Target-controlled infusion and population pharmacokinetics of landiolol hydrochloride in patients with peripheral arterial disease

Abstract

PurposeWe previously determined the pharmacokinetic (PK) parameters of landiolol in healthy male volunteers and gynecological patients. In this study, we determined the PK parameters of landiolol in patients with peripheral arterial disease.MethodsEight patients scheduled to undergo peripheral arterial surgery were enrolled in the study. After inducing anesthesia, landiolol hydrochloride was administered at target plasma concentrations of 500 and 1,000 ng/mL for 30 minutes each. A total of 112 data points of plasma concentration were collected from the patients and used for the population PK analysis. A population PK model was developed using a nonlinear mixed-effect modeling software program (NONMEM).ResultsThe patients had markedly decreased heart rates at 2 minutes after initiation of landiolol hydrochloride administration; however, systolic blood pressures were lower than the baseline values at only five time points. The concentration time course of landiolol was best described by a two-compartment model with lag time. The estimates of PK parameters were as follows: total body clearance, 30.7 mL/min/kg; distribution volume of the central compartment, 65.0 mL/kg; intercompartmental clearance, 48.3 mL/min/kg; distribution volume of the peripheral compartment, 54.4 mL/kg; and lag time, 0.633 minutes. The predictive performance of this model was better than that of the previous model.ConclusionThe PK parameters of landiolol were best described by a two-compartment model with lag time. Distribution volume of the central compartment and total body clearance of landiolol in patients with peripheral arterial disease were approximately 64% and 84% of those in healthy volunteers, respectively.

Model-based drug administration

“…Patient-controlled analgesia with TCI for hydromorphone infusion for postoperative pain therapy using a recently described new pharmacokinetic model [39] was found to offer satisfactory postoperative pain therapy with moderate side-effects [40 & ]. Outside the field of perioperative medicine, TCI of landiolol hydrochloride, a newly developed cardioselective, ultrashort acting b1-adrenergic receptor blocking agent, was found to be very effective in controlling heart rate (HR) and the pharmacokinetic parameters were best described by a two compartmental pharmacokinetic model [41,42].…”