Malaria, Human Immunodeficiency Virus (HIV) and tuberculosis (TB) are global health problems having their worst situation in sub-Saharan Africa. Consequently, concomitant use of antimalarial, antiretroviral and antitubercular drugs may be needed, resulting in a potential risk of drug-drug interactions. Cytochrome P-450 (CYP) enzyme induction/inhibition may lead to drug-drug interactions and can be detected by probe drugs. An analytical method was developed for the quantitation of mephenytoin, CYP2B6 and CYP2C19 probe, and its metabolites. Induction/inhibition of principal CYP enzymes by the antimalarials; artemisinin, dihydroartemisinin, arteether, artemether and artesunate, was evaluated using the 4-hour plasma concentration ratios of probe drugs and their metabolites along with modelling the population pharmacokinetics of S-mephenytoin and its metabolites. The extent of change in enzymatic activities was different among the antimalarials, with artemisinin having strongest capacity for induction and inhibition, consequently, the strongest potential risk for drug-drug interactions. Drug-drug interactions between the antitubercular rifampicin and the antiretrovirals nevirapine and lopinavir were assessed, in TB/HIV patients, by developing population pharmacokinetic models. Rifampicin increased nevirapine oral clearance. Simulations suggested that increasing the nevirapine dose to 300 mg twice daily when co-administered with rifampicin, would result in nevirapine concentrations above subtherapeutic levels, with minimum exposure above the recommended maximum concentration. Lopinavir is co-formulated with ritonavir in the ratio of 4:1. In children, increasing ritonavir dose four times did not completely compensate the enhancement of lopinavir oral clearance caused by rifampicin. However, the predicted lopinavir trough concentration was above the recommended minimum therapeutic concentration. The work presented in this thesis followed an investigation line though not done for a particular drug. First the CYP enzymes involved in the interaction are identified. Afterwards, the expected drug-drug interaction is investigated where the potentially interacting drugs are concomitantly administered and an adjustment in the dose regimen is proposed that is subsequently evaluated.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / In the present work, behavioral, neurochemical (determination of monoamines and metabolites levels rat in striatum), histopatological and biochemical (lipoproteins and transaminases) alterations produced by cocaine, ethanol and the association of theses were analyzed. Females Wistar rats (180-200 g) were treated during 7 days with cocaine (Coc 10 and 20 mg/kg, i.p.), ethanol (Et 2 and 4g/kg, p.o.) and the association of theses (Coc 10 mg + Et 2g - low interaction doses; Coc 20 mg + Ethanol 4g - high interaction doses). The results demonstrated that the spontaneous locomotor activity (SLA) was increased after cocaine administration and decreased after ethanol in both doses. It was not observed alterations in the SLA in the association cocaine + ethanol. The treatment with cocaine and ethanol caused an increase in dopamine level. The association cocaine + ethanol in higher doses caused an increase of dopamine and serotonin and decrease of DOPAC levels, suggesting that those drugs would can actuate directly in those systems or, indirectly, across a process of modulation. Cocaine, ethanol and the association of theses, after subcronic administration and in both doses, caused a donwregulation of D2-like receptors, not by recurring alterations in the values of Kd. The values of Bmax and Kd of the M1 + M2-like receptors have not already suffered alterations. In the biochemical study, the administration of cocaine induced an increase the concentrations of TGO and triglycerides, and decrease of the concentrations of TGP, total cholesterol and HDL. The treatment with ethanol decreases the levels of HDL, total cholesterol and triglycerides. The association cocaine + ethanol caused in both doses decrease of