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Document 0742
DOCN M9620742
TI Ganciclovir absolute bioavailability and steady-state pharmacokinetics
after oral administration of two 3000-mg/d dosing regimens in human
immunodeficiency virus- and cytomegalovirus-seropositive patients.
DT 9602
AU Anderson RD; Griffy KG; Jung D; Dorr A; Hulse JD; Smith RB; Novum, Inc.,
Pittsburgh, Pennsylvania, USA.
SO Clin Ther. 1995 May-Jun;17(3):425-32. Unique Identifier : AIDSLINE
MED/96070351
AB Oral ganciclovir has recently been approved for use in long-term
maintenance therapy in the treatment of cytomegalovirus (CMV) retinitis
in immunocompromised patients. Although oral ganciclovir at a dose of
3,000 mg/d is moderately less effective than intravenous (i.v.)
ganciclovir maintenance therapy (5 mg/kg as a 1-hour i.v. infusion every
24 hours), convenience and practicality make oral maintenance therapy
desirable. Two dosing regimens--1,000 mg three times daily (TID) and 500
mg every 3 hours (six times daily)--have been shown to be efficacious.
Eighteen human immunodeficiency virus- and CMV-seropositive patients
participated in a three-way, open-label, crossover study to evaluate the
steady-state pharmacokinetics and absolute bioavailability of the two
oral regimens compared with the i.v. regimen. Sixteen patients completed
the study and received ganciclovir as a single 5-mg/kg i.v. infusion
over 1 hour, 500 mg orally every 3 hours while awake (six times daily)
for 3 days, and 1,000 mg TID orally for 3 days. Blood samples were
obtained over a 24-hour period after the single i.v. dose and on day 3
of the oral dosing regimens. Mean peak serum concentrations were 8.27,
1.02, and 1.18 micrograms/mL for the i.v. and oral regimens,
respectively. Twenty-four-hour area under the curve (AUC) for the oral
regimens--500 mg every 3 hours and 1,000 mg TID--were 15.9 and 15.4
micrograms.h/mL, respectively, as compared with a total AUC of 22.1
micrograms.h/mL for the single i.v. dose. The absolute bioavailabilities
for the two oral regimens were 8.84% and 8.53%, respectively. The extent
of ganciclovir absorption, peak concentrations, and average
concentration at steady state were not statistically different between
the two oral regimens. The peak-to-trough concentration ratio
(Cmax:Cmin) was greater for the 1,000-mg TID regimen than for the
regimen of 500 mg every 3 hours (5.35 vs 3.81 [P < 0.01]). Both oral
regimens resulted in concentrations in the range of the concentration
that inhibits 50% of most human CMV isolates. Because both oral regimens
provide equivalent absorption, the 1,000-mg TID regimen may be preferred
for the convenience and potentially greater compliance associated with
fewer daily doses.
DE Administration, Oral Adult Antiviral Agents/ADMINISTRATION &
DOSAGE/*PHARMACOKINETICS Biological Availability Comparative Study
Cross-Over Studies Cytomegalovirus Infections/*METABOLISM Female
Ganciclovir/ADMINISTRATION & DOSAGE/*PHARMACOKINETICS Human HIV
Seropositivity/*METABOLISM Infusions, Intravenous Male CLINICAL TRIAL
JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).