The Role of Cytochrome P450 3A Inducers and Inhibitors in the Metabolism and the Effects of Oxycodone

Oxycodone is an opioid used in the treatment of moderate or severe pain. It is principally metabolized in the liver by cytochrome P450 3A (CYP3A) enzymes whereas approximately 10% is metabolized by CYP2D6. Little is known about the interactions between oxycodone and other drugs, herbals and nutritional substances. In this work the effects of CYP3A inducers rifampicin and St. John’s wort and CYP3A inhibitors voriconazole, grapefruit juice, ritonavir and lopinavir/ritonavir were investigated on the pharmacokinetics and pharmacodynamics of oxycodone. All studies were randomized, balanced, placebo-controlled crossover clinical studies in healthy volunteers. The plasma concentrations of oxycodone and its metabolites were determined for 48 hours and pharmacodynamic parameters were recorded for 12 hours in each study. Pharmacokinetic parameters were calculated by noncompartmental methods. Rifampicin decreased the plasma concentrations, analgesic effects, and oral bioavailability of oral oxycodone. St. John’s wort reduced the concentrations of oxycodone and diminished the self-reported drug effect. Voriconazole increased the exposure to oral oxycodone by 3.6-fold whereas grapefruit juice, which inhibits predominantly the intestinal CYP3A, elevated the mean concentrations of oxycodone by 1.7-fold. Ritonavir and lopinavir/ritonavir increased the mean AUC of oxycodone by 3.0- and 2.6-fold, respectively, and prolonged its elimination half-life. In spite of increased oxycodone plasma concentrations during concomitant administration of CYP3A inhibitors, the analgesic effects were not increased. These studies show that the induction or inhibition of CYP3A alters the pharmacokinetics and pharmacologic effects of oxycodone. The exposure to oxycodone decreased after induction and increased after inhibition of CYP3A. As a conclusion, the clinicians should avoid concomitant administration of CYP3A inducers or inhibitors and oral oxycodone. If this is not possible, they should be prepared to interactions leading to impaired analgesia after CYP3A inducers or increased adverse effects after CYP3A inhibitors and oral oxycodone.

Pas caart van de Oost zee. Detalji.

Amsterdam 1664

Pharmacokinetics of Oxycodone and Paracetamol in the Elderly. Clinical Pharmacokinetic Study on Orthopaedic Surgical Patients and Healthy Volunteers

The proportion of elderly people over 65 years of age in Finland is expected to grow to over 25% by the 2025. It has been estimated that elderly people today consume nearly 40% of all drugs. Age brings about number of physiological changes that may affect the disposition, metabolism and excretion of drugs. The function of heart, lungs, liver and kidneys decreases even in healthy people, as they get older. The proportion of total body water decreases and the relative fat percentage increases. Also several other factors such as concurrent diseases, concomitant medication and nutritional factors have an effect on drug therapy in elderly. Age increases the risk of adverse drug reactions, which most often are dose-dependent. Despite all this there are not enough studies involving the elderly people and the elderly are most often excluded from clinical trials. Oxycodone is a strong opioid analgesic, which is used to treat moderate or severe pain. Paracetamol is a widely used nonopioid analgesic, which has become popular in the treatment of pain in many patient groups. In this series of studies the pharmacokinetics of oral and intravenous oxicodone as well as intravenous paracetamol in the elderly and young adult patients were investigated. Also a study investigating the interaction of oral antibiotic clarityhromycin, a known cytochrome P450 (CYP) 3A4 inhibitor, with oxycodone pharmacokinetics and pharmacodynamics in elderly and young healthy volunteers was carried out. The pharmacokinetics of oxycodone showed a clear age depency. Patients over 70 years had 50-80% higher mean exposure to oral oxycodone and a twofold greater plasma concentration than young adults 12 h after ingestion of the drug. Elderly patients had 40-80% greater exposure to intravenous oxycodone and patients over 80 years had over twofold greater plasma concentrations 8 h post dose than the young adults. The elderly patients had also greater exposure to intra venous paracetamol compared to young adults. Clarithromycin increased the exposure to oral oxycodone in both young and elderly volunteers. The elderly had marked interindividual variation in the pharmacokinetics and pharmacodynamics when clarithromycin was given concomitantly with oxycodone. Because the pharmacokinetics of oxycodone and intravenous paracetamol depend on the age of the subject, it is important to titrate the analgesic dose individually in the elderly.

