Physiological pharmacokinetics clearance

Recent advances in the field of physiological pharmacokinetics, in which organ blood flows, volumes, and drug clearances are considered, have been useful in estimating drug concentrations in a specific organ. These models have been applied for the most part to antitumor agents. 

Figure 7.1 Compartmental models for drug distribution and clearance. Empirical pharmacokinetics models typically include (a) a single compartment or (b) multiple compartments. In physiological pharmacokinetic models, each organ is composed of multiple compartments, which reflect the anatomy of the organ, as shown in (c).

The realization of sensitive bioanalytical methods for measuring dmg and metaboUte concentrations in plasma and other biological fluids (see Automatic INSTRUMENTATION BlosENSORs) and the development of biocompatible polymers that can be tailor made with a wide range of predictable physical properties (see Prosthetic and biomedical devices) have revolutionized the development of pharmaceuticals (qv). Such bioanalytical techniques permit the characterization of pharmacokinetics, ie, the fate of a dmg in the plasma and body as a function of time. The pharmacokinetics of a dmg encompass absorption from the physiological site, distribution to the various compartments of the body, metaboHsm (if any), and excretion from the body (ADME). Clearance is the rate of removal of a dmg from the body and is the sum of all rates of clearance including metaboHsm, elimination, and excretion. 

Figure 22.1 A. Schema for a physiologically based pharmacokinetic model incorporating absorption in the stomach and intestines and distribntion to various tissues. B. Each organ or tissue type includes representation of perfusion (Q) and drug concentrations entering and leaving the tissue. Fluxes are computed by the product of an appropriate rate law, and permeable surface area accounts for the affinity (e.g., lipophilic drugs absorbing more readily into adipose tissue). Clearance is computed for each tissue based on physiology and is often assumed to be zero for tissues other than the gut, the liver, and the kidneys.

Another method of predicting human pharmacokinetics is physiologically based pharmacokinetics (PB-PK). The normal pharmacokinetic approach is to try to fit the plasma concentration-time curve to a mathematical function with one, two or three compartments, which are really mathematical constructs necessary for curve fitting, and do not necessarily have any physiological correlates. In PB-PK, the model consists of a series of compartments that are taken to actually represent different tissues [75-77] (Fig. 6.3). In order to build the model it is necessary to know the size and perfusion rate of each tissue, the partition coefficient of the compound between each tissue and blood, and the rate of clearance of the compound in each tissue. Although different sources of errors in the models have been... 

There are several approaches to pharmacokinetic modelling. These include empirical, compartmental, clearance-based and physiological models. In the latter full physiological models of blood flow to and from all major organs and tissues in the body are considered. Such models can be used to study concentration-time profiles in the individual organs and e. g. in the plasma [57-60]. Further progress in this area may result in better PK predictions in humans [61]... 

Age-related alterations in pharmacokinetics (absorption, distribution, metabolism, and excretion) have received considerable attention. Thus, physiological changes in elderly patients, when taken together, may contribute to impairments in drug clearance in this segment of the population (Table 6.5). 

Marked inter-patient variability exists in the pharmacokinetics of intravenous anaesthetics. Factors that can influence drug disposition include the degree of protein binding, the efficiency of the hepatic and renal clearance systems, physiological changes with ageing, disease states, site of operation, body temperature, and drug interactions (premedicants, volatile anaesthetics). 

Once a chemical is in systemic circulation, the next concern is how rapidly it is cleared from the body. Under the assumption of steady-state exposure, the clearance rate drives the steady-state concentration in the blood and other tissues, which in turn will help determine what types of specific molecular activity can be expected. Chemicals are processed through the liver, where a variety of biotransformation reactions occur, for instance, making the chemical more water soluble or tagging it for active transport. The chemical can then be actively or passively partitioned for excretion based largely on the physicochemical properties of the parent compound and the resulting metabolites. Whole animal pharmacokinetic studies can be carried out to determine partitioning, metabolic fate, and routes and extent of excretion, but these studies are extremely laborious and expensive, and are often difficult to extrapolate to humans. To complement these studies, and in some cases to replace them, physiologically based pharmacokinetic (PBPK) models can be constructed [32, 33]. These are typically compartment-based models that are parameterized for particular... 

Much has been published on the extrapolation of in vivo data from animals to humans. These include pharmacokinetic data (e.g. half-lives, plasma concentrations, clearances and rates of metabolism) and pharmacodynamic data (e.g. effective and toxic doses). Two excellent reviews present many examples and insightful discussions on isometric and allometric relationships, time scales, interspecies pharmacokinetic and pharmacodynamic scaling, and physiological models (Boxenbaum and D Souza, 1990 Chappell and Mordenti, 1991). 

Achievement of a desired drug concentration-time profile. Although physiological processes govern the disposition of drug in the body, several pharmacokinetic parameters are still useful for evaluating drugs as candidates for controlled release delivery systems. In addition to potency, the pharmacokinetic parameters systemic clearance Cl, volume of... 

The covariate analysis revealed physiologically plausible covariate effects, partly explaining the variability observed in the pharmacokinetic parameters. A high interindividual variability on the CL/F not responsible for the generation of Ml still remained even after the incorporation of the covariates sex and creatinine clearance. This indicates that there still might be yet undiscovered covariates additionally influencing the elimination of NS2330. 

The PPK approach estimates the joint distribution of population specific pharmacokinetic model parameters for a given drug. Fixed effect parameters quantify the relationship e.g. of clearance to individual physiology like function of liver, kidney, or heart. The volume of distribution is typically related to body size. Random effect parameters quantify the inter-subject variability which remains after the fixed effects have been taken into account. Then the observed concentrations will still be randomly distributed around the concentration time course predicted by the model for an individual subject. This last error term called residual variability... 

Russel FG, Wouterse AC, Van Ginneken CA. 1987. Physiologically based pharmacokinetic model for the renal clearance of salicyluric acid and the interaction with phenolsulfon-phthalein in the dog. Drug Metab Dispos 15 695-701. 

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