Development of a physiologically based pharmacokinetic model for levetiracetam in patients with renal impairment to guide dose adjustment based on steady-state peak/trough concentrations

Xenobiotica. 2024 Feb 12:1-27. doi: 10.1080/00498254.2024.2317888. Online ahead of print.ABSTRACT1. Levetiracetam may cause acute renal failure and myoclonic encephalopathy at high plasma levels, particularly in patients with renal impairment. The aim of this study was to develop a physiologically based pharmacokinetic (PBPK) model to predict levetiracetam pharmacokinetics in Chinese adults with epilepsy and renal impairment and to define appropriate levetiracetam dosing regimen.2. PBPK models for healthy subjects and epilepsy patients with renal impairment were developed, validated and adapted. Furthermore, we predicted the steady-state trough and peak concentrations of levetiracetam in patients with renal impairment using the final PBPK model, thereby recommending appropriate levetiracetam dosing regimens for different renal function stages.3. The predicted maximum plasma concentration (Cmax), time to maximum concentration (Tmax), area under the plasma concentration-time curve (AUC) were in agreement (0.8 ≤ fold error ≤ 1.2) with the observed, and the fold error of the trough concentrations in end-stage renal disease (ESRD) was 0.77 - 1.22.4. The prediction simulations indicated that the recommended doses of 1000 mg, 750 mg, 500 mg and 500 mg twice daily for epilepsy patients with mild, moderate, severe renal impairment and ESRD, respectively, were sufficient to achieve the target plasma concentration of levetiracetam.PMID:38344757 | DOI:10.1080/00498254.2024.2317888
Source: Xenobiotica - Category: Research Authors: Source Type: research