Document Detail


Monitoring glucocorticoid therapy: a pharmacokinetic approach.
MedLine Citation:
PMID:  2225699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although glucocorticoid therapy is essential for the treatment of severe inflammatory disorders, there is no systematic approach to patient variables that may affect availability of a steroid dose. After the development of a data base of pharmacokinetic parameters, we examined glucocorticoid pharmacokinetics in 54 patients between 2 and 70 years of age using 70 pharmacokinetic studies after administration of intravenous methylprednisolone (n = 25), oral methylprednisolone (n = 15), intravenous prednisolone (n = 18), and oral prednisone (n = 12). Eleven patients had unusually rapid methylprednisolone elimination (clearance, 565 to 837 ml/min/1.73 m2; population mean, [+/- SD] 380 +/- 100 ml/min/1.73 m2) without an identifiable cause. Incomplete absorption of methylprednisolone and prednisone was observed in three patients and one patient, respectively. Evaluation of glucocorticoid pharmacokinetics in children aged 1 year 8 months to 18 years demonstrated a significant inverse correlation (r = 0.88; p less than 0.001) between prednisolone clearance and age. It is therefore important to consider age in the interpretation of pharmacokinetic data. To simplify measurement of prednisolone clearance, a single-dose single-point method was developed. This was based on a highly significant relationship between the 6-hour postdose prednisolone concentration and prednisolone clearance (log prednisolone clearance = 2.66 + [6-hour postdose concentration] [-0.00167]; r2 = 0.96; p less than 0.0001). Evaluation of glucocorticoid pharmacokinetics in the clinical setting can be used to identify abnormalities in absorption, elimination, and patient compliance. This technique can be used to individualize glucocorticoid dosing regimens.
Authors:
M R Hill; S J Szefler; B D Ball; M Bartoszek; A M Brenner
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical pharmacology and therapeutics     Volume:  48     ISSN:  0009-9236     ISO Abbreviation:  Clin. Pharmacol. Ther.     Publication Date:  1990 Oct 
Date Detail:
Created Date:  1990-12-10     Completed Date:  1990-12-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372741     Medline TA:  Clin Pharmacol Ther     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  390-8     Citation Subset:  AIM; IM    
Affiliation:
Ira J. and Jacqueline, Neimark Laboratory of Clinical Pharmacology in Pediatrics, Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colo.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adolescent
Adult
Age Factors
Aged
Asthma / drug therapy*,  metabolism
Child
Child, Preschool
Glucocorticoids / administration & dosage,  pharmacokinetics*
Humans
Injections, Intravenous
Methylprednisolone / administration & dosage,  blood
Middle Aged
Monitoring, Physiologic
Prednisolone / administration & dosage,  blood
Prospective Studies
Chemical
Reg. No./Substance:
0/Glucocorticoids; 50-24-8/Prednisolone; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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