Kinetics of subcutaneous versus intravenous epoetin-beta in dogs, rats and mice.

The total body clearance of recombinant human erythropoietin (rhEPO) calculated per kilogram of body weight increased in the order man = dog < rat << mouse. The differences disappeared or were reversed when clearance was expressed per square meter of body surface. There was no similar species difference in terminal half life. Total body clearance increased with the dose in dogs and mice, but not in rats. The bioavailability from a subcutaneous depot was 80% in dogs, 76% in rats, and 70% in mice. The absorption from the subcutaneous depot is rapid in rats and mice, but slow in dogs. The pharmacodynamic activity of rhEPO injected by both routes was compared in polycythemic mice. The equipotent doses were 2.44 times higher with intravenous than with subcutaneous injection. Taking into account the bioavailability of 70% from a subcutaneous depot, one obtains a potency ratio of 3.5 for absorbed subcutaneous versus intravenous rhEPO.

Receptor kinetics and concentration-effect relation of cardiac glycosides.

Therapeutic and toxic actions of cardiac glycosides are attributed to an inhibition of Na, K-ATPase. The therapeutically relevant range is between 25% and 50% inhibition. There is a good correlation between the average steady state serum concentration of glycosides and their therapeutic action. However, therapeutic and toxic effects set in with a latency and therefore do not follow the daily variations in glycoside concentration. Although the effect follows the average serum concentrations, only the minimal concentration is measured. In principle this is only adequate if the ratio of average/minimal concentration is constant. A model calculation showed that with a constant average steady state concentration an increase in the distribution volume or a decrease in total body clearance with corresponding reduction of the daily dose lead to an increase of the minimal concentrations of 5-7%. This means a corresponding underestimation of the average concentration from the minimum concentration. However, the deviations are too small to be of clinical relevance.

Picumast dihydrochloride (Auteral), a new anti-allergic inhibitor of mediator release and action.

Picumast dihydrochloride (PDH), (3,4-dimethyl-7-[4-chlorobenzyl) piperazine-1-yl]propoxycoumarin dihydrochloride) is a prophylactically active anti-allergic compound which combines inhibition of mediator release and action. The activity profile of PDH differs clearly from that of known prophylactic anti-allergic drugs such as DSCG and ketotifen. Other inhibitory actions of PDH in addition to its H1-antagonism (and that of its metabolites M2 and M1) may be the cause of the suppression of immediate and late phase allergic reactions in animals as well as allergic rhinitis and bronchial responsiveness and symptom scores in asthmatic patients.

Antiallergic activity of picumast dihydrochloride in several animal species.

Picumast dihydrochloride (3,4-dimethyl-7-[4-(4-chlorobenzyl)piperazine-1-yl]propoxycoumarin dihydrochloride) was compared with cromoglycate, ketotifen and mepyramine as an inhibitor of allergic and anaphylactoid reactions. 1. In guinea-pigs, pretreatment with picumast dihydrochloride given intravenously, orally or by inhalation prevented bronchospasm induced by antigen or histamine. The fraction of the bronchospasm remaining after mepyramine pretreatment was further reduced by picumast dihydrochloride. 2. Systemic administration of picumast dihydrochloride inhibited antigen-induced conjunctivitis, whereas mepyramine and ketotifen were inactive. 3. Intravenous and oral pretreatment with picumast dihydrochloride inhibited the antigen-induced mast cell degranulation in rat mesentery. The effective doses of cromoglycate given intravenously were twice as high as those of picumast dihydrochloride. Picumast dihydrochloride did not inhibit antigen-induced bronchoconstriction in rats. 4. The cutaneous reaction induced with Ascaris antigen in atopic monkeys was insensitive to the antihistaminic action of ketotifen, whereas it was inhibited by low doses of picumast dihydrochloride. Both compounds suppressed skin reactions induced by histamine. 5. Picumast dihydrochloride decreased IgE production in atopic high responder mice. It did not prevent autoimmune nephritis in NZB/W mice. 6. In rats, picumast dihydrochloride did not reduce cotton pellet granuloma, nor adjuvant arthritis. The inhibition of carrageenin oedema is presumably due to its anti-oedematous properties rather than to an antiproliferative activity. In conclusion, the inhibition of allergic and anaphylactoid reactions by picumast dihydrochloride can be attributed to a combined inhibition of liberation and action of histamine and other mediators.

Metabolism of picumast after administration of picumast dihydrochloride and antiallergic activity of the main metabolites.

