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Biomedical subjects

E Yukawa

Publications and source records attributed to E Yukawa.

At least 55 records · Page 3Linked to original sources

Cell cycle-dependent chronotoxicity of irinotecan hydrochloride in mice.

The mechanisms underlying the circadian rhythm of the toxicity induced by irinotecan hydrochloride (CPT-11; 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin) were investigated from the viewpoint of the sensitivity of living organisms and the pharmacokinetics of the drug. ICR male mice were housed under standardized light-dark cycle conditions (lights on at 0700, off at 1900) with food and water ad libitum. The loss of body weight after an intraperitoneal injection of CPT-11 (100 mg/kg) was more serious in the late dark and the early light and milder in the late light and the early dark. The CPT-11-induced leukopenia was more serious in the late dark and milder in the late light. The lower toxicity of CPT-11 was observed when DNA synthesis and type I DNA topoisomerase activity in bone marrow cells decreased and the higher toxicity was observed when these activities began to increase. There were circadian stage-dependent changes in the concentrations of CPT-11 and its major metabolite (SN-38; 7-ethyl-10-hydroxycamptothecin) in plasma. The higher concentrations of CPT-11 and SN-38 in plasma were observed when the level of CPT-11-induced toxicity increased. The present study suggests that the toxicity of CPT-11 is influenced by circadian rhythm-dependent processes.

Animals↗

Detection of carbamazepine drug interaction by multiple peak approach screening using routine clinical pharmacokinetic data.

Multiple peak approach screening was used to detect the effects of other antiepileptic drugs on the population estimates of relative clearance of carbamazepine. Routine clinical pharmacokinetic data (N = 1,010) collected from 466 patients receiving carbamazepine were analyzed according to a simple steady-state pharmacokinetic model with the use of NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data. NONMEM estimates indicated that carbamazepine clearance decreased nonlinearly with increasing total body weight (TBW) in the maturation process (over an age range of 5 months to 15 years) and increased nonlinearly with increasing daily dose (mg/kg) of carbamazepine. Concomitant administration of other antiepileptic drugs resulted in an increased in clearance of carbamazepine as follows: valproic acid alone (VPA), 7%; phenobarbital alone (PB), 16%; more than two antiepileptic drugs (POLY), 27%. Final regression model of relative clearance (Cl) for all data was: Cl (mL/hr/kg) = 64.9. TBW (kg)-0.336.DOSE (mg/kg/day)0.465 1.07VPA 1.16PB 1.27POLY.

Adolescent↗

Comparison of two binding equations for prediction of the concentration of unbound valproic acid in the serum of adult epileptic polytherapy patients.

Because binding of valproic acid to plasma proteins affects the efficacy of the drug in the treatment of epilepsy (only the unbound fraction of the drug is effective) we have compared two methods which use different binding parameters to predict the in-vivo concentration of unbound valproic acid in serum. The study was performed on 46 serum samples from 29 polytherapy adult patients with epilepsy. Mean prediction error, mean absolute prediction error and root mean squared error were calculated for each method; these values served as a measure of prediction bias and precision. The mean absolute prediction errors and root mean squared errors for the two methods were similar in magnitude (Method 1, mean absolute prediction error = 10.0 microM, root mean squared error = 15.0 microM; Method 2, mean absolute prediction error = 10.3 microM, root mean squared error = 13.5 microM). Method 2 had a general tendency to over-predict unbound valproic acid; both methods had a tendency to over-prediction for total concentrations above 500 microM. Method 1 had a tendency to under-prediction at total concentrations below 250 microM. Within the total concentration range of valproic acid investigated, Method 1 was superior to Method 2 for prediction of unbound serum valproic acid. Our approach using Method 1 may be useful for prediction of unbound serum valproic acid concentration in patients with total valproic acid concentrations ranging from 250 to 500 microM; Method 2 may be useful for patients with total valproic acid below 500 microM. Our results suggest that there is wide and unpredictable variability in valproic acid binding to serum proteins among study populations.

Adolescent↗

Optimisation of antiepileptic drug therapy. The importance of serum drug concentration monitoring.