triglycerides, HDL, TGP and total cholesterol. All treatments did promote histopatological alterations in cardiac and hepatic woven. Ours results suggest that the association cocaine + ethanol appears to interfere more intense in the systems of neurotransmitters and in the biochemical parameters than the use of the isolated drugs. / No presente trabalho foram estudadas as alteraÃÃes comportamentais, neuroquÃmicas (determinaÃÃes dos nÃveis de monoaminas e metabÃlitos), histopatolÃgicas e bioquÃmicas (lipoproteÃnas e transaminases) em corpo estriado de ratos tratados com cocaÃna e etanol isoladamente ou em associaÃÃo. Foram utilizadas ratas Wistar (180-200 g), que foram tratadas durante 7 dias com cocaÃna (Coc 10 e 20 mg/kg, i.p.), etanol (Et 2 e 4g/kg, v.o.) e a associaÃÃo destes (Coc 10 mg + Et 2g - interaÃÃo baixas doses; Coc 20 mg + Etanol 4g - interaÃÃo altas doses). Os resultados demonstraram que a atividade locomotora espontÃnea (ALE) foi aumentada apÃs administraÃÃo de cocaÃna em ambas as doses e diminuÃda apÃs a administraÃÃo de etanol em ambas as doses. NÃo foram observadas alteraÃÃes na ALE na associaÃÃo cocaÃna + etanol. O tratamento com cocaÃna e etanol causou um aumento de dopamina, sem alteraÃÃes nos demais neurotransmissores e metabÃlitos. A associaÃÃo cocaÃna + etanol em altas doses, promoveu aumento dos nÃveis de dopamina, diminuiÃÃo de DOPAC e aumento dos nÃveis de 5-HT, sugerindo que essas drogas poderiam atuar diretamente nesses sistemas ou, indiretamente, atravÃs de um processo de modulaÃÃo. A cocaÃna, etanol e a associaÃÃo destes, apÃs administraÃÃo sub-crÃnica e em ambas as doses, causou uma downregulation em receptores D2-sÃmile, nÃo ocorrendo alteraÃÃes nos valores de Kd. Os valores de Bmax e Kd dos receptores M1 + M2-sÃmile nÃo sofreram alteraÃÃes. No estudo bioquÃmico, a administraÃÃo de cocaÃna induziu um aumento nas concentraÃÃes de TGO e triglicerÃdeos, e diminuiÃÃo das concentraÃÃes de TGP, colesterol total e HDL. O tratamento com etanol diminuiu os nÃveis de HDL, colesterol total e triglicerÃdeos. A associaÃÃo cocaÃna + etanol promoveu em ambas as doses diminuiÃÃo de trigicerÃdeos, HDL, TGP e colesterol total. Todos os tratamentos promoveram alteraÃÃes histopatolÃgicas em tecido cardÃaco e hepÃtico. Nossos resultados sugerem que a associaÃÃo cocaÃna + etanol parece interferir de maneira mais intensa nos sistemas de neurotransmissÃo e nos parÃmetros bioquÃmicos do que o uso das drogas isoladas.

O acetato de ciproterona é um esteróide sexual sintético com atividade antiandrogênica, antigonadotrópica e progestagênica. O objetivo deste estudo foi avaliar a bioequivalência de duas marcas comerciais de comprimidos contendo 100 mg de acetato de ciproterona em voluntários sadios. O ensaio foi do tipo quantitativo direto, com delineamento aleatório, cruzado e aberto, formando-se dois grupos de voluntários, A e B. Entre as fases houve um período de \"wash out\" de 27 dias, correspondente a, no mínimo, 10 vezes o valor de meia-vida de eliminação de acetato de ciproterona. Amostras de sangue foram coletadas em tubo heparinizado até 216 horas após a administração dos produtos. A bioequivalência dos produtos foi avaliada quantificando-se o fármaco em plasma, através de metodologia bioanalítica desenvolvida e previamente validada. As curvas médias de decaimento plasmático obtidas para os produtos teste (Androsteron® 100 mg - Bergamo, lote PI0004) e referência (Androcur® 100 mg Schering, lote 14616A) foram semelhantes, da mesma forma que as médias dos parâmetros farmacocinéticos Cmax (referência: 159,05 ng/mL; teste: 170,40 ng/mL), tmax (referência: 3,59 h; teste: 3,50 h) e ASC0-t (referência: 5563,03 ngxh/mL; teste: 5453,80 ngxh/mL) e ASC0-∞ (referência: 6266,22 ngxh/mL; teste: 6218,31 ngxh/mL). No presente estudo, a análise de variância (ANOVA) realizada para avaliação do efeito de produto, grupo e período em relação aos parâmetros farmacocinéticos avaliados demonstrou ausência destes efeitos em ASC0-t e ASC0-∞ para os valores calculados com todos os picos da curva plasmática. A ANOVA indicou ainda