Pharmacokinetics of Gepirone in Subjects with Normal Renal Function and in Patients with Chronic Renal Dysfunction
作者:Peter Dogterom、Jan A.M. Huisman、Ryszard Gellert、Aalt Verhagen
DOI:10.2165/00044011-200222080-00003
日期:——
Objective: To compare the pharmacokinetic profiles of gepirone and its main metabolites, 1-(2-pyrimidinyl)-piperazine (1-PP) and the 3′-hydroxy derivative (3′-OH-gepirone) after a single oral dose of gepirone extended-release (gepirone-ER) in subjects with normal renal function and in patients with various levels of renal dysfunction. Design: Open-label, parallel-group, single oral dose pharmacokinetic study. Participants: 37 subjects, aged 35 to 65 years with normal renal function (n = 9) or mild (n = 9), moderate (n = 9) or severe (n = 10) renal impairment Methods: All subjects received a single oral dose of gepirone-ER (two 20mg tablets) under fasting conditions. Participants were matched with regard to age and body mass index. Serial blood samples were drawn over 96 hours to measure plasma concentrations of gepirone, 1-PP and 3′-OH-gepirone. Urine was collected to assess the excretion of gepirone and its metabolites. Results: The exposure [area under the plasma concentration-time curve (AUC), maximum plasma concentration (Cmax)] to gepirone, 1-PP and 3′-OH-gepirone increased with decreasing renal function. The AUC of gepirone and its metabolites was greatest in patients with the severest renal dysfunction. No difference was observed in the elimination half-life (t1/2) of gepirone, but the t1/2 of the metabolites was longer in patients with severe dysfunction than in those with normal renal function. Renal clearance of gepirone, 1-PP and 3′-OH-gepirone was higher in those with normal function than in patients with severe dysfunction. Adverse events (18) occurred more frequently only in subjects with severe renal impairment. Conclusions: Gepirone-ER was generally well tolerated among patients with varying degrees of renal impairment. Exposure to gepirone and its metabolites was increased by renal impairment, especially in subjects with severe dysfunction. Therefore, caution should be used when selecting the dose of gepirone in patients with severe renal impairment.
目标:比较正常肾功能受试者和不同程度肾功能障碍患者服用单剂量吉匹隆缓释剂(gepirone-ER)后,吉匹隆及其主要代谢产物1-(2-嘧啶基)-哌嗪(1-PP)和3'-羟基衍生物(3'-OH-gepirone)的药代动力学特征。
设计:开放标签、平行分组、单剂量药代动力学研究。
参与者:37名35-65岁受试者,包括肾功能正常组(n=9)、轻度(n=9)、中度(n=9)和重度(n=10)肾功能损害组。
方法:所有受试者空腹服用单剂量吉匹隆缓释剂(两片20mg片剂)。根据年龄和体重指数进行分组匹配。96小时内连续采集血样测定吉匹隆、1-PP和3'-OH-gepirone的血浆浓度。收集尿液评估吉匹隆及其代谢产物的排泄。
结果:随着肾功能下降,吉匹隆、1-PP和3'-OH-gepirone的暴露量(血浆浓度-时间曲线下面积AUC、最大血浆浓度Cmax)增加。重度肾功能障碍患者的AUC最大。吉匹隆的消除半衰期(t1/2)无差异,但重度肾功能障碍患者代谢产物的t1/2长于正常肾功能者。正常肾功能者的吉匹隆、1-PP和3'-OH-gepirone肾清除率高于重度肾功能障碍患者。不良事件(18例)仅在重度肾功能障碍受试者中更为常见。
结论:不同程度肾功能障碍患者对吉匹隆缓释剂的耐受性普遍良好。肾功能损害会增加吉匹隆及其代谢产物的暴露量,尤其是重度肾功能障碍患者。因此,对重度肾功能障碍患者选择吉匹隆剂量时应谨慎。