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Brand Name(s) include: Lariam, Mephaquin, Mefliam

Disease: Malaria

Drug Class: Antimalarials

Date Updated: November 2021

The model at-a-glance

  Absorption Model

First-Order

  Volume of Distribution

Full PBPK (Method 2)

  Route of Elimination

CYP3A4 (fm =100); renal clearance (fe = 0.05)

  Perpetrator DDI

  • CYP2C9 Inhibitor
  • CYP2D6 Inhibitor
  • CYP3A4 Inhibitor

  Validation

  • Six clinical studies describing single and multiple dose exposure of mefloquine were used the verify the PBPK model.  Most of the studies (83%) were within 1.5-fold, with all simulations falling within 2-fold of the observed values. 
  • Two clinical DDI studies where mefloquine was the victim of a CYP3A4-mediated DDI were accurately recovered using the PBPK model.

  Limitations

  • Only profiles of plasma concentrations assessed, many studies report blood concentrations​
  • Mefloquine has significant uptake into erythrocytes and haematocrit levels typically not reported​
  • Could be important in disease population (Possible time-varying B/P for Malaria patients?)​
  • Cmax for doses > 750 mg over predicted ​
  • fa possibly decreases with dose, more data needed to fully determine the cause​
  • Most literature data extracted from graphs of mean data, difficulty determining accurate early time points due to poor image quality​
  • Verification needed for perpetrator DDI assessment as literature data is unavailable at this time

  Updates in V19

  • Updated in vitro­ data
    • fup: 0.016 -> 0.015
    • B:P ratio 1.7 -> 1.1 and subsequent re-calculation of CLint using the retrograde approach
  • Converted model to full PBPK distribution model with Vss predicted through Method 2
  • Sensitivity analysis of ka

 

Avibactam_V15R1_USFDA_20170810

http://onlinelibrary.wiley.com/doi/10.1002/cpt.750/full Avibactam compound file in healthy volunteers. Evaluation of the effect of renal impairment on PK of OAT substrates

Bergamottin_V19R1_AstraZeneca_20210423

CYP inhibitor found in grapefruit juice. AstraZeneca file.

Cefuroxime_V12R1_FDA_20150709

Table 1 of main paper and further discussion in supplemental file. IV only. Key feature is the use of mechanistic kidney model to simulate the effect of severe renal impairment and probenecid inhibition.

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