The present experiments were carried out to elucidate the chemical structure and the pharmacological activity of the main metabolites of picumast (3,4-dimethyl-7-[4-(4-chlorobenzyl)piperazine-1-yl]propoxycoumarin ). The metabolic pathways were identical in animals and man, but there were major quantitative differences. The fraction of the radioactivity in the plasma attributable to the parent compound 0.5 to 3 h after oral administration of picumast dihydrochloride was less than 15% in animals but 95% to 57% in man. Inhibition of the C3-zymosan-induced chemilumiescence of human leucocytes was taken as an indicator of the diminished liberation of mediators and inhibition of the histamine-induced contraction of isolated guinea-pig lung strips as an example for the antagonism of picumast dihydrochloride to mediators of allergic reactions. Stepwise oxidation of the 3-methyl substituent of the coumarin ring to the alcohol and the carbonic acid increased the histaminolytic potency, but decreased the inhibition of chemiluminescence. Another metabolite formed by cleavage of the piperazine-containing side chain was inactive in both tests.

Pharmacokinetics of picumast after administration of 14C-picumast dihydrochloride in dogs, rats, rabbits and monkeys.

In dogs, rats, monkeys and rabbits, picumast (3,4-dimethyl-7-[4-(4-chlorobenzyl)piperazine-1-yl]propoxycoumarin ) is eliminated from the plasma by metabolic clearance. Its main metabolic pathway is oxidation of the 3-methyl group of the coumarin ring. After oral administration, the parent compound accounted for less than 15% of the concentration of radioactivity in the plasma. In rats the hydroxylation product M2 was the main metabolite in the plasma; in the other species it was the carbonic acid M1. The hydroxylation of picumast was highly saturable, whereas further oxidation was independent of the dose in dogs and only slightly dose-dependent in rats. Picumast, M1 and M2 are pharmacologically active and potentially toxic. The sum of all three was defined as active compounds. The renal clearance of the active compounds, particularly of picumast, was very low. The terminal half-lives of the active compounds varied between 11 h in rats and 26 h in monkeys. The low plasma concentrations of other metabolites are at least partly due to their renal clearance. In dogs the bioavailability of the parent compound was 14%, the absorption of radioactivity 68%. Of radioactivity injected intravenously 54.8% was recovered from the faeces, 21.8% from the urine. The minimum toxic plasma concentrations of the active compounds were calculated from the minimum toxic dose (MTD) found in chronic or reproduction toxicity studies and the ratio Cl/f of total body clearance/bioavailability determined in the present investigations. The results showed that the differences between the MTDs in dogs and rats and on administration in rats by gavage or in the diet are largely due to differences in total body clearance and bioavailability.

Pharmacokinetics of isosorbide dinitrate and isosorbide-5-mononitrate.

Short-acting nitrates like glyceryl trinitrate are most suitable for interrupting attacks of angina pectoris, long-acting nitrates for their prophylaxis. A salient feature of drugs used in prophylaxis is a long duration of action. Among many organic nitrates developed for this purpose, ISDN became the most prominent. ISDN is metabolized to isosorbide-2-mononitrate (IS-2-MN) and isosorbide-5-mononitrate (IS-5-MN) which are pharmacologically active. Since denitration is practically the only way of elimination, the denitration rate of the compounds is proportional to their total body clearance, which is 3.2 l/min for ISDN, 0.371 l/min for IS-2-MN and 0.124 l/min for IS-5-MN. Their terminal elimination half-life is 63, 108 and 264 min respectively. These figures are the weighted means from studies with intravenous administration. Several authors determined the AUCs of ISDN and its mononitrates after administration of ISDN. From the AUCs and the respective total body clearances, the amounts of ISDN were calculated which enter the systemic circulation intact, and those of the mononitrates formed by denitration of ISDN. After intravenous administration of ISDN, 62% were metabolized to IS-5-MN, 24% to IS-2-MN. The remaining 14% must be eliminated by other routes. After oral administration as plain tablets, 26% of the ISDN enter the systemic circulation intact. Forty-seven percent of the dose are metabolized to IS-5-MN during absorption, 17% after absorption. The figures for IS-2-MN are 14% and 5%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Digitalis intoxication and treatment with digoxin antibody fragments in renal failure.

Severe digitalis intoxication today is preferentially treated by intravenous infusion of Fab fragments of digoxin antibodies (Digitalis Antidot BM). The kinetics of Fab fragments in the circulation are well known when kidney function is normal or slightly impaired. There are no data available, however, in complete renal failure. We observed a patient with life-threatening digitalis intoxication (serum digoxin, 3.7 ng/ml) and anuria, who was treated successfully by 160 mg Fab fragments i.v. Serum digoxin and Fab fragment concentrations could be followed for 229 h. The extrarenal clearance of Fab fragments was lower (5.6 ml/min) than in patients with normal kidney function (10.9 ml/min). This finding suggests that lower doses than usual might be sufficient for treating patients with severe digitalis intoxication and renal failure.

Animal experiments for estimating the radiation exposure of human subjects by radioactive drugs.

