University of Arizona College of Pharmacy, Tucson, AZ, USA
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Zhang L, Yan X, Nobe S, Zannikos P, Etropolski M, Nandy P. Quantifying the Exposure of Tapentadol Extended Release in Japanese Patients with Cancer Pain and Bridging Tapentadol Pharmacokinetics Across Populations Using a Modeling Approach. Clin Drug Investig 2016; 37:273-283. [PMID: 27853999 DOI: 10.1007/s40261-016-0482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Tapentadol extended release (ER) is approved for the management of chronic and acute pain in adults. There has been no report of tapentadol ER pharmacokinetics in subjects with cancer pain. This analysis investigated tapentadol ER pharmacokinetics in Japanese patients with cancer pain and bridged it with the pharmacokinetics in Japanese healthy subjects and Caucasian patients with cancer pain. METHODS Nonlinear mixed-effect pharmacokinetic modeling was conducted based on pooled tapentadol ER concentration data collected in five Phase 1 studies from 138 Japanese and Korean healthy subjects and in two Phase 3 studies from 215 Japanese and Korean subjects with cancer pain. Expected tapentadol exposure in subjects with different characteristics was assessed via simulation. Tapentadol ER exposures in Caucasian populations were compared with those in corresponding Japanese populations. RESULTS Tapentadol ER pharmacokinetics in Japanese cancer-pain patients were adequately described by a time-invariant, one-compartment disposition model with two input functions and first-order elimination. Weight, age, and albumin were identified as statistically significant covariates, but do not warrant dose adjustment. Comparable pharmacokinetics were shown between Japanese healthy and Caucasian healthy subjects, and between Japanese cancer-pain patients and Caucasian cancer-pain patients. CONCLUSION The apparent differences in the estimated individual pharmacokinetic parameters in Japanese healthy subjects and Japanese cancer-pain patients taking tapentadol ER were explained by covariates incorporated in a unified pharmacokinetic model. Population modeling was essential in this cross-population bridging analysis.
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Affiliation(s)
- Liping Zhang
- Global Clinical Pharmacology, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA.
| | - Xiaoyu Yan
- Global Clinical Pharmacology, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA
| | - Sayori Nobe
- Clinical Pharmacology, Janssen Pharm KK, Tokyo, Japan
| | - Peter Zannikos
- Global Clinical Pharmacology, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA
| | - Mila Etropolski
- TV Pain, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, USA
| | - Partha Nandy
- Global Clinical Pharmacology, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA
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Kodati D, Kotakonda HK, Yellu N. Population Pharmacokinetic Modeling of Olmesartan, the Active Metabolite of Olmesartan Medoxomil, in Patients with Hypertension. Eur J Drug Metab Pharmacokinet 2016; 42:573-581. [PMID: 27535556 DOI: 10.1007/s13318-016-0371-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Olmesartan medoxomil is an orally given angiotensin II receptor antagonist indicated for the treatment of hypertension. OBJECTIVE The aim of the study was to establish a population pharmacokinetic model for olmesartan, the active metabolite of olmesartan medoxomil, in Indian hypertensive patients, and to evaluate effects of covariates on the volume of distribution (V/F) and oral clearance (CL/F) of olmesartan. METHODS The population pharmacokinetic model for olmesartan was developed using Phoenix NLME 1.3 with a non-linear mixed-effect model. Bootstrap and visual predictive check were used simultaneously to validate the final population pharmacokinetic models. The covariates included age, sex, body surface area (BSA), bodyweight, height, creatinine clearance (CLCR) as an index of renal function and liver parameters as indices of hepatic function. RESULTS A total of 205 olmesartan plasma sample concentrations from 69 patients with hypertension were collected in this study. The pharmacokinetic data of olmesartan was well described by a two-compartment linear pharmacokinetic model with first-order absorption and an absorption lag-time. The mean values of CL/F and V/F of olmesartan in the patients were 0.31565 L/h and 44.5162 L, respectively. Analysis of covariates showed that age and CLCR were factors influencing the clearance of olmesartan and the volume of distribution of olmesartan was dependent on age and BSA. CONCLUSION The final population pharmacokinetic model was demonstrated to be appropriate and effective and it can be used to assess the pharmacokinetic parameters of olmesartan in Indian patients with hypertension.
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Affiliation(s)
- Devender Kodati
- Department of Pharmacology and DMPK, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, 506009, India
| | | | - Narsimhareddy Yellu
- Department of Pharmacology and DMPK, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, 506009, India.
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