Plasma drug concentration variation

Fig. 2.6 Effect of variation in absorption rate on plasma drug concentration. The graph shows simulated plasma concentration-time curves for theophyUine after oral administration, illustrating a 20% difference in Cpmax values resulting from variation in the absorption rate constant. Absorption rate constants top curve 2.2 per h (Cpmax 20 pg/mL) middle curve 1.0 per h (Cptnax 18 M-g/mL) bottom curve 0.7 per h. Note that tmax also changes. The established therapeutic concentration of theophyUin is 10-20 pg/mL. The most rapidly absorbed formulation produces the highest concentration and greatest chance of side effects. Also, the duration for which the plasma concentration is within the therapeutic range also varies. Pharmacokinetic parameters dose, 400 mg bioavaUabiUty, 0.8 volume of distribution, 29 L half-Ufe, 5.5 h.

Figure 1. Time-dependent variation of plasma drug concentrations...

Various factors may account for the variability in response to neuroleptics. These include differences in the diagnostic criteria, concurrent administration of drugs which may affect the absorption and metabolism of the neuroleptics (e.g. tricyclic antidepressants), different times of blood sampling, and variations due to the different type of assay method used. In some cases, the failure to obtain consistent relationships between the plasma neuroleptic concentration and the clinical response may be explained by the contribution of active metabolites to the therapeutic effects. Thus chlorpromazine, thioridazine, levomepromazine (methotrime-prazine) and loxapine have active metabolites which reach peak plasma concentrations within the same range as those of the parent compounds. As these metabolites often have pharmacodynamic and pharmacokinetic activities which differ from those of the parent compound, it is essential to determine the plasma concentrations of both the parent compound and its metabolites in order to establish whether or not a relationship exists between the plasma concentration and the therapeutic outcome. 

Once the steady state of the drug has been reached, there is a fairly consistent relationship between the plasma and the brain concentrations. It should therefore be possible to define those plasma concentrations that are associated with the optimal clinical effects (i.e. the optimal balance between the effectiveness and the side effects). Because of the biological variation, however, such concentrations may vary from one individual to another but it is possible to develop a range of drug concentrations which are based on... 

Gorsline, J. Okerholm, R.A. Rolf, C.N. Moos, C.D. Hwang, S.S. Comparison of plasma nicotine concentrations after application of nicoderm (nicotine transdermal system) to different skin sites. J. Clin. Pharmacol. 1992,32, 576-581. Wester, R.C. Maibach, H.I. Bucks, D.A.W. In vivo percutaneous absorption of paraquat from hand, leg and forearm of humans. J. Toxicol. Environ. Health 1984, 14, 759-762. Taskovich, L. Shaw, J.E. Regional differences in the morphology of human skin correlation with variations in drug permeability. J. Invest. Dermatol. 1978, 70, 111. Roberts, M.S. Eavretto, W.A. Meyer, A. Reckmann, M. Wongseelashote, T. Topical bioavailability of methyl sahcy-late. Aust. N.Z. J. Med. 1982, 12, 303-305. 

Many disease states can cause individual variation in response to drugs. Any disease that results in alteration in the pharmacokinetics of a drug will create these variations. Diseases of the liver and kidney, any disease that affects intestinal motility, mal-absorption syndromes and any condition that reduces plasma protein concentration are all implicated. Some diseases can alter the physiological sensitivity to a drug at its site of action. 

There is no simple relationship between the dose of carbamazepine and concentrations of the drug in plasma. Therapeutic concentrations are reported to be 6—12 jlg/mL, although considerable variation occurs. Side effects referable to the CNS are frequent at concentrations >9 jlg/mL. 

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