Kovar Lukas, Weber Andreas, Zemlin Michael, Kohl Yvonne, Bals Robert, Meibohm Bernd, Selzer Dominik, Lehr Thorsten
Department of Clinical Pharmacy, Saarland University, 66123 Saarbrücken, Germany.
Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany.
Pharmaceutics. 2020 Sep 23;12(10):908. doi: 10.3390/pharmaceutics12100908.
Fentanyl is widely used for analgesia, sedation, and anesthesia both in adult and pediatric populations. Yet, only few pharmacokinetic studies of fentanyl in pediatrics exist as conducting clinical trials in this population is especially challenging. Physiologically-based pharmacokinetic (PBPK) modeling is a mechanistic approach to explore drug pharmacokinetics and allows extrapolation from adult to pediatric populations based on age-related physiological differences. The aim of this study was to develop a PBPK model of fentanyl and norfentanyl for both adult and pediatric populations. The adult PBPK model was established in PK-Sim using data from 16 clinical studies and was scaled to several pediatric subpopulations. ~93% of the predicted AUC values in adults and ~88% in pediatrics were within 2-fold of the corresponding value observed. The adult PBPK model predicted a fraction of fentanyl dose metabolized to norfentanyl of ~33% and a fraction excreted in urine of ~7%. In addition, the pediatric PBPK model was used to simulate differences in peak plasma concentrations after bolus injections and short infusions. The novel PBPK models could be helpful to further investigate fentanyl pharmacokinetics in both adult and pediatric populations.
芬太尼广泛用于成人和儿童的镇痛、镇静及麻醉。然而,由于在该人群中开展临床试验极具挑战性,目前关于芬太尼在儿科的药代动力学研究较少。基于生理的药代动力学(PBPK)建模是一种探索药物药代动力学的机制性方法,可根据年龄相关的生理差异从成人外推至儿科人群。本研究的目的是建立成人和儿科人群的芬太尼及去甲芬太尼PBPK模型。利用16项临床研究的数据在PK-Sim中建立了成人PBPK模型,并将其缩放到几个儿科亚组。成人预测的AUC值约93%、儿科约88%在相应观察值的2倍范围内。成人PBPK模型预测芬太尼剂量代谢为去甲芬太尼的比例约为33%,经尿液排泄的比例约为7%。此外,儿科PBPK模型用于模拟推注和短时间输注后血浆峰浓度的差异。该新型PBPK模型可能有助于进一步研究成人和儿科人群的芬太尼药代动力学。