James E. Patrick

The Plasma Concentration and LDL‐C Relationship in Patients Receiving Ezetimibe

Ezetimibe is a novel selective inhibitor of intestinal cholesterol absorption, which has been shown to significantly decrease low‐density lipoprotein cholesterol (LDL‐C). In this article, the relationship between plasma ezetimibe concentrations and lowering of LDL‐C is determined using Emax and regression models. Data from two phase II doubleblind placebo‐controlled studies (n = 232 and 177) were used in which daily doses of ezetimibe ranging from 0.25 to 10 mg were administered for 12 weeks. Ezetimibe concentrations correlated significantly with percentage change in LDL‐C from baseline (%LDL‐C). Reductions in %LDL‐C of 10%, 15%, and 20% were achieved with concentrations in the ranges 0 to 2, 2 to 15, and ® 15 ng/ml, respectively, as compared with placebo. To achieve ® 15% reduction in LDL‐C, patients need to maintain trough concentrations ® 15 ng/ml, taking plasma concentrations as a surrogate for concentrations at the enterocyte. Based on the doses administered, the 10 mg dose had the highest likelihood of sustaining such concentrations, confirming that a daily 10 mg dose of ezetimibe is an optimal therapeutic dose in the treatment of hypercholesterolemia.

Disposition of 14C-eptifibatide after intravenous administration to healthy men

Eptifibatide, a synthetic peptide inhibitor of the platelet glycoprotein IIb/IIIa receptor, has been studied as an antithrombotic agent in a variety of acute ischemic coronary syndromes. The purpose of the present study was to characterize the disposition of 14C-eptifibatide in man after a single intravenous (i.v.) bolus dose. 14C-Eptifibatide (approximately 50 microCi) was administered to eight healthy men as a single 135-microgram/kg i.v. bolus. Blood, breath carbon dioxide, urine, and fecal samples were collected for up to 72 hours postdose and analyzed for radioactivity by liquid scintillation spectrometry. Plasma and urine samples were also assayed by liquid chromatography with mass spectrometry for eptifibatide and deamidated eptifibatide (DE). Mean (+/- SD) peak plasma eptifibatide concentrations of 879 +/- 251 ng/mL were achieved at the first sampling time (5 minutes), and concentrations then generally declined biexponentially, with a mean distribution half-life of 5 +/- 2.5 minutes and a mean terminal elimination half-life of 1.13 +/- 0.17 hours. Plasma eptifibatide concentrations and radioactivity declined in parallel, with most of the radioactivity (82.4%) attributed to eptifibatide. A total of approximately 73% of administered radioactivity was recovered in the 72-hour period following 14C-eptifibatide dosing. The primary route of elimination was urinary (98% of the total recovered radioactivity), whereas fecal (1.5%) and breath (0.8%) excretion was small. Eptifibatide is cleared by both renal and nonrenal mechanisms, with renal clearance accounting for approximately 40% of total body clearance. Within the first 24 hours, the drug is primarily excreted in the urine as unmodified eptifibatide (34%), DE (19%), and more polar metabolites (13%).

Disposition and pharmacokinetics of temozolomide in rat

1. Temozolomide, an imidazotetrazine derivative, is a cytotoxic alkylating agent of broad-spectrum antitumour activity. The absorption, metabolism, distribution and excretion of temozolomide have been investigated in male and female Sprague–Dawley and Long–Evans rats following single oral or intravenous dose administration of 200 mg m−2 non-radiolabelled or 14C-radiolabelled temozolomide. The distribution of 14C-temozolomide was also evaluated by whole-body autoradiography in male Sprague–Dawley rats. Plasma concentrations of temozolomide and its active metabolite 3-methyl-(triazen-1-yl)imidazole-4-carboxamide (MTIC) were determined by high-performance liquid chromatography (HPLC) with ultraviolet detection. Plasma, urine and faeces were profiled by HPLC with radiochemical detection. 2. Temozolomide was rapidly and extensively (>90%) absorbed and widely distributed in tissues. The distribution pattern of radioactivity was gender independent. Penetration into the brain following oral or intravenous administration was 35–39% based on the brain/plasma AUC ratio. 3. Following intravenous or oral administration, temozolomide was primarily eliminated renally (75–85% of the dose) as either unchanged drug, a carboxylic acid analogue, AIC (a degradation product) and a highly polar unidentified peak. Biliary excretion was minimal (1.4–1.6%). The pharmacokinetics (oral versus intravenous) were similar and gender independent. The absolute oral availability was 96–100%. Temozolomide was rapidly eliminated (t1/2 = 1.2 h) and converted to MTIC. 4. Systemic exposure to MTIC was about 2% that of temozolomide. Overall, the disposition of temozolomide in rats was similar to that observed in humans.