ausência de efeito de produto e período para Cmax, mas presença de efeito grupo para este parâmetro. Entretanto a constatação do efeito grupo não significa que as formulações avaliadas não sejam bioequivalentes, apenas que há uma diferença entre os grupos de indivíduos. Os valores do intervalo de confiança 90% para a razão de Cmax, (91,0 a 117,9%), ASC0-t (88,4 a 107,8%) e ASC0-∞. (90,6 a 107,8%) encontram-se entre 80 a 125 %, intervalo proposto pelo FDA e ANVISA. Desta forma, a avaliação dos resultados obtidos permite concluir que não houve diferença significativa entre as formulações teste e referência, ou seja, as duas formulações possuem biodisponibilidades estatisticamente equivalentes, em termos de velocidade e extensão da absorção. / Cyproterone acetate (6-chloro-1β,2βα-dihydro-17-hydroxy-3\'H-cyclopropa[1,2] pregna - 1,4,6-triene-3,20-dione acetate) (CPA) is a synthetic steroid with antiandrogenic and progestogenic properties. The aim of the present study was to evaluate the bioequivalence of two cyproterone acetate formulations. The bioequivalence of cyproterone acetate 100 mg tablets was determined in healthy volunteers after a single dose in a randomized crossover study, with a 27 days washout period between the doses. Reference (Androcur®) and test (Androsteron®) products were administered to twenty-four volunteers with 200 mL water after overnight fasting. Blood samples were taken up to 216 h post dose, the plasma was separated and the concentrations of cyproterone acetate were measured using a simple and rapid chromatographic method (HPLC). The pharmacokinetic parameters AUC0-t, AUC0-∞, Cmax, tmax and t(1/2)el were calculated for both formulations from plasma concentration time profiles. The calculated pharmacokinetic parameters were compared statistically to evaluate bioequivalence between the two brands and no significant differences between the two studied formulations were found. The 90% geometric confidence intervals of the mean ratio of In-transformed Cmax, AUC0-t and AUC0-∞ values were between 91,0 and 117,9% (Cmax), 88,4 and 107,8% (AUC0-t) ando 90,6 and 107,8% (AUC0-∞), and thus within the acceptance ranges, satisfying the bioequivalence criteria of the European Committee for Proprietary Medicinal Products and the US Food and Drug Administration Guidelines. In the Iight of the present study it can be concluded that the two evaluated cyproterone acetate formulations are bioequivalent in terms of the rate and extent of absorption.

Tuberculosis, the leading cause of death by a single infection disease caused by bacteria, requires long treatments and the bacteria are prone to develop drug resistance. Therefore, new efficient treatment regiments needs developing, which requires new tools for drug development. A major reason for discontinuance of a drug under development is undesired pharmacokinetic properties. Therefore, it is important to have early information of this, preferably the first time the drug is tested in animals. The first in vivo pharmacokinetic experiment is often done in mice and the only information present at this stage are often in vitro values and physicochemical properties. Physiological-based pharmacokinetic modelling can be used to extrapolate from in vitro to in vivo values. From this, the first in vivo pharmacokinetic experiment can be designed, often with the goal of reducing the amount of mice. This goal is one of the three R.s and it is called Reduction. To explore the Reduction of an experiment population pharmacokinetic modelling can be utilized via exploration of the imprecision, bias and probability of an informative experiment to evaluate if a design meets the goal of Reduction. In this report a recommendation of the first in vivo pharmacokinetic experiment is presented. This is based on in vitro values and physicochemical properties that are common in anti-tuberculosis drugs. If the probability of an informative experiment is critical, a terminal sampling of 40 mice is recommended. If imprecision and bias are necessary, zipper sampling of 10 mice is recommended.

