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British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1994 May;37(5):421–426. doi: 10.1111/j.1365-2125.1994.tb05708.x

Pharmacokinetics of zidovudine and dideoxyinosine alone and in combination in patients with the acquired immunodeficiency syndrome.

M Barry 1, J L Howe 1, S Ormesher 1, D J Back 1, A M Breckenridge 1, C Bergin 1, F Mulcahy 1, N Beeching 1, F Nye 1
PMCID: PMC1364896  PMID: 8054247

Abstract

1. Zidovudine (ZDV) has proved unsuccessful in controlling disease progression over extended periods of time in patients with AIDS. Combination of ZDV with another reverse transcriptase inhibitor, dideoxyinosine (ddI) may improve the duration of effectiveness of antiretroviral therapy. The aim of this study was to investigate the possibility of a pharmacokinetic drug interaction between ZDV and ddI. 2. The pharmacokinetics of ZDV and ddI were determined in eight patients with AIDS who were randomised to receive ZDV 250 mg orally, ddI 250 mg orally or a combination of ZDV 250 mg plus ddI 250 mg orally on 3 study days separated by 1 week. 3. The administration of ZDV did not significantly alter ddI pharmacokinetics. The mean AUC was 6.8 +/- 2.0 s.d. and 7.6 +/- 2.5 s.d. mumol l-1 h and oral clearance was 2766 +/- 686 and 2660 +/- 1297 ml min-1 in the presence and absence of ZDV, respectively. 4. In the presence of ddI the elimination half-life of ZDV was increased significantly by 18% from 1.1 +/- 0.3 to 1.3 +/- 0.3 h (P < 0.05) and the mean AUC increased significantly by 35% from 4.8 +/- 1.5 to 6.5 +/- 1.5 mumol l-1 h (P < 0.05). The clearance was decreased by 29% from 3518 +/- 1123 to 2505 +/- 575 ml min-1, but this difference was not significant. The renal clearance of ZDV was not altered by ddI. 5. Administration of ddI also resulted in a significant 22% increase in the AUC of GZDV, from 28.5 +/- 15.7 to 34.9 +/- 12.8 mumol l-1 h (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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Selected References

