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Wang Y, Liu X, Li K, Fan Y, Yu J, Wu H, Li Y, Wu X, Guo B, Li X, Hu J, Wu J, Cao G, Zhang J. Pharmacokinetics and Safety of Doripenem in Healthy Chinese Subjects and Monte Carlo Dosing Simulations. Antibiotics (Basel) 2022; 11:antibiotics11070958. [PMID: 35884212 PMCID: PMC9311841 DOI: 10.3390/antibiotics11070958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to investigate the pharmacokinetics (PK) of doripenem in healthy Chinese subjects and evaluate the optimal dosage regimens of doripenem. A randomized, single-dose, three-period, self-crossover controlled extended-infusion clinical trial was conducted with 12 healthy Chinese subjects. Plasma and urine samples were collected to determine doripenem concentrations. Non-compartmental and population PK analysis were performed to characterize the PK of doripenem. The Monte Carlo simulation was employed to optimize dosing regimens based on the probability of target attainment of doripenem against pathogens with different minimum inhibitory concentrations (MIC). All 12 healthy Chinese subjects completed the study, and the doripenem was well tolerated. The study showed linearity relationships in the peak plasma concentration and the area under the concentration-time curve after intravenous infusion of doripenem from 0.25 g to 1.0 g. The cumulative urinary recovery rate of doripenem was 68.1–72.0% within 24 h. PPK modeling showed a two-compartmental model, with first-order elimination presenting the best fit for doripenem PK. Monte Carlo simulation results showed that 1.0 g q12h or 0.5 g q8h was an optimal regimen for pathogens susceptible to doripenem (MIC ≤ 1 mg/L); while high dose and extended infusion (1 g, q8h, 4 h infusion) was proposed for unsusceptible pathogens (2 ≤ MIC ≤ 8 mg/L). In the dose range of 0.25 to 1.0 g, doripenem showed linear pharmacokinetics. Doripenem at 1.0 g with a prolonged infusion time of 4 h was predicted to be effective against pathogens with MICs as high as 8 mg/L.
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Affiliation(s)
- Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Kun Li
- Chia Tai Tianqing Pharmaceutical Group Co., Ltd., Nanjing 210042, China;
| | - Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jicheng Yu
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Hailan Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaojie Wu
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jiali Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jufang Wu
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Guoying Cao
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
- Correspondence: (G.C.); (J.Z.)
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
- Correspondence: (G.C.); (J.Z.)
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Kai M, Tanaka R, Suzuki Y, Goto K, Ohchi Y, Yasuda N, Tatsuta R, Kitano T, Itoh H. Simultaneous quantification of plasma levels of 12 antimicrobial agents including carbapenem, anti-methicillin-resistant Staphylococcus aureus agent, quinolone and azole used in intensive care unit using UHPLC-MS/MS method. Clin Biochem 2021; 90:40-49. [PMID: 33539809 DOI: 10.1016/j.clinbiochem.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Critically ill patients in intensive care unit (ICU) are susceptible to infectious diseases, thus empirical therapy is recommended. However, the therapeutic effect in ICU patients is difficult to predict due to fluctuation in pharmacokinetics because of various factors. This problem can be solved by developing personalized medicine through therapeutic drug monitoring. However, when different measurement systems are used for various drugs, measurements are complicated and time consuming in clinical practice. In this study, we aimed to develop an assay using ultra-high performance liquid chromatography coupled with tandem mass spectrometry for simultaneous quantification of 12 antimicrobial agents commonly used in ICU: doripenem, meropenem, linezolid, tedizolid, daptomycin, ciprofloxacin, levofloxacin, pazufloxacin, fluconazole, voriconazole, voriconazole N-oxide which is a major metabolite of voriconazole, and posaconazole. DESIGN & METHODS Plasma protein was precipitated by adding acetonitrile and 50% MeOH containing standard and labeled IS. The analytes were separated with an ACQUITY UHPLC CSH C18 column, under a gradient mobile phase consisting of water and acetonitrile containing 0.1% formic acid and 2 mM ammonium formate. RESULTS The method fulfilled the criteria of US Food and Drug Administration for assay validation. The recovery rate was more than 84.8%. Matrix effect ranged from 79.1% to 119.3%. All the calibration curves showed good linearity (back calculation of calibrators: relative error ≤ 15%) over wide concentration ranges, which allowed determination of Cmax and Ctrough. Clinical applicability of the novel method was confirmed. CONCLUSIONS We have developed an assay for simultaneous quantification of 12 antimicrobial agents using a small sample volume of 50 μL with a short assay time of 7 min. Our novel method may contribute to simultaneous calculation of pharmacokinetic and pharmacodynamic parameters.
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Affiliation(s)
- Makoto Kai
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan.
