Pharmacometric Characterization of Dabigatran Hemodialysis

BACKGROUND: Hemodialysis has been shown to be a useful method of decreasing dabigatran plasma levels in situations that require rapid elimination of this thrombin inhibitor. However, there is currently no clinical recommendation for the accelerated/optimized elimination of dabigatran via hemodialysis (e.g., flow rates, filter type, duration of dialysis). OBJECTIVES: The primary objective of the present work was to characterize, via pharmacometric methods, the effects of different blood flow rates in hemodialysis on the pharmacokinetics of dabigatran, using data from a dedicated phase I dialysis study of end-stage renal disease (ESRD) patients. In addition, the effects of various clinically relevant hemodialysis settings were evaluated by simulation to assess their potential use in non-ESRD situations. METHODS: Seven patients with ESRD were investigated in an open-label, fixed-sequence, two-period comparison trial. A population pharmacokinetic model was developed to fit the data and then used for various simulations. Data analyses were performed using NONMEM(®), Berkeley Madonna, or SAS. RESULTS: The pharmacokinetics of dabigatran were best described by a two-compartment model with first-order absorption and a lag time. In addition to total body clearance in ESRD subjects, a first-order dialysis clearance was implemented which was greater than zero during hemodialysis and zero during the interdialytic periods. The relationship between the dialysis clearance and the blood flow rate was best described by the Michaels function. Simulations showed that varying clinically relevant dialysis settings such as filter properties or flow rates had only minor effects. Dialysis duration had the strongest impact on dabigatran plasma concentration. The observed geometric mean redistribution effect after hemodialysis was low (<16 %). The final model was successfully evaluated through the prediction of plasma concentrations from a case report undergoing dialysis. CONCLUSIONS: This analysis allowed the influences of various hemodialysis parameters on the dabigatran plasma concentration to be predicted in detail for the first time. Dialysis duration was identified as having the strongest impact on the reduction in dabigatran plasma concentration. The model developed here can potentially serve as a tool to provide guidance when considering the use of hemodialysis in patients who have received dabigatran

Electronic properties of two isomeric charge transfer [2.2]paracyclophanes

The emission spectra and the zero field splitting parameters of the two diastereomeric 4,7-dicyano-12,15-dimethoxy-[2.2] paracyclophanes 3 and 4 in comparison to the corresponding monomers 1 and 2 were investigated in order to study the orientation dependence of charge transfer (CT) interactions. The general results in glasses (PMMA) are: broad structureless emission bands with large spectral overlap between fluorescence and phosphorescence; strong reduction of the zero field splitting parameters D and D* by a factor of two for the pseudo-ortho isomer 3 and by a factor of four for the pseudo-geminal isomer 4 showing the strong effect of the geometrical orientation. In single crystals of the same phanes the zero field parameters were found to be further reduced to about one fifth of the value of the monomers which indicates, in accordance with the emission spectra, an additional intermolecular interaction between adjacent phanes

Transanular interaction in [2.2]phanes: models for dimers?

The emission spectra of pseudo-ortho 3 and pseudo-geminal-4,7,12,15-tetramethoxy[2.2]-paracyclophane 3 were measured in glass matrices at 1.3 K. Furthermore, the zero field splitting parameters D and E and the decay rate constants ki of the excited triplet state were studied by optical detection of magnetic resonance in zero field. The results were compared with the corresponding monomer 1,4-dimethyl-2,5-dimethoxybenzene

Transanular interaction in [2.2]phanes: [2.2](2,7)pyrenophane

The emission spectra of [2.2](2,7)pyrenophane and the zero field splitting parameters D and E of its excited triplet state were measured in glasses and in small single crystals at 1.3 K. The results are being compared with monomer pyrene and 2,7 dimethylpyrene in liquid and solid solutions as well as in single crystals

Spectroscopic properties of kekulene

Kekulene [1,2] is the first example of a new class of aromatic compounds in which the annelation of six membered rings leads to a cyclic system enclosing a cavity with hydrogen atoms

Electronic properties of kekulene

The fluorescence and phosphorescence of kekulene in a host matrix of polycrystalline tetrachlorobenzene are investigated, together with the triplet zero field splitting parameters |D| and |E| obtained by ODMR in zero field. The D value is also calculated within a semi-empirical &#960;-theory and compared with experiment. It could be shown that the triplet state energies of a number of different sites of kekulene in the host matrix and the zero field splitting parameters are related, in first order, by spin orbit interaction

Transannular interactions in [2.2] phanes as studied by luminescence and optical detection of magnetic resonance

Emission spectra of different types of [2.2] naphthalenophanes were measured at 1.25 K in glasses as well as in small single crystals. In addition, the D and E values of the excited triplet states were studied by optical detection of magnetic resonance in zero field and the results compared with the corresponding monomeres

Transannular interactions in [2.2] phanes as studied by magnetic resonance and optical spectra

The interaction of &#960;-electrons in [2.2] phanes was studied both experimentally and theoretically. The fluorescence and phosphorescence spectra were measured at liquid helium temperature; in addition, the zero field splitting parameters D and E were determined by ODMR in zero field and by ordinary ESR at X-band. The results for the phanes with two identical aromatic units can be summarized as follows: The rather small reduction of the D and E values of the order of 10% with respect to the monomers indicates, in agreement with the theoretical treatment given in part II, that the two unpaired electrons of the excited triplet state have a high probability to be at a given time in the same half of the molecule. While the fluorescence spectra show the typical behaviour of emission spectra of dimers or excimers, the phosphorescence spectra exhibit some remaining structure. This behaviour which indicates a somewhat weaker coupling among the triplet orbitals as compared to the singlet orbitals can also be understood on the basis of theoretical considerations. For a phane with two different aromatic units the behaviour is found to be more similar to the corresponding aromatic monomer with the lower excited states with some perturbation by the other part of the phase also in agreement with theoretical expectation

Factors associated with worse lung function in cystic fibrosis patients with persistent staphylococcus aureus

Background Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads. Methods Therefore, we conducted an observational prospective longitudinal multi-center study and assessed the association between lung function and S. aureus bacterial density in respiratory samples, co-infection with other CF-pathogens, nasal S. aureus carriage, clinical status, antibiotic therapy, IL-6- and IgG-levels against S. aureus virulence factors. Results 195 patients from 17 centers were followed; each patient had an average of 7 visits. Data were analyzed using descriptive statistics and generalized linear mixed models. Our main hypothesis was only supported for patients providing throat specimens indicating that patients with higher density experienced a steeper lung function decline (p<0.001). Patients with exacerbations (n = 60), S. aureus small-colony variants (SCVs, n = 84) and co-infection with Stenotrophomonas maltophilia (n = 44) had worse lung function (p = 0.0068; p = 0.0011; p = 0.0103). Patients with SCVs were older (p = 0.0066) and more often treated with trimethoprim/sulfamethoxazole (p = 0.0078). IL-6 levels positively correlated with decreased lung function (p<0.001), S. aureus density in sputa (p = 0.0016), SCVs (p = 0.0209), exacerbations (p = 0.0041) and co-infections with S. maltophilia (p = 0.0195) or A. fumigatus (p = 0.0496). Conclusions In CF-patients with chronic S. aureus cultures, independent risk factors for worse lung function are high bacterial density in throat cultures, exacerbations, elevated IL-6 levels, presence of S. aureus SCVs and co-infection with S. maltophilia