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  1. Balis F. M., Pizzo P. A., Murphy R. F., Eddy J., Jarosinski P. F., Falloon J., Broder S., Poplack D. G. The pharmacokinetics of zidovudine administered by continuous infusion in children. Ann Intern Med. 1989 Feb 15;110(4):279–285. doi: 10.7326/0003-4819-110-4-279. [DOI] [PubMed] [Google Scholar]
  2. Barry M., Back D., Ormesher S., Beeching N., Nye F. Metabolism of didanosine (ddI) by erythrocytes: pharmacokinetic implications. Br J Clin Pharmacol. 1993 Jul;36(1):87–88. doi: 10.1111/j.1365-2125.1993.tb05899.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barry M., Howe J. L., Back D. J., Swart A. M., Breckenridge A. M., Weller I. V., Beeching N., Nye F. Zidovudine pharmacokinetics in zidovudine-induced bone marrow toxicity. Br J Clin Pharmacol. 1994 Jan;37(1):7–12. doi: 10.1111/j.1365-2125.1994.tb04231.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barry M., Howe J., Back D., Breckenridge A., Brettle R., Mitchell R., Beeching N. J., Nye F. J. The effects of indomethacin and naproxen on zidovudine pharmacokinetics. Br J Clin Pharmacol. 1993 Jul;36(1):82–85. doi: 10.1111/j.1365-2125.1993.tb05898.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Broder S., Mitsuya H., Yarchoan R., Pavlakis G. N. NIH conference. Antiretroviral therapy in AIDS. Ann Intern Med. 1990 Oct 15;113(8):604–618. doi: 10.7326/0003-4819-113-8-604. [DOI] [PubMed] [Google Scholar]
  6. Collier A. C., Coombs R. W., Fischl M. A., Skolnik P. R., Northfelt D., Boutin P., Hooper C. J., Kaplan L. D., Volberding P. A., Davis L. G. Combination therapy with zidovudine and didanosine compared with zidovudine alone in HIV-1 infection. Ann Intern Med. 1993 Oct 15;119(8):786–793. doi: 10.7326/0003-4819-119-8-199310150-00003. [DOI] [PubMed] [Google Scholar]
  7. Fauci A. S. The human immunodeficiency virus: infectivity and mechanisms of pathogenesis. Science. 1988 Feb 5;239(4840):617–622. doi: 10.1126/science.3277274. [DOI] [PubMed] [Google Scholar]
  8. Fischl M. A., Richman D. D., Grieco M. H., Gottlieb M. S., Volberding P. A., Laskin O. L., Leedom J. M., Groopman J. E., Mildvan D., Schooley R. T. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med. 1987 Jul 23;317(4):185–191. doi: 10.1056/NEJM198707233170401. [DOI] [PubMed] [Google Scholar]
  9. Gallo J. M., Finco T. S., Swagler A. R., Mehta M. U., Viswanathan C. T., Qian M. Pharmacokinetic evaluation of drug interactions with anti-HIV drugs, II: Effect of 2',3'-dideoxyinosine (ddI) on zidovudine kinetics in monkeys. AIDS Res Hum Retroviruses. 1992 Feb;8(2):277–283. doi: 10.1089/aid.1992.8.277. [DOI] [PubMed] [Google Scholar]
  10. Groopman J. E., Molina J. M. Nucleoside therapy for HIV infection--some answers, many questions. N Engl J Med. 1992 Aug 27;327(9):639–641. doi: 10.1056/NEJM199208273270912. [DOI] [PubMed] [Google Scholar]
  11. Knupp C. A., Shyu W. C., Dolin R., Valentine F. T., McLaren C., Martin R. R., Pittman K. A., Barbhaiya R. H. Pharmacokinetics of didanosine in patients with acquired immunodeficiency syndrome or acquired immunodeficiency syndrome-related complex. Clin Pharmacol Ther. 1991 May;49(5):523–535. doi: 10.1038/clpt.1991.63. [DOI] [PubMed] [Google Scholar]
  12. McDougal J. S., Martin L. S., Cort S. P., Mozen M., Heldebrant C. M., Evatt B. L. Thermal inactivation of the acquired immunodeficiency syndrome virus, human T lymphotropic virus-III/lymphadenopathy-associated virus, with special reference to antihemophilic factor. J Clin Invest. 1985 Aug;76(2):875–877. doi: 10.1172/JCI112045. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Metroka C. E., McMechan M. F., Andrada R., Laubenstein L. J., Jacobus D. P. Failure of prophylaxis with dapsone in patients taking dideoxyinosine. N Engl J Med. 1991 Sep 5;325(10):737–737. doi: 10.1056/nejm199109053251014. [DOI] [PubMed] [Google Scholar]
  14. Morse G. D., Shelton M. J., O'Donnell A. M. Comparative pharmacokinetics of antiviral nucleoside analogues. Clin Pharmacokinet. 1993 Feb;24(2):101–123. doi: 10.2165/00003088-199324020-00002. [DOI] [PubMed] [Google Scholar]
  15. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  16. Richman D. D., Grimes J. M., Lagakos S. W. Effect of stage of disease and drug dose on zidovudine susceptibilities of isolates of human immunodeficiency virus. J Acquir Immune Defic Syndr. 1990;3(8):743–746. [PubMed] [Google Scholar]
  17. Sim S. M., Back D. J., Breckenridge A. M. The effect of various drugs on the glucuronidation of zidovudine (azidothymidine; AZT) by human liver microsomes. Br J Clin Pharmacol. 1991 Jul;32(1):17–21. doi: 10.1111/j.1365-2125.1991.tb05607.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. St Clair M. H., Martin J. L., Tudor-Williams G., Bach M. C., Vavro C. L., King D. M., Kellam P., Kemp S. D., Larder B. A. Resistance to ddI and sensitivity to AZT induced by a mutation in HIV-1 reverse transcriptase. Science. 1991 Sep 27;253(5027):1557–1559. doi: 10.1126/science.1716788. [DOI] [PubMed] [Google Scholar]
  19. Stagg M. P., Cretton E. M., Kidd L., Diasio R. B., Sommadossi J. P. Clinical pharmacokinetics of 3'-azido-3'-deoxythymidine (zidovudine) and catabolites with formation of a toxic catabolite, 3'-amino-3'-deoxythymidine. Clin Pharmacol Ther. 1992 Jun;51(6):668–676. doi: 10.1038/clpt.1992.79. [DOI] [PubMed] [Google Scholar]
  20. Wientjes M. G., Au J. L. Lack of pharmacokinetic interaction between intravenous 2',3'-dideoxyinosine and 3'-azido-3'-deoxythymidine in rats. Antimicrob Agents Chemother. 1992 Mar;36(3):665–668. doi: 10.1128/aac.36.3.665. [DOI] [PMC free article] [PubMed] [Google Scholar]

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