3 1.3 Pharmacokinetic Variability
4 1.4 Pharmacokinetics Optimization in Drug Discovery
5 1.5 Pharmacodynamic Principles 1.5.1 Pharmacological Targets and Drug Action 1.5.2 Functional Adaptation Processes 1.5.3 Biomarkers, Surrogate Endpoints, and Clinical Endpoints Keywords References
1.1 INTRODUCTION
The dose and dosing frequency of a drug (dosage regimen), needed to maintain an efficacious concentration at the site of its pharmacological action, for a duration that is long enough to achieve the therapeutic objective, should be safe and convenient to the patient. To achieve this optimal exposure at the target site of pharmacological action in humans, the rate and extent of multiple processes like drug absorption from the site of administration into systemic circulation, tissue distribution, metabolism, and elimination (ADME) are optimized during lead optimization in drug discovery. Pharmacokinetics (PK) is the study of the fate of drug in the body, that determines its exposure/concentration at the target effect site, driven by ADME processes. The relationship of the exposure/concentration at the target effect site to the onset, intensity, and duration of drug action is determined by pharmacodynamics (PD). A well‐defined, quantitative relationship between drug concentrations in biological fluids and pharmacodynamic effect can support the selection of dose and dosing regimen for early clinical trials. This chapter is intended to provide a brief overview of PK and PD principles. The forthcoming chapters will draw heavily upon the concepts laid out in this chapter.
1.2 PHARMACOKINETIC PRINCIPLES
1.2.1 Routes of Drug Administration
Common routes of drug administration include per oral (PO), intramuscular (IM), subcutaneous (SC) intravenous (IV) bolus and infusion, and intrathecal (around the spinal cord). Other less common routes include buccal, sublingual, rectal, transdermal, inhalational, and topical. The oral route is the most preferred route, but it is not suitable for drugs that are not stable in the gut, like for example peptide and protein drugs.
1.2.2 Intravenous Bolus
Intravenous (IV) administration ensures rapid, complete drug availability for drugs that are not in the form of suspensions or oils, by bypassing absorption barriers. Drugs having poor oral bioavailability or causing unacceptable pain when administered intramuscularly or subcutaneously may be administered by this route. However, it is potentially hazardous, as the initial high drug concentration may elicit toxic effects. Therefore, the use of IV route is restricted to situations demanding a rapid onset of action as in anesthesia, emergency medicine etc. or, when the patient is persistently vomiting, is unconscious or is too young to safely swallow solid forms of medication. Controlled drug administration through IV infusions offers one way to mitigate the risk of toxicity, as the infusion may be halted in the unexpected event of adverse effects during administration. Apart from causing severe pain, intra‐arterial administration is associated with the risk of dangerous pressure buildup in the muscles leading to decreased blood flow and consequently to nerve and muscle damage. Intra‐arterial injections are therefore reserved to situations in which localizations to specific tissues are desired.
1.2.2.1 Zero‐ and First‐Order Kinetics
Drug elimination from the body may follow zero or first‐order kinetics (Figure 1.1). In zero‐order kinetics, a constant amount of the drug is eliminated in a certain time (e.g., 20 mg per hour). In first‐order processes, a constant proportion of the drug is eliminated in a certain time (e.g., 20% per hour). Though relatively rare, zero‐order kinetics may be encountered in intravenous infusions as well as in elimination of some drugs (e.g. ethanol) but will not be further elaborated here.
The temporal changes in the drug concentrations following an IV bolus injection of 50 mg of a drug with first‐order kinetics are depicted in Figure 1.2. The slope and area under the curve (AUC) are the two parameters that can be extracted from the concentration‐time profile as shown in the semilogarithmic and linear plots respectively. Other useful pharmacokinetic parameters may be derived from these two parameters, as will become evident from the mathematical derivations below.
1.2.2.2 Clearance, Volume of Distribution, Half‐life, and AUC
The first‐order rate equation depicting the rate of change of drug concentrations in the blood (C) is given by
Figure 1.1. Temporal changes in drug concentrations for (a) zero‐order and (b) first‐order kinetics.
Figure 1.2. Linear (a) and semilogarithmic (b) plots of drug concentrations vs. time. Area under the curve (AUC) and slope are the two parameters that can be obtained from the plot. C2 and C1 are drug concentrations at times t2 and t1 respectively. kel, first‐order elimination rate constant; CL, is the total drug clearance; and V, volume of distribution.
where A is the amount of drug in the body at any time, t, kel is the first‐order