The radiation exposure of human subjects is extrapolated from the elimination rate of radioactivity from the plasma and a single determination of the tissue distribution of radioactivity in rats. With an interval of 3-4 half-lives between administration and determination, the radiation exposure of an organ is underestimated only if the elimination rate from the organ is 5.5-12.9 times lower than from the plasma. Determining the elimination rate from the relevant organs is recommendable only if the radiation exposure calculated for the commonly used dose of 100 microCi per volunteer approaches the official yearly limit.

Pharmacodynamics, pharmacokinetics and metabolism of digitoxin and derivatives in cats.

Derivatives of dihydro-digitoxin (DHD) were studied in the search for a glycoside with a primarily extrarenal clearance and a faster elimination rate than digitoxin. The positive inotropic doses of the derivatives of DHD were higher than those of digitoxin and digoxin. There was no significant difference in the therapeutic margin. After injection of 3H-digoxin in unaesthetized cats, no metabolites were found in the serum which did not bind with the antibody used for the RIA. After injection of 3H-digitoxin and its derivatives, the radioactivity was cleared from the serum at a much lower rate than the concentrations assayed by RIA. The metabolites which did not bind to the digitoxin antibody were hydrophilic and had a low protein binding. Digitoxin-bisdigitoxoside (Dt-2) determined by RIA rapidly disappeared from the serum. The radioactivity remaining after 24 h was eliminated with a half-life of 219 h. Ten min after injection of DHD the serum contained no unchanged DHD, but 36% digitoxin suggesting that the reduction of digitoxin to DHD is reversible and that the conversion of DHD to Dt-2 is the rate limiting step in the metabolism of digitoxin. The total body clearance of digitoxin, its metabolites and derivatives determined by RIA increased in the order DHD-oxime less than or equal to digitoxin less than DHD less than or equal to DHD-acetyloxime less than DHD-methyloxime. The clearance and the elimination rate of DHD-methyloxime were significantly higher than those of digitoxin (P = 0.05).

Kinetics of the Fab fragments of digoxin antibodies and of bound digoxin in patients with severe digoxin intoxication.

17 patients with severe digoxin intoxication were successfully treated with 320 to 480 mg Fab fragments of digoxin-specific IgG from sheep. The infusion period ranged between 0.5 and 7 h. Serum and urine concentrations of digoxin bound to Fab fragments, and in 11 cases unbound Fab fragments in serum, were determined during and after the infusion. The renal clearance of bound digoxin and therefore of the antibody was 13.6 ml/min. The median extrarenal clearance of the Fab fragments was 10.9 ml/min. The half-life of the serum concentrations starting at 12 h was 14.3 h, and the value was increased to 25.4 h when regression began at 24 h; the corresponding apparent distribution volumes were 25.9 and 541. These figures exceed the volume of the extracellular space and suggest intracellular penetration of the Fab fragments. The dosage of the antibody should be sufficiently high to bind digoxin in the most severe cases of poisoning. The maximum serum concentrations of bound antibody were 30 mg/l after 3 h and 20 mg/l after 5 h. A loading dose of 160 mg followed by an infusion of 0.5 mg/min was sufficient to absorb digoxin re-diffusing into the serum during the first 8 h. In some cases free digoxin reappeared in the serum 8-12 h after beginning the treatment. This might be prevented by infusing a further ampoule at a rate of 0.1 mg/min or less.

Increase in the cardiotonic action and in the therapeutic margin of digoxin by the adrenergic beta-stimulant doxaminol in cats.

The interaction between digoxin and the beta-sympathomimetic drug doxaminol was investigated in cats with acute heart failure induced by pentobarbital sodium. Doxaminol, 50 micrograms/kg X min, infused for 60 min caused a dose-dependent rise in dp/dtmax with little increase in heart rate. The maximum increase of 4.3 mHg/s was obtained after about 37 min. Digoxin, 10 micrograms/kg X min, and the combination of both drugs were infused until cardiac arrest. The maximum increase of dp/dtmax was observed after 29 min in both experiments; it was 5.7 mHg/s with digoxin alone and 7.3 mHg/s with the combination (p = 0.025). The combined infusion of epinephrine (0.3 micrograms/kg X min) plus digoxin (10 micrograms/kg X min) caused a maximal increase of dp/dtmax by 7.9 mHg/s. The cardiotoxic dose of digoxin was markedly reduced by epinephrine, not by doxaminol. The relevance of this difference to man cannot be assessed definitely because the ECG changes produced by digoxin in cats are different from those seen in man.

Optimizing the lymphocyte transformation test in whole blood. I. Optimum conditions for thymidine incorporation.