Angus Chun-tim Lo. / Thesis (M. Phil.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves 138-147). / ACKNOWLEDGEMENTS --- p.i / LIST OF PUBLICATIONS --- p.ii / ABSTRACT --- p.iii / ABBREVIATIONS --- p.viii / Chapter CHAPTER 1 --- General Introduction --- p.1 / Chapter CHAPTER 2 --- The Effects of Danshen (Salvia miltiorrhiza) on Pharmacokinetics and Pharmacodynamics of Warfarin / Chapter 2.1 --- Introduction --- p.35 / Chapter 2.2 --- Materials and Methods --- p.42 / Chapter 2.3 --- Results --- p.54 / Chapter 2.4 --- Discussion --- p.64 / Chapter CHAPTER 3 --- The Effects of Danshen (Salvia miltiorrhiza) on Pharmacological Properties of the Stereoisomers of Warfarin / Chapter 3.1 --- Introduction --- p.68 / Chapter 3.2 --- Materials and Methods --- p.72 / Chapter 3.3 --- Results --- p.84 / Chapter 3.4 --- Discussion --- p.99 / Chapter CHAPTER 4 --- The Effects of Danggui (Angelica sinensis) on Pharmacokinetics and Pharmacodynamics of Warfarin / Chapter 4.1 --- Introduction --- p.104 / Chapter 4.2 --- Materials and Methods --- p.114 / Chapter 4.3 --- Results --- p.120 / Chapter 4.4 --- Discussion --- p.127 / Chapter CHAPTER 5 --- General Conclusion --- p.131 / REFERENCES --- p.138

Pang Siu Kwong. / "August 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 181-191) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Although the clinical efficacy of statins has been well established, there is a wide inter-individual variation in the lipid responses to statins. Pharmacogenetic studies have identified some genetic differences that contribute to the variation, but overall the results have been disappointing. The studies described in this thesis were performed to examine whether certain genetic variants predicted the lipid responses to rosuvastatin in Chinese patients. Over 400 Chinese patients with increased risk of cardiovascular disease (CVD) who were treated with rosuvastatin 10 mg daily for at least 4 weeks (more than 97% of patients had at least 6 weeks treatment) were studied, including 166 having familial hypercholesterolaemia (FH) and 36 having rheumatoid arthritis (RA). They were genotyped for 135 polymorphisms in 62 candidate genes/loci potentially related to pharmacokinetics or pharmacodynamics of statins and lipid metabolism. Associations between genetic polymorphisms and the lipid responses to rosuvastatin were analyzed in 386 patients with good compliance. The associations between genetic polymorphisms and some risk factors for CVD including baseline lipid levels, high-sensitivity C-reactive protein (hsCRP), uric acid and bilirubin levels were also analyzed. / Some novel genetic determinants of the LDL-C response to rosuvastatin treatment have been identified in this study. The responses in HDL-C and triglycerides were related more closely to the baseline levels of these lipids than to any of the polymorphisms examined. Genetic associations with baseline lipid parameters, hsCRP, uric acid and bilirubin were identified and generally correspond with some of the previous reports of studies in Chinese and other ethnic groups. / The key findings of the study are as follows: 1. The polymorphisms most highly associated with the low-density lipoprotein cholesterol (LDL-C) response were 421C>A in the ATP-binding cassette G2 (ABCG2) gene (P=9.2x10 -7), followed by 18281G>A (V257M) in the flavin-containing monooxygenase 3 (FMO3) gene (P=0.0002), 1421C>G in the lipoprotein lipase (LPL) gene (P=0.002), and rs4420638 in the apolipoprotein E/C-I/C-IV/C-II (APOE/C1/C4/C2) gene cluster (P=0.004). These genetic polymorphisms and having FH totally explained 13.6% of the variance in percentage change in LDL-C in response to rosuvastatin. The greater percentage reduction in LDL-C in patients with the ABCG2 421AA genotype compared to those with the ABCG2 421CC genotype was equivalent to at least doubling the dose of rosuvastatin. 