Abstract
Carvedilol is a β1-, β1-, and α1-adrenoreceptor blocker indicated for treatment of hypertension and mild-tosevere congestive heart failure. The objective of this study was to develop and evaluate a single population model that describesS(−)-carvedilol pharmacokinetics from both the immediate-release (IR) and the new controlled-release dosage forms of the racemate. Carvedilol IR data (1270 measurements) were obtained from 2 open-label studies (50 mg/25 mg Q12 hours for 2 doses). Carvedilol CR data (2058 measurements) were obtained from an open-label, nonrandomized, dose-rising (10, 20, 40, and 80 mg), 4-period balanced crossover study. All data were simultaneously analyzed using NONMEM V. Leverage analysis and internal evaluations were conducted for the final model. A 2-compartment model with first-order absorption and elimination provided the best fit. The model included different absorption rates (KAs) for the CR and IR morning (IRAM) and evening (IRPM) doses; incorporating change-points at certain times. Estimates of KAs indicated that the absorption was slower at equivalent times and extended for CR relative to IR carvedilol. Oral clearance ofS(−)-carvedilol was 149 L/h. The IRPM and the CR doses had bioavailability (Frel) of 0.80 and 0.76, respectively, relative to the IRAM dose. The inter-subject variability in KAs was lower for the CR dosage form than the original IR dosage form. Estimation of interoccasion variability on KAs and Frel for the CR dosage form improved the fit. The model performed well in simulation and leverage analysis indicated its robustness. The model will be a useful tool for future simulation studies.
Keywords: Carvedilol, controlled-release, NONMEM, relative bioavailability, population analysis
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Footnotes
An erratum to this article is available at http://dx.doi.org/10.1007/BF02826252.
References
- 1.Ruffolo RR, Boyle DA, Venuti RP, Lukas MA. Preclinical and clinical pharmacology of carvedilol. J Hum Hypertens. 1993;7:S2–15. [PubMed] [Google Scholar]
- 2.Ruffolo RR, Gellai M, Hieble JP, Willette RN, Nichols AJ. The pharmacology of carvedilol. Eur J Clin Pharmacol. 1990;38:S82–S88. doi: 10.1007/BF01409471. [DOI] [PubMed] [Google Scholar]
- 3.van Zwieten PA. Pharmacodynamic profile of carvedilol. Cardiology. 1993;82:19–23. doi: 10.1159/000175939. [DOI] [PubMed] [Google Scholar]
- 4.Colucci WS, Packer M, Bristow MR, et al. Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure US Carvedilol Heart Failure Study Group. Circulation. 1996;94:2800–2806. doi: 10.1161/01.cir.94.11.2800. [DOI] [PubMed] [Google Scholar]
- 5.Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. US Carvedilol Heart Failure Study Group. N Engl J Med. 1996;334:1349–1355. doi: 10.1056/NEJM199605233342101. [DOI] [PubMed] [Google Scholar]
- 6.Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357:1385–1390. doi: 10.1016/S0140-6736(00)04560-8. [DOI] [PubMed] [Google Scholar]
- 7.Bartsch W, Sponer G, Strein K, et al. Pharmacological characteristics of the stereoisomers of carvedilol. Eur J Clin Pharmacol. 1990;38:S104–S107. doi: 10.1007/BF01409475. [DOI] [PubMed] [Google Scholar]
- 8.Ruffolo RR, Boyle DA, Venuti RP, Lukas M. Carvedilol (Kedrex®): a novel multiple action cardiovascular agent. Drugs Today. 1991;27:465–492. [Google Scholar]
- 9.Neugebauer G, Akpan W, Kaufmann B, Reiff K. Stereoselective disposition of carvedilol in man after intravenous and oral administration of the racemic compound. Eur J Clin Pharmacol. 1990;38:S108–S111. doi: 10.1007/BF01409476. [DOI] [PubMed] [Google Scholar]
- 10.Zhou HH, Wood AJ. Stereoselective disposition of carvedilol is determined by CYP2D6. Clin Pharmacol Ther. 1995;57:518–524. doi: 10.1016/0009-9236(95)90036-5. [DOI] [PubMed] [Google Scholar]
