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Population pharmacokinetics of lopinavir in combination with ritonavir in HIV-1-infected patients.

Abstract：

AIMS:To develop a population pharmacokinetic model for lopinavir in combination with ritonavir, in which the interaction between both drugs was characterized, and in which relationships between patient characteristics and pharmacokinetics were identified. METHODS:The pharmacokinetics of lopinavir in combination with ritonavir were described using NONMEM (version V, level 1.1). First, ritonavir data were fitted to a previously developed model to obtain individual Bayesian estimates of pharmacokinetic parameters. Hereafter, an integrated model for the description of the pharmacokinetics of lopinavir with ritonavir was designed. RESULTS:From 122 outpatients 748 lopinavir and 748 ritonavir plasma concentrations were available for analysis. The interaction between the drugs was described by a time-independent inverse relationship between the exposure to ritonavir over a dosing-interval and the apparent clearance (CL/F) of lopinavir. The model parameters volume of distribution and absorption rate constant were 61.6 l (95% prediction interval (PI) 22.4, 83.7) and 0.564 h(-1) (95% PI 0.208, 0.947), respectively. The model yielded a theoretical value for the CL/F of lopinavir without ritonavir of 14.8 l h(-1) (95%PI 12.1, 20.1), which translates to a value of 5.73 l h(-1) in the presence of ritonavir. The only factor with significant effect on the pharmacokinetics was concurrent use of non-nucleoside reverse transcriptase inhibitors (NNRTI), which increased the CL/F of lopinavir by 39% (P < 0.001). CONCLUSIONS:We have developed a model that has defined a time-independent inverse relationship between the exposure to ritonavir and the CL/F of lopinavir, and provided an adequate description of the pharmacokinetic parameters for the latter. Concomitant use of the NNRTIs efavirenz and nevirapine increased the CL/F of lopinavir.

journal_name

Br J Clin Pharmacol

journal_title

British journal of clinical pharmacology

authors

Crommentuyn KM,Kappelhoff BS,Mulder JW,Mairuhu AT,van Gorp EC,Meenhorst PL,Huitema AD,Beijnen JH

doi

10.1111/j.1365-2125.2005.02455.x

keywords:

subject

Has Abstract

pub_date

2005-10-01 00:00:00

pages

378-89

issue

eissn

0306-5251

issn

1365-2125

pii

BCP2455

journal_volume

pub_type

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Population pharmacokinetics of lopinavir in combination with ritonavir in HIV-1-infected patients.