2. Three SNPs (glucokinase regulator [ GCKR] rs1260326, apolipoprotein AS [APOA5] -1131T>C and the solute carrier organic anion transporter 1B1 [SLCO1B1] 521T>C) tended to be associated with percentage changes in high-density lipoprotein cholesterol (HDL-C) (P<0.05), but none of these reached the overall significance level. In multivariate stepwise regression analysis, baseline HDL-C (P=1.6x10 -6), having diabetes (P=0.0004) or RA (P=0.002) and the SLCO1B1 521T>C polymorphism (P=0.03) were determinants of HDL-C responses, contributing 9.9% of the variance in percentage change in HDL-C, but the genetic factors only contributed to 0.8% of the variance. 3. The triglyceride response to rosuvastatin was highly variable and was strongly related to baseline levels. The diacylglycerol acyltransferase-2 (DGAT2) rs10899113 C>T polymorphism tended to be associated with reduced triglyceride response in a gene-dose dependent manner. However, in multivariate stepwise regression analysis, baseline triglyceride level was the only factor that strongly related to the triglyceride response, explaining 14.4% of the variance. 4. This study has also analyzed relationships between on-treatment plasma hsCRP concentrations and cardiovascular risk factors and 14 single nucleotide polymorphisms in CRP and other candidate genes, which showed that central obesity, low HDL-C and CRP polymorphisms are major determinants of higher hsCRP levels in Chinese patients on treatment with rosuvastatin. 5. The association between genetic polymorphisms and lipid traits were analyzed in FH and non-FH patients separately due to their different lipid profiles. The analysis has shown that there were different genetic predictors of lipid levels in patients with and without FH and that more genetic factors appeared to affect the baseline lipid levels in patients with FH compared to non-FH patients, suggesting complex interactions between genetic and environmental factors and plasma cholesterol levels in patients with and without FH. 6. The SLC2A9 (solute carrier family 2, member 9) rs1014290 T>C was significantly associated with plasma uric acid levels in a gene-dose dependent manner (P=1.0x10-5) and the relationship was more pronounced in women or in patients without hypertension than in men or patients with hypertension. The ABCG2 421 C>A did not show a significant effect on uric acid levels. 7. The UGT1A1 (uridine diphosphate glucuronosyltransferases family, polypeptide A1) variants *28 (P=1.5x10 -9) and *6 (P=2.2x10-7) were independently associated with increased baseline bilirubin levels. Polymorphisms in SLCO1B1 did not appear to affect bilirubin levels in this study. / Hu, Miao. / Adviser: Brian Tomlinson. / Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 230-264). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

A oxcarbazepina (OXC) é indicada como terapia adjuvante ou monoterapia no tratamento de crises epilépticas parciais ou crises tônico-clônicas generalizadas em adultos e crianças. A OXC sofre rápida eliminação pré-sistêmica com formação do metabólito ativo 10-hidroxicarbazepina (MHD), o qual possui como enantiômeros o R-(-)- e o S-(+)-MHD. A OXC e o MHD são substratos da glicoproteína-P (P-gp), que pode ser inibida pelo verapamil. O presente estudo avalia a influência do verapamil na farmacocinética e perfusão cerebral da OXC e dos enantiômeros do MHD em voluntários sadios. Os voluntários sadios (n=12) receberam em uma ocasião doses de 300 mg/12h de OXC e em outra ocasião doses de 300 mg/12h de OXC associadas com 80 mg/8h de verapamil. As amostras de sangue foram coletadas no estado de equilíbrio durante 12 horas e a avaliação da perfusão cerebral realizada utilizando a tomografia computadorizada por emissão de fóton único (SPECT) antes do início do tratamento e nos tempos 4, 6 ou 12h após a administração da OXC. As concentrações plasmáticas total e livre da OXC e dos enantiômeros do MHD foram