Article

Intracellular Pharmacokinetics of Once versus Twice Daily Zidovudine and Lamivudine in Adolescents

Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.45). 11/2007; 51(10):3516-22. DOI: 10.1128/AAC.01626-06
Source: PubMed

ABSTRACT Zidovudine (ZDV) and lamivudine (3TC) metabolism to triphosphates (TP) is necessary for antiviral activity. The aims of this study were to compare ZDV-TP and 3TC-TP concentrations in adolescents receiving twice daily (BID) and once daily (QD) regimens and to determine the metabolite concentrations of ZDV and 3TC during chronic therapy on a QD regimen. Human immunodeficiency virus-infected patients (12 to 24 years) taking ZDV (600 mg/day) and 3TC (300 mg/day) as part of a highly active antiretroviral therapy regimen received QD and BID regimens of ZDV and 3TC for 7 to 14 days in a crossover design. Serial blood samples were obtained over 24 h on the QD regimen. Intracellular mono-, di-, and triphosphates for ZDV and 3TC were measured. The median ratio of BID/QD for ZDV-TP predose concentrations was 1.28 (95% confidence interval [CI] = 1.00 to 2.45) and for 3TC-TP was 1.12 (95% CI = 0.81 to 1.96). The typical population estimated half-lives (+/- the standard error of the mean) were 9.1 +/- 0.859 h for ZDV-TP and 17.7 +/- 2.8 h for 3TC-TP. Most patients had detectable levels of the TP of ZDV (24 of 27) and 3TC (24 of 25) 24 h after dosing, and half-lives on a QD regimen were similar to previously reported values when the drugs were given BID. Lower, but not significantly different, concentrations of ZDV-TP were demonstrated in the QD regimen compared to the BID regimen (P = 0.056). Although findings were similar between the BID and QD groups, the lower concentrations of ZDV and the number of patients below the level of detection after 24 h suggests that ZDV should continue to be administered BID.

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    • "It has been observed that the cellular amounts of zidovudine diphosphate (AZT-DP) and AZT-TP are significantly smaller than the corresponding AZT and AZT-MP levels (approximately 1:100) (Wattanagoon et al., 2000; Barry et al., 1996; Rodman et al., 1996; Aweeka et al., 2007; Toyoshima et al., 1991; Furman et al., 1986; Arnér et al., 1992; Flynn et al., 2007). The levels of di-and triphosphates in the rest of the body insignificantly influence the kinetics of AZT and AZT-MP (Chow et al., 1997). "
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