The ability to measure the serum concentrations of antiepileptic drugs, and the widespread use of this procedure, has markedly improved the treatment given to patients with epilepsy during the past 3 decades. The monitoring of antiepileptic drug concentrations in serum is necessary for the optimal drug therapy of seizures, because the therapeutic and toxic effects of these drugs are better related to serum concentration than to administered dosage. Monitoring appeared to have a major impact on improving the effectiveness and safety of antiepileptic drug therapy. The age-related variability of pharmacokinetic parameters may also require the individualisation of therapy, with subsequent re-evaluation as the person grows older. Monitoring serum concentrations of antiepileptic drugs may help to optimise the dose. A drug concentration, however, can only be regarded as a guide around which to alter the dosage according to the patient's clinical condition. Serum drug concentration monitoring is particularly useful to ensure compliance and in helping to manage combinations of antiepileptic drugs that invariably interact. The addition or deletion of other antiepileptic drugs may change dosage requirements. Therefore, routine monitoring of antiepileptic drug serum concentrations would be extremely useful, especially in the paediatric population, and in patients who require associated antiepileptic medication.

Anticonvulsants↗

A feasibility study of the multiple-peak approach for pharmacokinetic screening: population-based investigation of valproic acid relative clearance using routine clinical pharmacokinetic data.

The multiple-peak approach was used to evaluate the effect of age, body mass, dose and gender on the population estimates of valproic acid relative clearance. Routine clinical pharmacokinetic data (n = 474) was collected from 250 patients receiving valproic acid and no other drug. The data was analysed according to a simple steady-state pharmacokinetic model using NONMEM, a computer program designed for population pharmacokinetic analysis allowing pooling of data. The final regression model for relative clearance (CL, mL kg-1 h-1) was: CL = 18.9 x body weight(-0.276) x daily dose(0.142) x gender where gender = 1 for males, 0.877 for females. NONMEM estimates suggested that the rate of valproic acid clearance decreased nonlinearly with increasing body weight in the maturation process, and increased nonlinearly with increasing valproic acid dose (mg kg-1 day-1). The clearance in females was about 11% less than in males. These estimates were similar to those detected from previous studies.

Adolescent↗

New and simple method for estimating metildigoxin dosing regimens by multiple trough screen analysis.

The pharmacokinetics of digitalis glycosides were studied using routine therapeutic drug monitoring data to evaluate the role of patient characteristics for estimating metildigoxin dosing regimens. The 232 serum glycoside concentration data at steady-state after repetitive oral administration in 144 hospitalized patients was analyzed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data. Pharmacokinetic analysis of digitalis glycosides was described using a simple steady-state pharmacokinetic model. The effect of a variety of developmental and demographic factors on glycoside clearance was investigated. NONMEM estimates indicated that this digitalis glycoside clearance was influenced by the demographic variables of age, total body weight, serum creatinine, gender, daily dose and the coadministration of spironolactone. An elderly patient was expected to have a lower rate of clearance than a young patient of equal body weight and serum creatinine. The interindividual variability in glycoside clearance was modelled with proportional error with an estimated coefficient of variation of 19.7% and the residual variability was 21.8% The dosing method based on glycoside clearance value obtained by NONMEM analysis allowed the prediction of the minimum steady-state glycoside concentration as a function of metildigoxin maintenance dose with acceptable error for therapeutic drug monitoring.

Adolescent↗

Lithium population pharmacokinetics from routine clinical data: role of patient characteristics for estimating dosing regimens.

Routine clinical pharmacokinetic data (n = 303) collected from 90 patients receiving lithium have been analyzed to evaluate the role of patient characteristics for estimating dosing regimens. The data were analyzed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data. The pharmacokinetic model of lithium was described using a one-compartment steady-state model. The effect of a variety of developmental and demographic factors on clearance was investigated. NONMEM estimates indicated that lithium clearance was influenced by the demographic variables of age, total body weight, and serum creatinine. The interindividual variability in lithium clearance was modeled with proportional error with an estimated coefficient of variation of 25.1%. The intraindividual variability, or residual error, was 14.3%. The dosing method based on clearance values obtained by NONMEM analysis allowed the prediction of the minimum steady-state lithium concentration as a function of maintenance dose with acceptable error for therapeutic drug monitoring.

Adolescent↗

Influence of age and co-medication on steady-state carbamazepine serum level-dose ratios in Japanese paediatric patients.

The effects of age and co-medication on steady-state carbamazepine (CBZ) level-dose (L/D) ratios were evaluated retrospectively in 370 paediatric patients. The CBZ L/D ratio increased significantly with age up to 15 years in patients on monotherapy (L/D = 0.051 x AGE + 0.334, n = 111, r = 0.593, P less than 0.001). Associated anti-epileptic therapy affected the CBZ L/D ratio, which was significantly reduced in patients on polytherapy as compared to patients on monotherapy. The study therefore suggests that routine monitoring of CBZ serum levels is extremely useful, especially in the paediatric age group, and in patients who require associated anti-epileptic medication.

Adolescent↗

Influence of age and co-medication on steady-state phenobarbital serum level-dose ratios in Japanese paediatric patients.

