Key result
Morbidity state and concomitant use of amisulpride significantly altered venlafaxine pharmacokinetics, with morbidity decreasing venlafaxine clearance by 61.7% and amisulpride decreasing it by 39.2%.
Why the study?
What are the population pharmacokinetic characteristics of venlafaxine and O-desmethyl venlafaxine in healthy volunteers and psychiatric patients?
What are the population pharmacokinetic characteristics of venlafaxine and O-desmethyl venlafaxine in healthy volunteers and psychiatric patients?
Morbid state and concomitant amisulpride significantly affect the clearance of venlafaxine and its active metabolite, which may inform precision dosing in clinical practice.
Answers are grounded in this paper and cite their sources.
May inform venlafaxine dosing in depression; leaves open prospective validation before clinical use.
Introduction:Venlafaxine (VEN) is a widely used dual selective serotonin/noradrenaline reuptake inhibitor indicated for depression and anxiety. It undergoes first-pass metabolism to its active metabolite, O-desmethyl venlafaxine (ODV). The aim of the present study was to develop a joint population pharmacokinetic (PPK) model to characterize their pharmacokinetic characters simultaneously. Methods:Plasma concentrations with demographic and clinical data were derived from a bioequivalence study in 24 healthy subjects and a naturalistic TDM setting containing 127 psychiatric patients. A parent-metabolite PPK modeling was performed with NONMEM software using a non-linear mixed effect modeling approach. Goodness of fit plots and normalized prediction distribution error method were used for model validation. Results and conclusion:Concentrations of VEN and ODV were well described with a one-compartment model incorporating first-pass metabolism. The first-pass metabolism was modeled as a first-order conversion. The morbid state and concomitant amisulpride were identified as two significant covariates affecting the clearance of VEN and ODV, which may account for some of the variations in exposure. This model may contribute to the precision medication in clinical practice and may inspire other drugs with pre-system metabolism.
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Wang et al. (2022) studied Psychiatric disorders and healthy volunteers (n=151). Venlafaxine vs. Healthy status / No amisulpride was evaluated on Clearance of venlafaxine (CL/F) (p=<0.001). Morbidity state and concomitant use of amisulpride significantly altered venlafaxine pharmacokinetics, with morbidity decreasing venlafaxine clearance by 61.7% and amisulpride decreasing it by 39.2%.
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