Bioavailability and population pharmacokinetics of voriconazole in lung transplant recipients

K. Han, B. Capitano, Robert Bies, B. A. Potoski, S. Husain, S. Gilbert, D. L. Paterson, K. McCurry, R. Venkataramanan

Research output: Contribution to journalArticle

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Abstract

This study was undertaken to characterize the pharmacokinetics and bioavailability of voriconazole in adult lung transplant patients during the early postoperative period, identify factors significantly associated with various pharmacokinetic parameters, and make recommendations for adequate dosing regimens. Thirteen lung transplant patients received two intravenous infusions (6 mg/kg, twice daily [b.i.d.]) immediately posttransplant followed by oral doses (200 mg, b.i.d.) for prophylaxis. Blood samples (9/interval) were collected during one intravenous and one oral dosing interval from each patient. Voriconazole plasma concentrations were measured by high-pressure liquid chromatography (HPLC). NONMEM was used to develop pharmacokinetic models, evaluate covariate relationships, and perform Monte Carlo simulations. There was a good correlation (R2 = 0.98) between the area under the concentration-time curve specific for the dose evaluated (AUC 0-∞) and trough concentrations. A two-compartment model adequately described the data. Population estimates of bioavailability, clearance, Vc, and Vp were 45.9%, 3.45 liters/h, 54.7 liters, and 143 liters. Patients with cystic fibrosis (CF) exhibited a significantly lower bioavailability (23.7%, n = 3) than non-CF patients (63.3%, n = 10). Bioavailability increased with postoperative time and reached steady levels in about 1 week. Vp increased with body weight. Bioavailability of voriconazole is substantially lower in lung transplant patients than non-transplant subjects but significantly increases with postoperative time. CF patients exhibit significantly lower bioavailability and exposure of voriconazole and therefore need higher doses. Intravenous administration of voriconazole during the first postoperative day followed by oral doses of 200 mg or 400 mg appeared to be the optimal dosing regimen. However, voriconazole levels should be monitored, and the dose should be individualized based on trough concentrations as a good measure of drug exposure.

Original languageEnglish
Pages (from-to)4424-4431
Number of pages8
JournalAntimicrobial Agents and Chemotherapy
Volume54
Issue number10
DOIs
StatePublished - Oct 2010

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Biological Availability
Pharmacokinetics
Lung
Population
Transplants
Cystic Fibrosis
Voriconazole
Transplant Recipients
Postoperative Period
Intravenous Infusions
Intravenous Administration
Area Under Curve
Fibrosis
High Pressure Liquid Chromatography
Body Weight
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology
  • Infectious Diseases

Cite this

Han, K., Capitano, B., Bies, R., Potoski, B. A., Husain, S., Gilbert, S., ... Venkataramanan, R. (2010). Bioavailability and population pharmacokinetics of voriconazole in lung transplant recipients. Antimicrobial Agents and Chemotherapy, 54(10), 4424-4431. https://doi.org/10.1128/AAC.00504-10

Bioavailability and population pharmacokinetics of voriconazole in lung transplant recipients. / Han, K.; Capitano, B.; Bies, Robert; Potoski, B. A.; Husain, S.; Gilbert, S.; Paterson, D. L.; McCurry, K.; Venkataramanan, R.

In: Antimicrobial Agents and Chemotherapy, Vol. 54, No. 10, 10.2010, p. 4424-4431.

Research output: Contribution to journalArticle

Han, K, Capitano, B, Bies, R, Potoski, BA, Husain, S, Gilbert, S, Paterson, DL, McCurry, K & Venkataramanan, R 2010, 'Bioavailability and population pharmacokinetics of voriconazole in lung transplant recipients', Antimicrobial Agents and Chemotherapy, vol. 54, no. 10, pp. 4424-4431. https://doi.org/10.1128/AAC.00504-10
Han, K. ; Capitano, B. ; Bies, Robert ; Potoski, B. A. ; Husain, S. ; Gilbert, S. ; Paterson, D. L. ; McCurry, K. ; Venkataramanan, R. / Bioavailability and population pharmacokinetics of voriconazole in lung transplant recipients. In: Antimicrobial Agents and Chemotherapy. 2010 ; Vol. 54, No. 10. pp. 4424-4431.
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