- 11.Tenero DM, Henderson LS, Baidoo CA, et al. Pharmacokinetic properties of a new controlled-release formulation of carvedilol. Am J Cardiol. 2006;98:5–16. doi: 10.1016/j.amjcard.2006.07.014. [DOI] [PubMed] [Google Scholar]
- 12.Packer M, Lukas MA, Tenero DM, Baidoo CA, Greenberg BH. Pharmacokinetic profile of controlled-release carvedilol in patients with left ventricular dysfunction associated with chronic heart failure or after myocardial infarction. Am J Cardiol. 2006;98:39–45. doi: 10.1016/j.amjcard.2006.07.018. [DOI] [PubMed] [Google Scholar]
- 13.Weber MA, Sica DA, Tarka EA, Iyengar M, Fleck R, Bakris GL. Controlled-release carvedilol in the treatment of essential hypertension. Am J Cardiol. 2006;98:32–38. doi: 10.1016/j.amjcard.2006.07.017. [DOI] [PubMed] [Google Scholar]
- 14.Yang E, Wang S, Kratz J, Cyronak MJ. Stereoselective analysis of carvedilol in human plasma using HPLC/MS/MS after chiral derivatization. J Pharm Biomed Anal. 2004;36:609–615. doi: 10.1016/j.jpba.2004.07.008. [DOI] [PubMed] [Google Scholar]
- 15.Karlsson MO, Sheiner LB. The importance of modeling interoccasion variability in population pharmacokinetic analyses. J Pharmacokinet Biopharm. 1993;21:735–750. doi: 10.1007/BF01113502. [DOI] [PubMed] [Google Scholar]
- 16.Karlsson MO, Jonsson EN, Wiltse CG, Wade JR. Assumption testing in population pharmacokinetic models illustrated with an analysis of moxonidine data from congestive heart failure patients. J Pharmacokinet Biopharm. 1998;26:207–246. doi: 10.1023/A:1020561807903. [DOI] [PubMed] [Google Scholar]
- 17.Sheiner LB, Ludden TM. Population pharmacokinetics/dynamics. Annu Rev Pharmacol Toxicol. 1992;32:185–209. doi: 10.1146/annurev.pa.32.040192.001153. [DOI] [PubMed] [Google Scholar]
- 18.Beal SL, Sheiner LB. NONMEM Users Guide., Part V. San Francisco, CA: Division of Clinical Pharmacology, University of California, San Francisco; 1979. [Google Scholar]
- 19.Park SI, Felipe CR, Pinheiro-Machado PG, Garcia R, Tedesco-Silva H, Medina-Pestana JO. Circadian and time-dependent variability in tacrolimus pharmacokinetics. Fundam Clin Pharmacol. 2007;21:191–197. doi: 10.1111/j.1472-8206.2007.00468.x. [DOI] [PubMed] [Google Scholar]
- 20.Aronson JK, Chappell MJ, Godfrey KR, Yew MK. Modelling circadian variation in the pharmacokinetics of non-steroidal anti-inflmmatory drugs. Eur J Clin Pharmacol. 1993;45:357–361. doi: 10.1007/BF00265955. [DOI] [PubMed] [Google Scholar]
- 21.Milanian I, Ghods AJ, Mahmoudian M, et al. Study of circadian variation of cyclosporine pharmacokinetics. Transplant Proc. 1997;29:2930–2931. doi: 10.1016/S0041-1345(97)00733-1. [DOI] [PubMed] [Google Scholar]
- 22.Vener KJ, Moore JG. Chronobiologic properties of the alimentary canal affecting xenobiotic absorption. Ann Rev Chronopharmacol. 1987;4:257–281. [Google Scholar]
- 23.De Mey C, Brendel E, Enterling D. Carvedilol increases the systemic bioavailability of oral digoxin. Br J Clin Pharmacol. 1990;29:486–490. doi: 10.1111/j.1365-2125.1990.tb03668.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Jonsson O, Behnam-Motlagh P, Persson M, Henriksson R, Grankvist K. Increase in doxorubicin cytotoxicity by carvedilol inhibition of P-glycoprotein activity. Biochem Pharmacol. 1999;58:1801–1806. doi: 10.1016/S0006-2952(99)00262-2. [DOI] [PubMed] [Google Scholar]
- 25.Kaijser M, Johnsson C, Zezina L, Backman U, Dimeny E, Fellstrom B. Elevation of cyclosporin A blood levels during carvedilol treatment in renal transplant patients. Clin Transplant. 1997;11:577–581. [PubMed] [Google Scholar]
- 26.Giessmann T, Modess C, Hecker U, et al. CYP2D6 genotype and induction of intestinal drug transporters by rifam pin predict presystemic clearance of carvedilol in healthy subjects. Clin Pharmacol Ther. 2004;75:213–222. doi: 10.1016/j.clpt.2003.10.004. [DOI] [PubMed] [Google Scholar]