Enantiomers pharmacokinetic effects

Fleishaker JC, Mucci M, Pellizzoni C et al (1999) Absolute bioavailabihty of reboxetine enantiomers and effect of gender on pharmacokinetics. Biopharm Drug Dispos 20 53-57... 

The separation of enantiomers is a very important topic to the pharmaceutical industry. It is well recognized that the biological activities and bioavailabilities of enantiomers often differ [1]. To further complicate matters, the pharmacokinetic profile of the racemate is often not just the sum of the profiles of the individual enantiomers. In many cases, one enantiomer has the desired pharmacological activity, whereas the other enantiomer may be responsible for undesirable side-effects. What often gets lost however is the fact that, in some cases, one enantiomer may be inert and, in many cases, both enantiomers may have therapeutic value, though not for the same disease state. It is also possible for one enantiomer to mediate the harmful effects of the other enantiomer. For instance, in the case of indacrinone, one enantiomer is a diuretic but causes uric acid retention, whereas the other enantiomer causes uric acid elimination. Thus, administration of a mixture of enantiomers, although not necessarily racemic, may have therapeutic value. 

The applicant should provide justification for using the racemate. Where the interconversion of the enantiomers in vivo is more rapid than the distribution and elimination rates, then use of the racemate is justified. In cases where there is no such interconversion or it is slow, then differential pharmacological effects and fate of the enantiomers may be apparent. Use of the racemate may also be justified if any toxicity is associated with the pharmacological action and the therapeutic index is the same for both isomers. For preclinical assessment, pharmacodynamic, pharmacokinetic (using enantiospecific analytical methods) and appropriate toxicological studies of the individual enantiomers and the racemate will be needed. Clinical studies on human pharmacodynamics and tolerance, human pharmacokinetics and pharma-cotherapeutics will be required for the racemate and for the enantiomers as appropriate. 

Chan K, Lo AC, Yeung JH, Woo KS. The effects of danshen Salvia miltior-rhiza) on pharmacodynamics and pharmacokinetics of warfarin enantiomers in rats. J Pharm Pharmacol 1995 47 402-406. 

Ho PC, Ghose K, Saville D, Wanwimolruk S. Effect of grapefruit juice on pharmacokinetics and pharmacodynamics of verapamil enantiomers in healthy volunteers. Eur J Clin Pharmacol 2000 56(9-10) 693-698. 

Benmebarek M, Devaud C, Gex-Fabry M, et al. Effects of grapefruit juice on the pharmacokinetics of the enantiomers of methadone. Clin Pharmacol Ther 2004 76(l) 55-63. 

The breakthrough in the development of quinolones came with the appearance of norfloxacin 6 [19], a second-generation quinolone which combined a 6-fluorine substituent with a piperazine ring in the 7-position of the basic compound. Additional quinolones then followed in rapid succession pefloxacin [20], enoxacin [21] and fleroxacin [22] (Fig. 14.5). Particular mention must be made of ciprofloxacin 8 [23-25], ofloxacin 5 [26,27] and its active enantiomer levofloxacin 7 [28]. These quinolones have a broad spectrum of activity, which also includes Gram-positive bacteria and Pseudomonas aeruginosa, as well as favorable pharmacokinetics. The rapid absorption of these compounds from the gastrointestinal tract and their effective tissue penetration also allows them to be used for the treatment of systemic infections. 

Measurement of underivatized propranolol enantiomers in serum using a celluIose-tris(3,5-dimethylphenylcarbamate) high performance liquid chromatographic (HPLC) chiral stationary phase" (54). A method for the direct measurement of the enantiomers of propranolol in human serum was developed using the OD CSP and a mobile phase composed of hexane 2-propranol W,W-dimethyloctylamine (92 8 0.01, v/v/ v). The assay was validated for use in pharmacokinetic and metabolic studies and was subsequently used in the investigation of the effect of cimetidine on the metallism and clearance of propranolol enantiomers (60). 

The single stereogenic or chiral center in the chemical structure of verapamil results in two stereoisomers of verapamil S(-)-verapamil and R(+)-verapamil (Fig. 1). These enantiomers have different pharmacokinetic and pharmacodynamic properties (3,6-9). Although both enantiomers have similar types of pharmacologic activity, the S enantiomer has been shown to be the more potent with respect to several of the effects (3,6-8). 

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