The effects of age and co-medication on steady-state phenobarbital (PB) level-dose (L/D) ratios were evaluated retrospectively in 539 paediatric patients. The PB L/D ratio increased significantly with age up to 15 years. Associated anti-epileptic therapy affected the PB L/D ratio, which was significantly increased in patients on polypharmacy as compared to patients on monopharmacy. Therefore, routine monitoring of PB serum levels is extremely useful, particularly in the paediatric age group, and in patients who require associated anti-epileptic medication.

Adolescent↗

Phenobarbitone population pharmacokinetics from routine clinical data: role of patient characteristics for estimating dosing regimens.

Routine clinical pharmacokinetic data collected from patients receiving phenobarbitone have been analysed to evaluate the role of patient characteristics for estimating dosing regimens. The data were analysed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data. The pharmacokinetic model of phenobarbitone was described using a one-compartment steady-state model. The effect of a variety of developmental and demographic factors on clearance was investigated. NONMEM estimates indicated a nonlinear function of total body weight as the optimum adjustment of phenobarbitone clearance. Concomitant administration of phenobarbitone and other antiepileptic drugs showed a decrease of phenobarbitone clearance in young children. The dosing method based on clearance values obtained by NONMEM analysis allowed the prediction of the steady-state concentration as a function of maintenance dose with acceptable error for therapeutic drug monitoring.

Adolescent↗

Digoxin population pharmacokinetics from routine clinical data: role of patient characteristics for estimating dosing regimens.

Routine clinical pharmacokinetic data collected from patients receiving digoxin have been analysed to evaluate the role of patient characteristics for estimating dosing regimens. The data were analysed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data. The pharmacokinetic model of digoxin was described using a one-compartment steady-state model. The effect of a variety of developmental and demographic factors on clearance was investigated. NONMEM estimates indicate that digoxin clearance was influenced by the demographic variables of age, total body weight, serum creatinine and sex. The interindividual variability in digoxin clearance was modelled with additive error with an estimated standard deviation of 46.15 L day-1 and the intraindividual variability, or residual error was 0.209 ng mL-1. The dosing method based on clearance values obtained by NONMEM analysis allowed the prediction of the steady-state concentration as a function of maintenance dose with acceptable error for therapeutic drug monitoring.

Aged↗

[Evaluation of the effect of proton pump inhibitors on stomal ulcer].

Four reports on proton pump inhibitors related to the clinical effects on stomal ulcer were reviewed. Two reports were on omeprazole and the other two on lansoprazole, carried out in the pre-marketing stage. They are compared with two reports on H2-receptor antagonists (famotidine and ranitidine), which were also done in the pre-marketing stage. It appears that the proton pump inhibitors bring more rapid ulcer healing than H2-receptor antagonists without severe side effects, and there seems to be no difference in clinical effect between omeprazole and lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗

Influence of age and concurrent medication on steady-state valproic acid serum level-dose ratios in Japanese paediatric patients.

The effects of age and co-medication on steady-state valproic acid (VPA) level/dose (L/D) ratios were evaluated retrospectively in 382 paediatric patients. The VPA L/D ratio increased significantly with age up to 15 years of age in patients on monotherapy (L/D = 0.149 x AGE + 2.708, n = 192, r = 0.549, P less than 0.001). In patients taking three or more anti-epileptic drugs, including VPA, there was no such effect. Associated anti-epileptic therapy affected the VPA L/D ratio, which was significantly reduced in patients on polytherapy as compared to patients on monotherapy. Therefore, routine monitoring of VPA serum levels would be extremely useful, especially in the paediatric age group, and in patients who require associated anti-epileptic medication.

Adolescent↗

One-point feedback control method for phenytoin dosage adjustment.

Routine clinical pharmacokinetic data collected from patients receiving phenytoin have been analysed to propose a new and simple equation to aid the dosage adjustment of this drug. The data were analysed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data. The rate equation for the elimination of phenytoin can be written as Do = kCssn, which fits the steady-state serum concentration (Css) and daily dose data (Do). The parameter n is the kinetic order and the parameter k is an arbitrary rate constant. From the above equation, D2 = D1C1 -nC2n can be derived, which forms the basis of predicting the dosage, D2, to obtain a desired Css, C2, using one initial Css, C1, obtained with an initial dose, D1, and using a population value of n. The value of n for phenytoin was estimated to be 0.312 in this study. The predictive performance of this equation was compared with the Richens and Dunlop nomogram and Bayesian feedback method using two or more steady-state concentration/dose pairs from each of 78 outpatients. This equation allowed the prediction of a dose needed to produce a desired steady-state concentration with errors comparable with the Bayesian feedback method for therapeutic drug monitoring.