Biotransformation of norgestimate in women

The metabolism of norgestimate (ORF-10131; 14C-d-13-ethyl-17-acetoxy-18,19-dinor-17 alpha-pregn-4-en-20- yn -3-oxime) was studied in humans. Compound labeled with carbon-14 in the 17 alpha-ethynyl group was administered to four female subjects. An average of 46.8 percent of the administered radioactivity was excreted in the urine and 36.8 percent in the feces over a two-week collection period. About 12 percent of the urinary radioactivity represented freely extractable metabolites and another 57 percent consisted of extractable material released by enzyme hydrolysis. The ethynylated metabolites of norgestimate were separated from endogenous compounds and non- ethynylated metabolites by silver- sulfoethyl cellulose column chromatography. Metabolites were subsequently isolated by high performance liquid chromatography and thin layer chromatography. The identification of five urinary metabolites was accomplished by combined gas-liquid chromatography/mass spectrometry. These metabolites include norgestrel, 16 beta- hydroxynorgestrel , 2 alpha- hydroxynorgestrel , 3 alpha, 5 beta- tetrahydronorgestrel , and a fifth trihydroxylated metabolite of undetermined stereochemical configuration; 3,16-dihydroxy-5- tetrahydronorgestrel .

Disposition of desloratadine in healthy volunteers

The absorption, metabolism and excretion of desloratadine (DL, Clarinex®) were characterized in six healthy male volunteers. Subjects received a single oral 10-mg dose of [14C]DL (∼104 µCi). Blood, urine and feces were collected over 240 h. DL was well absorbed; drug-derived radioactivity was excreted in both urine (41%) and feces (47%). With the exception of a single subject, DL was extensively metabolized; the major biotransformation pathway consisted of hydroxylation at the 3 position of the pyridine ring and subsequent glucuronidation (3-OH-DL-glucuronide or M13). In five of the six subjects, DL was slowly eliminated (mean t½ = 19.5 h) and persisted in the plasma for 48–120 h post-dose. This is in contrast to a t½ of ∼110 h and quantifiable plasma DL concentrations for the entire 240-h sampling period in one subject, who was identified phenotypically as a poor metabolizer of DL. This subject also exhibited correspondingly lower amounts of M13 in urine and 3-OH-DL (M40) in feces. Disposition of DL in this subject was characterized by slow absorption, slow metabolism and prolonged elimination. Further clinical studies confirmed the lack of safety issues associated with polymorphism of DL metabolism (Prenner et al. 2006, Expert Opinion on Drug Safety, 5: 211–223).

Disposition of loratadine in healthy volunteers

The absorption, metabolism and excretion of carbon-14-labeled loratadine (LOR, SCH 29851, Claritin®) administered orally to healthy male volunteers were evaluated. Following a single oral 10-mg dose of [14C]LOR (∼102 µCi), concentrations of LOR and desloratadine (DL; a pharmacologically active descarboethoxy metabolite of LOR) were determined in plasma. Metabolites in plasma, urine and feces were characterized using a liquid chromatography-mass spectrometry system (LC-MS) connected in line with a flow scintillation analyzer (FSA). Maximum plasma LOR and DL concentrations were achieved at 1.5 h and 1.6 h, respectively; thus, LOR was rapidly absorbed but also rapidly metabolized as indicated by these similar tmax values. Metabolite profiles of plasma showed that LOR was extensively metabolized via descarboethoxylation, oxidation and glucuronidation. Major circulating metabolites included 3-hydroxy-desloratadine glucuonide (3-OH-DL-Glu), dihydroxy-DL-glucuronides, and several metabolites resulting from descarboethoxylation and oxidation of the piperidine ring. LOR was completely metabolized by 6 h post-dose. LOR-derived radiocarbon was excreted almost equally in the urine (41%) and feces (43%). About 13% of the dose was eliminated in the urine as 3-OH-DL-Glu. DL accounted for less than 2% of the dose recovered in the urine and only trace amounts of LOR were detected. 3-OH-DL was the major fecal metabolite (∼17% of the dose). The combined amount of 5- and 6-hydroxy-DL contributed to an additional 10.7% of the dose in feces. Approximately 5.4% and 2.7% of the dose were excreted in the feces as unchanged drug and DL, respectively.

