Pharmacokinetics of incadronate, a new bisphosphonate, in healthy volunteers and patients with malignancy-associated hypercalcemia.

We investigated the pharmacokinetics of incadronate, a new bisphosphonate, after a 2-hour intravenous infusion to healthy volunteers and patients with malignancy-associated hypercalcemia. Following administration at 0.025-1.6 mg to healthy volunteers, peak plasma concentration of incadronate increased in a dose-proportional manner. Plasma concentration thereafter declined biexponentially with a half-life of 0.26-0.40 h (t1/2 alpha) and 1.58-1.98 h (t1/2 beta). AUC increased dose-proportionally, whereas distribution volume (Vdss), total body clearance (CLt), renal clearance (CLr) and nonrenal clearance (CLnr), corresponding to bone uptake clearance, changed little among doses, indicating the linear pharmacokinetics of the drug after intravenous administration. Within 24 h, 55.1-69.5% of the dose was excreted into urine as the unchanged drug, most in the first 6 h. CLr and CLnr accounted for about 60% and 40% of the CLt, respectively, suggesting that the pharmacokinetics of incadronate are affected by changes in these clearances. In patients, plasma concentration at 2 h increased dose-proportionally in the range of 2.5-10.0 mg. Urinary excretion of YM175 up to 24 h after dosing was as low as 10.5% of the dose, being 1/6 of those in volunteers. A positive correlation (r > 0.89) was observed between creatinine clearance and urinary incadronate excretion in all volunteers and patients, indicating that the reduction of urinary excretion in patients is due to the decrease in renal function accompanying hypercalcemia. Based on comparison of the dose-normalized plasma concentration, the plasma level at 2 h in patients was comparable with that in volunteers, whereas the level at 8 h was 3 times higher in patients, suggesting that elimination from plasma in patients is delayed due to decreased renal function. Nevertheless, the plasma concentration profile in patients was lower than that predicted from the decrease in CLr. This finding suggests that the increase in plasma concentration with decreasing renal excretion in hypercalcemic patients was compensated for by enhanced bone uptake of the drug.