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Population pharmacokinetic modelling of intravenous paracetamol in fit older people displays extensive unexplained variability

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Abstract
AIMS: Paracetamol is the analgesic most used by older people. The physiological changes occurring with ageing influence the pharmacokinetics (PK) of paracetamol and its variability. We performed a population PK-analysis to describe the PK of intravenous (IV) paracetamol in fit older people. Simulations were performed to illustrate target attainment and variability of paracetamol exposure following current dosing regimens (1000mg every 6 h, every 8 h) using steady-state concentration (Css-mean) of 10mg l–1 as target for effective analgesia. METHODS: A population PK-analysis, using NONMEM 7.2, was performed based on 601 concentrations of paracetamol from 30 fit older people (median age 77.3 years, range [61.8–88.5], body weight 79 kg [60–107]). All had received an IV paracetamol dose of 1000 mg (over 15 min) after elective knee surgery. RESULTS: A two-compartment PK-model best described the data. Volume of distribution of paracetamol increased exponentially with body weight. Clearance was not influenced by any covariate. Simulations of the standardized dosing regimens resulted in a Css of 9.2 mg l–1 and 7.2 mg l–1, for every 6 h and every 8 h respectively. Variability in paracetamol PK resulted in Css above 5.4 and 4.1 mg l–1, respectively, in 90% of the population and above 15.5 and 11.7, respectively, in 10% at these dosing regimens. CONCLUSIONS: The target concentration was achieved in the average patient with 1000 mg every 6 h, while every 8 h resulted in underdosing for the majority of the population. Furthermore, due to a large (unexplained) interindividual variability in paracetamol PK a relevant proportion of the fit older people remained either under- or over exposed.
Keywords
acetaminophen, aging, elderly, geriatric, pharmacokinetics, variability, ACETAMINOPHEN, MANAGEMENT, PLASMA, PAIN, METABOLITES, AGE

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Citation

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MLA
Mian, P. et al. “Population Pharmacokinetic Modelling of Intravenous Paracetamol in Fit Older People Displays Extensive Unexplained Variability.” British Journal of Clinical Pharmacology 85.1 (2019): 126–135. Print.
APA
Mian, P., van Esdonk, M. J., Olkkola, K. T., de Winter, B. C. M., Liukas, A., Spriet, I., Tibboel, D., et al. (2019). Population pharmacokinetic modelling of intravenous paracetamol in fit older people displays extensive unexplained variability. British Journal of Clinical Pharmacology, 85(1), 126–135.
Chicago author-date
Mian, P., M. J. van Esdonk, K. T. Olkkola, B. C. M. de Winter, A. Liukas, I. Spriet, D. Tibboel, Mirko Petrovic, B. C. P. Koch, and K. Allegaert. 2019. “Population Pharmacokinetic Modelling of Intravenous Paracetamol in Fit Older People Displays Extensive Unexplained Variability.” British Journal of Clinical Pharmacology 85 (1): 126–135.
Chicago author-date (all authors)
Mian, P., M. J. van Esdonk, K. T. Olkkola, B. C. M. de Winter, A. Liukas, I. Spriet, D. Tibboel, Mirko Petrovic, B. C. P. Koch, and K. Allegaert. 2019. “Population Pharmacokinetic Modelling of Intravenous Paracetamol in Fit Older People Displays Extensive Unexplained Variability.” British Journal of Clinical Pharmacology 85 (1): 126–135.
Vancouver
1.
Mian P, van Esdonk MJ, Olkkola KT, de Winter BCM, Liukas A, Spriet I, et al. Population pharmacokinetic modelling of intravenous paracetamol in fit older people displays extensive unexplained variability. British Journal of Clinical Pharmacology. Wiley; 2019;85(1):126–35.
IEEE
[1]
P. Mian et al., “Population pharmacokinetic modelling of intravenous paracetamol in fit older people displays extensive unexplained variability,” British Journal of Clinical Pharmacology, vol. 85, no. 1, pp. 126–135, 2019.
@article{8578676,
  abstract     = {AIMS: Paracetamol is the analgesic most used by older people. The physiological changes occurring with ageing influence the pharmacokinetics (PK) of paracetamol and its variability. We performed a population PK-analysis to describe the PK of intravenous (IV) paracetamol in fit older people. Simulations were performed to illustrate target attainment and variability of paracetamol exposure following current dosing regimens (1000mg every 6 h, every 8 h) using steady-state concentration (Css-mean) of 10mg l–1 as target for effective analgesia.
METHODS: A population PK-analysis, using NONMEM 7.2, was performed based on 601 concentrations of paracetamol from 30 fit older people (median age 77.3 years, range [61.8–88.5], body weight 79 kg [60–107]). All had received an IV paracetamol dose of 1000 mg (over 15 min) after elective knee surgery.
RESULTS: A two-compartment PK-model best described the data. Volume of distribution of paracetamol increased exponentially with body weight. Clearance was not influenced by any covariate. Simulations of the standardized dosing regimens resulted in a Css of 9.2 mg l–1 and 7.2 mg l–1, for every 6 h and every 8 h respectively. Variability in paracetamol PK resulted in Css above 5.4 and 4.1 mg l–1, respectively, in 90% of the population and above 15.5 and 11.7, respectively, in 10% at these dosing regimens.
CONCLUSIONS: The target concentration was achieved in the average patient with 1000 mg every 6 h, while every 8 h resulted in underdosing for the majority of the population. Furthermore, due to a large (unexplained) interindividual variability in paracetamol PK a relevant proportion of the fit older people remained either under- or over exposed.},
  author       = {Mian, P. and van Esdonk, M. J. and Olkkola, K. T. and de Winter, B. C. M. and Liukas, A. and Spriet, I. and Tibboel, D. and Petrovic, Mirko and Koch, B. C. P. and Allegaert, K.},
  issn         = {0306-5251},
  journal      = {British Journal of Clinical Pharmacology},
  keywords     = {acetaminophen,aging,elderly,geriatric,pharmacokinetics,variability,ACETAMINOPHEN,MANAGEMENT,PLASMA,PAIN,METABOLITES,AGE},
  language     = {eng},
  number       = {1},
  pages        = {126--135},
  publisher    = {Wiley},
  title        = {Population pharmacokinetic modelling of intravenous paracetamol in fit older people displays extensive unexplained variability},
  url          = {http://dx.doi.org/10.1111/bcp.13770},
  volume       = {85},
  year         = {2019},
}

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