The correlation between mitogen concentration and H3-thymidine incorporation can be described mathematically by a sigmoid dose-response curve. Thymidine incorporation/lymphocyte (Ti/Ly) was calculated to facilitate comparison of results. It was highest at a blood dilution of 1:50, lower at 1:10 or 1:250. Ti/Ly obtained with optimum concentrations of PHA was higher than with ConA. Advantages of this optimized method for whole blood over Ficoll-separated mononuclear cells are the higher Ti/Ly, the smaller quantities of blood required and the lower experimental effort.

Optimizing the lymphocyte transformation test in whole blood. II. Kinetics of thymidine incorporation.

From the 2nd day of incubation on, the thymidine incorporation per incubated lymphocyte increased exponentially with time. The duration of the exponential growth phase was inversely correlated with the number of cells. Under optimum conditions the average time for the doubling of thymidine incorporation (Ti) was 15.7 h. Ti after 1 day of incubation was taken as an equivalent for the number of proliferating cells. It was estimated that less than 20% of the incubated lymphocytes are stimulated by PHA under optimum conditions. In Ficoll-separated mononuclear cells, the percentage of cells stimulated by PHA was lower than in whole blood; the proliferation rate was not decreased.

Explanation of the biologically implausible correlation between distribution volume and total body clearance in an open two-compartment model.

The steady-state distribution volume Vss of digoxin decreases with its total body clearance Cltot, which in turn depends on renal function. It is implausible biologically that renal function should influence tissue distribution. The mathematical reason for this discrepancy is the large volume of the central compartment V1 of of 110 l for digoxin obtained by describing the time course of the serum concentrations by an open two-compartment model. With V1 = 17.5 l, Vss is independent of renal function and the regularly observed decrease of V beta with Cltot is explained by the simplification inherent in the one-compartment model used for calculating V beta. A good correlation between kinetic rate constants and biologic data for the exchange of a drug between central and peripheral compartments can be expected only if the volume of the central compartment is close to that of the inulin space. A low volume of the central compartment can be obtained with a multi-compartment model.

Pharmacokinetics of metildigoxin and digoxin in geriatric patients with normal and elevated serum creatinine levels.

The pharmacokinetics of digoxin and metildigoxin were investigated in geriatric patients on maintenance treatment. Minimum serum glycoside concentrations were determined on 3 consecutive days, and the elimination rate over a withdrawal period of 4 to 6 days was studied. In patients with serum creatinine levels of less than or equal to 1.3 mg/dl, the oral standard dose D1) of digoxin necessary for a minimum serum concentration of 1.0ng/ml was 1.4 times higher than that of metildigoxin. There was no significant difference in the elimination rate of both glycosides. The pharmacokinetics of metildigoxin were further investigated in patients with elevated serum creatinine levels. The standard dose was best correlated with the creatinine clearance, calculated from the serum creatinine, age, weight and sex of the patients. The apparent volume of distribution of metildigoxin decreased with the drug's total body clearance.

Extrarenal clearance, distribution volume, and elimination rate of digoxin and metildigoxin in anuric patients.

The pharmacokinetics of 3H-labeled digoxin and metildigoxin were compared in six anuric patients. The following means +/- s.e.m. were obtained: extrarenal clearance of digoxin, 43.3 +/- 5.4 ml/min, of metildigoxin, 30.3 +/- 2.9 ml/min; distribution volume of digoxin, 315 +/- 29 1, of metildigoxin, 258 +/- 22 1; rate constant for elimination of digoxin, 0.0086 +/- 0.0013 h-1, of metildogixon, 0.0071 +/- 0.0007 h-1. The elimination rates correspond to half-lives of 80 h for digoxin and of 97 h for metildigoxin. From our investigations and published data a weighed mean of 47 ml/min was calculated for the extrarenal clearance of metildigoxin. This is not significantly different from the mean extrarenal clearance of 40 ml/min reported for digoxin. A total body clearance of 40 ml/min and a daily intravenous dose of 0.1 mg correspond to an average steady-state glycoside concentration of 1.74 ng/ml.

[Comparison of in vitro methods for the determination of the activity of fosfomycin with the efficacy determined in experimentally infected mice (author's transl)]. / Zur Methodik der Aktivitätsbestimmung von Fostomycin in vitro unter Berücksichtigung der Wirkung an der experimentell infizierten Maus.

Effective doses of fosfomycin against 17 strains of bacteria were determined in therapeutic experiments using infected mice. The peak serum levels obtained after administration of these doses were compared with the minimum inhibitory concentrations determined in vitro. Reasonable minimum inhibitory concentrations were obtained only with Mueller-Hinton agar containing glucose-6-phosphate: 1. Correlation of in vivo and in vitro efficacy is much better in comparison with the use of media without glucose-6-phosphate. 2. Minimum inhibitory concentrations below the levels obtained after therapeutic doses were found only in Mueller-Hinton agar containing glucose-6-phosphate. 3. Minimum inhibitory concentrations are better reproducible when determined on solid media than in broth.