avaliadas por LC-MS/MS. A análise farmacocinética não compartimental foi realizada com o programa WinNonlin e a farmacocinética populacional foi desenvolvida utilizando a modelagem não-linear de efeitos mistos com o programa NONMEM. Os limites de quantificação obtidos foram de 12,5 ng OXC/mL de plasma e 31,25 ng de cada enantiômero MHD/mL de plasma para a análise da concentração total, enquanto foi de 4,0 ng de OXC/mL de plasma e de 20,0 ng de cada enantiômero do MHD/mL de plasma para a determinação da concentração livre. Os coeficientes de variação obtidos nos estudos de precisão e a porcentagem de inexatidão inter e intra-ensaios foram inferiores a 15%, assegurando a reprodutibilidade e repetibilidade dos resultados. A análise farmacocinética não compartimental da OXC em monoterapia resultou nos seguintes parâmetros: concentração plasmática máxima (Cmax) de 1,35 ?g/mL como valor total e 0,32 ?g/mL como concentração livre em 1,0 h, área sob a curva concentração plasmática versus tempo (AUC0-12) de 3,98 ?g.h/mL e meia-vida de eliminação de 2,45 h, volume de distribuição aparente (Vss/F) de 352,17 L e clearance aparente (CLss/F) de 75,58 L/h. A disposição cinética do MHD é enantiosseletiva, com observação de maior proporção para o enantiômero S-(+)-MHD em relação ao R-(-)-MHD (razão AUC0-12 S-(+)/R-(-) de 4,26). A fração livre avaliada no tmax da OXC foi 0,26 para a OXC, 0,42 para o R-(-)-MHD e 0,38 para o S- (+)-MHD, mostrando enantiosseletividade na ligação às proteínas plasmáticas do MHD. O tratamento com o verapamil reduziu o tempo médio de residência (MRT) (4,71 vs 3,83 h) e Cmax como concentração livre (0,32 vs 0,53 ?g/mL) da OXC e aumentou os valores para ambos os enantiômeros do MHD de Cmax como valor total (2,60 vs 3,27 ?g/mL para o R-(-)- e 11,05 vs 11,94 ?g/mL para o S-(+)-MHD), Cmax como concentração livre (3,11 vs 4,14 ?g/mL para o S-(+)-MHD), Cmédia (2,11 vs 2,42 ?g/mL para o R-(-)- e 8,10 vs 9,07 ?g/mL para o S-(+)-MHD) e AUC0-12 (25,36 vs 29,06 ?g.h/mL para o R-(-)- e 97,19 vs 111,37 ?g.h/mL para o S-(+)-MHD). A ii farmacocinética populacional da OXC foi melhor descrita por modelo de dois compartimentos com eliminação de primeira ordem e com um conjunto de três compartimentos de trânsito para descrever o perfil de absorção da OXC. A disposição de ambos os enantiômeros do MHD foi caracterizada por modelo de um compartimento. Os valores de CLss/F estimados na monoterapia foram de 84,9 L/h para a OXC e de 2,0 L/h para ambos enantiômeros do MHD, enquanto os valores de Vss/F foram de 587 L para a OXC, 23,6 L para o R-(-)-MHD e 31,7 L para o S-(+)- MHD. Concluindo, a associação do verapamil aumentou a biodisponibilidade da OXC em 12% (farmacocinética populacional) e aumentou os valores de AUC de ambos os enantiômeros do metabólito MHD (farmacocinética não compartimental), o que está provavelmente relacionado com a inibição da P-gp no trato intestinal. A associação do verapamil aumentou as concentrações cerebrais preditas de ambos os enantiômeros do MHD em maior extensão do que aquelas observadas no plasma. As mudanças no fluxo sanguíneo cerebral (SPECTs realizados 6h após a administração da OXC) associadas à coadministração de verapamil provavelmente foram causadas pelo aumento dos níveis cerebrais de ambos os enantiômeros do MHD. A confirmação dessa observação requer um braço experimental adicional com SPECTs realizados também após a administração do verapamil em monoterapia. / Oxcarbazepine (OXC) is indicated as adjunctive therapy or monotherapy for the treatment of partial or generalized tonic-clonic seizures in adults and children. OXC undergoes rapid pre-systemic reduction with formation of the active metabolite 10- hydroxycarbazepine (MHD), which has the enantiomers R-(-)- and S-(+)-MHD. OXC and MHD are substrates of P-glycoprotein (P-gp), which can be inhibited by verapamil. The present study evaluates the influence of verapamil on the