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Tokyo, Japan
| | - Koji Goto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Norihisa Yasuda
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Takaaki Kitano
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
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Nonoshita K, Suzuki Y, Tanaka R, Kaneko T, Ohchi Y, Sato Y, Yasuda N, Goto K, Kitano T, Itoh H. Population pharmacokinetic analysis of doripenem for Japanese patients in intensive care unit. Sci Rep 2020; 10:22148. [PMID: 33335198 PMCID: PMC7747597 DOI: 10.1038/s41598-020-79076-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/25/2020] [Indexed: 12/01/2022] Open
Abstract
We aimed to construct a novel population pharmacokinetics (PPK) model of doripenem (DRPM) for Japanese patients in intensive care unit, incorporating the clearance of DRPM by continuous renal replacement therapy (CRRT). Twenty-one patients treated with DRPM (0.25 or 0.5 g) by intravenous infusion over 1 h were included in the study. Nine of the 21 patients were receiving CRRT. Plasma samples were obtained before and 1, 2, 4, 6 and 8 h after the first DRPM administration. PPK analysis was conducted by nonlinear mixed effects modeling using a two-compartment model. Total clearance (CLtotal) in the model was divided into CRRT clearance (CLCRRT) and body clearance (CLbody). The final model was: CLtotal (L h-1) = CLbody(non-CRRT) = 3.65 × (Ccr/62.25)0.64 in the absence of CRRT, or = CLbody(CRRT) + CLCRRT = 2.49 × (Ccr/52.75)0.42 + CLCRRT in the presence of CRRT; CLCRRT = QE × 0.919 (0.919 represents non-protein binding rate of DRPM); V1 (L) = 10.04; V2 (L) = 8.13; and Q (L h-1) = 3.53. Using this model, CLtotal was lower and the distribution volumes (V1 and V2) tended to be higher compared to previous reports. Also, Ccr was selected as a significant covariate for CLbody. Furthermore, the contribution rate of CLCRRT to CLtotal was 30-40%, suggesting the importance of drug removal by CRRT. The population analysis model used in this study is a useful tool for planning DRPM regimen and administration. Our novel model may contribute greatly to proper use of DRPM in patients requiring intensive care.
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Affiliation(s)
- Ko Nonoshita
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan.
| | - Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Tetsuya Kaneko
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Yuhki Sato
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Norihisa Yasuda
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Koji Goto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Takaaki Kitano
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
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Fukunaga M, Kadowaki D, Mori M, Hagiwara S, Narita Y, Saruwatari J, Tanaka R, Watanabe H, Yamasaki K, Taguchi K, Ito H, Maruyama T, Otagiri M, Hirata S. In vivo evaluation of drug dialyzability in a rat model of hemodialysis. PLoS One 2020; 15:e0233925. [PMID: 32530952 PMCID: PMC7292355 DOI: 10.1371/journal.pone.0233925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/14/2020] [Indexed: 11/19/2022] Open
Abstract
It is important to calculate the drug removal by hemodialysis (HD) for drug dosing regimens in HD patients. However, there are limited and inconsistent information about the dialyzability of drugs by HD. Therefore, the aim of our study is to evaluate drug removal by utilizing a rat model of HD (HD rat) and to extrapolate this result to the drug removal rate in HD patients. HD rats received bilateral nephrectomy and HD for 2 h. The dialysis removal of 6 drugs was evaluated in HD rats. Dialysis efficiency, plasma protein binding rate (PBR) and distribution volume (Vd) of drugs were also measured. Furthermore, we examined the correlation between the dialyzability of drug in HD rats and humans and constructed the prediction formula of the drug dialyzability in HD patients. The clearance of urea and creatinine and normalized dialysis dose in HD rats were 0.83 ± 0.07 mL/min, 0.70 ± 0.08 mL/min, and 0.13 ± 0.06, respectively. The drug dialyzability in HD rats was similar to reported clinical data except for doripenem. A higher correlation was observed between drug dialyzability in reported clinical data and HD rats which were adjusted for PBR (r2 = 0.936; p < 0.001) compared to unadjusted (r2 = 0.812; p = 0.009). Therefore, we constructed the prediction formula of the drug dialyzability in HD patients by utilizing the HD rat model and PBR. This study is useful for evaluating the dialyzability of high-risk drugs in a clinical setting and might provide appropriate preclinical dialyzability data for new drug.
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Affiliation(s)
- Masaki Fukunaga
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
| | - Daisuke Kadowaki
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
- DDS Research Institute, Sojo University, Kumamoto, Japan
- * E-mail:
| | - Mika Mori
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satomi Hagiwara
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Narita
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Junji Saruwatari
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Japan
| | - Hiroshi Watanabe
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Keishi Yamasaki
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
- DDS Research Institute, Sojo University, Kumamoto, Japan
| | | | - Hiroki Ito
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Japan
| | - Toru Maruyama
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
- DDS Research Institute, Sojo University, Kumamoto, Japan
| | - Sumio Hirata
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
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