Pharmacokinetics II Drug Elimination

This royal-blue-colored drug is an anthracenedione that inhibits DNA topoisomerase II. The pharmacokinetics of mitoxantrone may best be described by a three-compartment model, with an a half-life of 3 to 10 minutes, a 3 half life of 0.3 to 3 hours, and a median terminal half-life of 12 days. Biliary elimination appears to be the primary route of elimination, with less than 10% of the drug eliminated by the kidney.23 Mitoxantrone has shown clinical activity in the treatment of acute leukemias, breast and prostate cancer, and non-Hodgkin s lymphomas. Myelosuppression, mucositis, nausea and vomiting, and cardiac toxicity are side effects of this drug. The total cumulative dose limit is 160 mg/m2 for patients who have not received prior anthracycline or mediastinal radiation. Patients who have received prior doxorubicin or daunorubicin therapy should not receive a cumulative dose greater than 120 mg/m2 of mitoxantrone. Patients should be counseled that their urine will turn a blue-green color. 

Hattis D, Ginsberg G, Sonawane B, Smolenski S, Russ A, Kozlak M, Goble R (2003) Differences in pharmacokinetics between children and adults — II. Children s variability in drug elimination half-lives and in some parameters needed for physiologically-based pharmacokinetic modeling. Risk Anal, 23 117-142. 

The clinical development stage comprises three distinct components or phases (I, II, and III), and culminates in the filing of the NDA/MAA. Each phase involves process scale-up, pharmacokinetics, drug delivery, and drug safety activities. During phase I clinical development, the compound s safety and pharmacokinetic profile is defined. The determination of maximum concentration at steady state (Cmax), area under the plasma concentration time curve (AUC), elimination half-life, volume of distribution, clearance and excretion, and potential for drug accumulation is made in addition to studies that provide estimates of efficacious doses. Dose levels typically... 

Unlike the estimates of dosage rates and average steady-state plasma concentrations, which may be determined independently of any pharmacokinetic model in that systemic clearance is the only pharmacokinetic parameter used, the prediction of peak and trough steady-state concentrations requires pharmacokinetic compartmental model assumptions. It is assumed that, (i) drug disposition can be adequately described by a one-compartment pharmacokinetic model, (ii) disposition is independent of dose (i.e. linear pharmacokinetics apply), and (iii) the absorption rate is much faster than the rate of elimination of the drug, which is always valid when the drug is administered intravenously. For clinical applications, these assumptions are reasonable. 

In the first part of this overview (Sections II, III, IV and V) some physiological aspects of drug absorption, distribution and elimination will be discussed. The second part (Sections VI and VII) will briefly focus on some pharmacokinetic parameters and terminology and on variability in pharmacokinetics. Due to its limited size, this chapter only includes some basic and general information. For more... 

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