Multiple‐Dose Albuterol Kinetics

Albuterol a beta‐adrenergic agonist bronchodilator, was studied in 12 healthy male volunteers to evaluate the steady‐state pharmacokinetics following oral administration of 4‐mg tablets, given every six hours for five days. The kinetics of albuterol were best described by a two‐compartment open model with first‐order absorption kinetics. Steady‐state plasma levels were predictable from the kinetic data and were reached by the third day of dosing (ninth and tenth dose). Small accumulation ratios of approximately two were seen based on area under the plasma concentration‐time curve and maximal and minimal concentration data. The elimination phase half‐life was determined to be 6.5 hours, which is similar to the values reported following single‐dose administration.

Metabolism and excretion of loratadine in male and female mice, rats and monkeys.

The metabolism and excretion of loratadine (LOR), a long–acting non–sedating antihistamine, have been evaluated in male and female mice, rats and monkeys. Following a single (8 mg kg−1) oral administration of [14C]LOR, radioactivity was predominantly eliminated in the faeces. Profiling and characterization of metabolites in plasma, bile, urine and faeces from male and female mice, rats and monkeys showed LOR to be extensively metabolized with quantitative species and gender differences in the observed metabolites. In all species investigated, the primary biotransformation of LOR involved decarboethoxylation to form desloratadine (DL), subsequent oxidation (hydroxylation and N–oxidation) and glucuronidation. More than 50 metabolites were profiled using liquid chromatography–mass spectrometry (LC–MS) with in–line flow scintillation analysis (FSA) and characterized using LC–MSn techniques. The major circulating metabolite in male rats is a DL derivative in which the piperidine ring was aromatized and oxidized to pyridine–N–oxide. Much lower levels of the pyridine–N–oxide metabolite were observed in female rat plasma. In contrast, the relative amount of DL was notably higher in female than in male rats. The major circulating metabolite in either gender of mouse and male monkey is a glucuronide conjugate of an aliphatic hydroxylated LOR; in the female monkey, the major circulating metabolite is formed through oxidation of the pyridine moiety and subsequent glucuronidation. Qualitatively similar metabolic profiles were observed in the mouse, rat and monkey urine and bile, and the metabolites characterized resulted from biotransformation of LOR to DL, hydroxylation of DL and subsequent glucuronide conjugation. 5–Hydroxy–desloratadine was the major faecal metabolite across all three species irrespective of gender.

Influence of food on the absorption of albuterol Repetabs

A study was conducted in 12 healthy, nonsmoking male volunteers to examine the effect of food intake on the absorption profile of albuterol repeat-action tablets. This randomized crossover study consisted of two phases separated by a 1-week washout period. All subjects fasted 10 hours preceding drug administration. Each subject received two 4 mg albuterol repeat-action tablets with and without a high fat content breakfast. Plasma albuterol concentrations were determined by a gas chromatographic/mass spectrophotometric assay. Relative bioavailability was assessed by comparing areas under the plasma-albuterol concentration time curves as well as peak concentrations and time to peak concentration. No significant differences were noted between the two treatment phases in the area under the curve or peak plasma concentrations. The areas under the curve were 100 and 105 hr.ng/ml when the drug was administered with and without food, respectively. The corresponding peak plasma concentration values were 9.4 and 10.4 ng/ml, respectively. The only significant difference observed was in the maximum time to reach peak plasma concentrations, which was delayed by about 1 hour when the drug was administered with food. Therefore, food has minimal effect on the absorption of albuterol from repeat-action tablets.

High-performance liquid chromatographic assay for hydrochlorothiazide in human urine

A high-performance liquid chromatographic assay was developed for the quantitative determination of hydrochlorothiazide (HCT) in human urine. Reversed-phase separation of HCT and the internal standard, trichloromethiazide (TCMT), was accomplished on a 300 X 3.9 mm mu Bondapak Phenyl column. Following solvent extraction, concentrations of HCT as low as 0.25 micrograms/ml in urine were quantified by UV detection at 280 nm. Detector response (peak-area ratio of HCT to TCMT) was linear to 50 micrograms/ml. No interferences were observed in the extracts obtained from drug-free urine nor from several antihypertensive agents which are commonly co-administered with HCT. This method has been routinely employed in bio-availability studies evaluating a variety of formulations as well as characterizing the pharmacokinetics of this drug from urinary excretion data.