Adolescent↗

Therapeutic drug monitoring services at Kyushu University Hospital in Japan.

Quantitative evaluation of the therapeutic drug monitoring services (TDMS) provided in Kyushu University Hospital from August 1981 to April 1989 was performed. Since 1982, the annual number of assay requests was about 4300-4400, but the annual number of clinical pharmacokinetic consultation services (CPCS) showed a tendency to increase. Antiepileptics were the drugs for which CPCS were most often performed (26.3 percent of the population given drugs for which TDMS was available); digoxin, lithium, and theophylline followed. Preparation of one consultation required 1.5-2.5 hours. Our TDMS team consists of eight members. In 1988, the average time per week spent for CPCS and TDMS was 8.2 and 11.3 hours per member, respectively. Thus, the number of pharmacists performing CPCS and TDMS was 1.2 and 1.7 full-time equivalents, respectively.

Drug Information Services↗

Population pharmacokinetics of phenytoin from routine clinical data in Japan: an update.

Routine clinical pharmacokinetic data collected from outpatients receiving phenytoin (PHT) were reanalyzed to estimate population pharmacokinetic parameters. There were 756 steady-state PHT concentrations and associated dosage rates (mg/d) from 334 outpatients. The data were analysed using nonlinear mixed effects model (NONMEM), a computer program designed for population pharmacokinetic analysis that allows pooling of data from many individuals. The influence of weight, co-anticonvulsants on the maximum elimination rate (Vm) and age, co-anticonvulsants on the Michaelis-Menten constant (Km) and the influence of dosage form on the bioavailability (F) of PHT were investigated. The Vm and Km of a 60 kg adult outpatient treated with PHT alone were estimated to be 325 mg/d and 2.41 micrograms/ml, respectively, while for a same size individual taking PHT with co-anticonvulsants respective estimates were 351 mg/d and 3.18 micrograms/ml. The parameter of a power function of weight was estimated to adjust Vm for body size. The best function adjusts Vm in proportion to weight to the 0.737 power. The Km for patients less than 15 years old was 24.8% less than that of adults. Assuming the F of PHT to be 1 in patients prescribed a tablet, the F value in patients prescribed a powder was [1-exp(-9.92/Dij)]; Dij is the daily dose of PHT for the ith Cpss in the jth patients (mg/kg/d).

Adolescent↗

Phenytoin dosage adjustment method using population clearance.

Phenytoin (PHT) is a commonly used drug in children and adults, but it is often difficult to adjust the dosage to attain therapeutic drug concentrations due to the nonlinear nature of PHT metabolism. Therefore, many techniques have been proposed to aid dosage adjustment based on single-point PHT concentration determined at the steady state. We have derived a simple equation to predict PHT dosage in a patient in whom one steady-state serum concentration is known. This equation is based on a power relationship between PHT clearance (CL; 1/d) and PHT concentration determined at the steady state (Css; micrograms/ml). CL = D/Css = a.Css(b) (1) Dn = Do.Co-(b+1).Cd(b+1) (2) where D is the PHT dose (mg/d), Do is the original dose, Dn is the new dose, Co is the original Css, and Cd is the desired Css. We retrospectively investigated the values of a and b in a population of 40 outpatients who had three or more reliable measurements of Css in serum, measured while they were taking different daily doses. The a and b values were estimated to be 114.34 and -0.6786, respectively (n = 126; r = 0.871). Graves et al. have previously derived a similar equation based on an exponential relation between CL of PHT and Css in 59 patients (a = 133.03, b = -0.804). The predictive ability of this equation was compared with the results of Graves's method and the Bayesian feedback method using retrospective data from 70 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Population pharmacokinetics of phenytoin from routine clinical data in Japan.

Routine clinical pharmacokinetic data collected from out-patients who received phenytoin were analysed to estimate population pharmacokinetic parameters. There were 505 steady-state phenytoin concentrations and associated dosage rates (mg/day) from 220 out-patients. The data were analysed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data from many individuals. The influence of weight on the maximum elimination rate (Vm) and age on the Michaelis-Menten constant (Km) or the influence of dosage form on the bioavailability (F) of phenytoin were investigated. The Vm and Km of a 60-kg adult out-patient were estimated to be 369 mg/day and 3.67 mg/l, respectively. The parameter of a power function of weight was estimated to adjust Vm for body size. The best function adjusts Vm in proportion to weight to the 0.55 power. The Km for patients less than 15 years old was 16% less than that for adults. When the F of phenytoin is assumed to be 100% in the patients prescribed a tablet, the F value in the patients prescribed a powder was 89.5%.

Adolescent↗