pharmacokinetics and cerebral perfusion of OXC and the MHD enantiomers in healthy volunteers. The healthy volunteers (n=12) received on one occasion doses of 300 mg/12h OXC and on another occasion they received doses of 300 mg/12h OXC associated with 80 mg/8h of verapamil. Blood samples were collected at steady state for 12 hours and the assessment of cerebral perfusion was performed using a single-photon emission computed tomography (SPECT) before the beginning of treatment and at times 4, 6 or 12 hours after OXC administration. The total and free plasma concentrations of OXC and MHD enantiomers were assessed by LC-MS/MS. The non-compartmental pharmacokinetics analysis was performed using the WinNonlin program, and population pharmacokinetics was developed using nonlinear mixed effects modelling with NONMEM.The limits of quantification obtained were 12.5 ng/mL plasma for OXC and 31.25 ng of each MHD enantiomer/mL plasma for total concentration analysis, while it was 4.0 ng OXC/mL plasma and 20.0 ng of each MHD enantiomer/mL plasma for the free concentration determination. The coefficients of variation obtained in studies of accuracy and the percentage of inaccuracy inter and intra-assay were less than 15%, ensuring the result reproducibility and repeatability. The non-compartmental pharmacokinetic analysis of OXC in monotherapy treatment, resulted in the following parameters: maximum plasma concentration (Cmax) of 1.35 ?g/mL as total concentration and 0.32 mg/mL as free concentration in 1.0 h, area under the plasma concentration vs time curve (AUC0-12) was 3.98 ?g.h/mL, half-life of 2.45 h, apparent volume of distribution (Vss/F) of 352.17 L and the apparent clearance (CLSS/F) of 75.58 L/h. The MHD kinetic disposition is enantioselective, with observation of a greater proportion of the S-(+)-MHD enantiomer compared to R-(-)-MHD (ratio AUC0-12 S-(+)/R-(-) of 4.26). The free fraction measured in the tmax of OXC was 0.26 for OXC, 0.42 for R-(-)-MHD and 0.38 for S-(+)-MHD, showing enantioselectivity in the plasma protein binding of MHD. Verapamil treatment reduced the mean residence time (MRT) (4.71 vs 3.83 h) and Cmax (0.26 vs 0.31 ?g/mL) as free concentration for OXC and increased the both MHD enantiomers values of Cmax (2.60 vs 3.27 ?g/mL for R-(-)- and 11.94 vs 11.05 ?g/mL for S-(+)-MHD) as total concentration, Cmax (3.11 vs 4,14 ?g/mL for S- (+)-MHD) as free concentration, Cavg (2.11 vs 2.42 ?g/mL for R-(-)- and 8.10 vs 9.07 ?g/mL for S-(+)-MHD) and AUC0-12 (25.36 vs 29.06 ?g.h/mL for R-(-)- and 97.19 vs 111.37 ?g.h/mL for S-(+)-MHD). The population pharmacokinetics of oxcarbazepine was best described by a two-compartment model with first-order elimination and a iv set of three transit compartments to describe the absorption profile of the parent compound. The disposition of both MHD enantiomers was characterised by onecompartment model. The CLss/F estimates in monotherapy were 84.9 L/h for OXC and 2.0 L/h for both MHD enantiomers, whereas the values of Vss/F were 587 L for OXC, 23.6 L for R-(-)-MHD and 31.7 L for S-(+)-MHD. In conclusion, verapamil coadministration increased the OXC bioavailability in 12% (population pharmacokinetics) and increased the AUC of both metabolite MHD enantiomers (non-compartmental pharmacokinetics), which is probably related to the inhibition of P-gp in the intestinal tract. Verapamil co-administration increased the predicted brain concentrations of both MHD enantiomers in a greater extent than those observed in plasma. Changes in cerebral blood flow (SPECTs performed 6h after administration of OXC) associated with co-administration of verapamil were probably caused by an increase in brain levels of both MHD enantiomers. Confirmation of this observation requires additional experimental arm with SPECTs also performed after administration of verapamil in monotherapy.

D. Tech. Pharmaceutical Sciences.

No description available.