Pikornavirusten käyttö geenivektoreina ja syöpäterapiassa sekä Coxsackievirus A7 -isolaattien sekvenssianalyysi

Kirjallisessa osassa tarkasteltiin pikornavirusten käyttöä geenivektoreina ja syöpäterapiassa. Pikornavirukset ovat positiivissäikeisiä RNA-viruksia, ja niiden genomi koostuu rakenteellisista kuoriproteiineista VP1-VP4 sekä ei-rakenteellisista proteiineista 2A-2C ja 3A-3D. Geenivektoritutkimukset ovat keskittyneet erilaisten inserttien kloonaamiseen virusten VP1-VP4-alueelle ja genomin 5'-päähän sekä näiden muutosten vaikutusten seuraamiseen virusten elinkierrossa solu- ja hiirimalleissa. Geenivektoreina on parhaiten toimineet coxsackievirukset B3, B4 ja A9 sekä mengo- ja poliovirus. Niitä on käytetty hiirissä mm. neuronien motorisen BDNF-reseptorin ilmentämiseen sekä hiiren interleukiini-10:n tuottamiseen selkäydinkanavan vaurioiden korjaamiseksi. Syöpäterapiatutkimuksissa on saatu lupaavia tuloksia coxsackieviruksilla A21, A13, A15 ja A18 sekä echo-, Seneca Valley 001- ja EMCV-viruksilla. Viruksilla on saatu mm. rintasyövän pääkasvain ja metastasoituneet etäpesäkkeet häviämään sekä eturauhassyövän kasvaimia pienenemään. Seneca Valley 001 -virus on osoittautunut tehokkaaksi syöpiä vastaan, joilla on neuroendokriinisiä ominaisuuksia. Viruksen käyttämistä faasi 2:n kliinisiin kokeisiin ollaan parhaillaan suunnittelemassa pienisoluisen keuhkosyövän ja lasten neuroendokriinisen syövän kohdalla. Kokeellisessa osassa optimoitiin RT-PCR-menetelmä coxsackievirus A7:n (CV-A7) genomin tuottamiseksi PCR-reaktiolla (FL-PCR). FL-PCR:n optimointi tehtiin vektoreilla, joihin oli kloonattu CV-A7-USSR- (USSR-pcDNA3) ja CV-A7-Parkerisolaattien (Parker-TA) genomit. Menetelmää käytettiin myöhemmin muiden CV-A7- virusisolaattien (275/58, ET1080 ja SVK) tutkimiseen. Näistä isolaateista eristettiin virus-RNA, joka käännettiin cDNA:ksi RT-entsyymillä. PCR:ssä käytetyt, CV-A7- spesifiset koettimet oli suunniteltu aiemmin sekvensoidun CV-A7-sekvenssin (GenBank AY421765) pohjalta. Infektiivisen kloonin tuottamiseksi USSR-pcDNA3- ja Parker-TA-vektoreista tuotettiin PCR:n avulla (T7-PCR) virusgenomin sisältävä DNAjakso, jonka 5'-päähän muodostui alukkeiden avulla T7RNA-polymeraasipromoottori ja 3'-päähän polyA-häntä. Työssä myös sekvensoitiin ja analysoitiin CV-A7-virusisolaatit Parker, USSR, 275/58, ET1080 ja SVK sekä kloonattiin täyspitkiä virusgenomeja cDNA-muodossa mutaatiokokeita varten. FL-PCR:n optimointi onnistui, ja neljä viidestä CV-A7-isolaatista sekvensoitiin. Virusgenomien pituus vaihteli 7403–7405 nt:n välillä. CV-A7-ET1080, -Parker ja - USSR osoittautuivat yli 99 % ja CV-A7-275/58 82,6 % nt samankaltaisiksi koko genomin pituudelta AY421765:en suhteen. Yksittäisten geenien ja proteiinien osalta CV-A7-275/58 oli 75,8–90,4 % nt ja 93,7–98,8 % aa samankaltainen muiden suhteen. Simplot-analyysissä 3B-geenialue oli heterogeenisin. CV-A7-SVK-isolaatti osoittautui echovirus kolmeksi. Infektiivistä kloonia ei saatu tuotettua T7-PCR-tuotteista.

Forest contractors entrepreneurial skills development in Finland by Forest Expertise and Innovation Network : project in 2009 - 2013

Julkaisumaa: 578 NO NOR Norja

Facing the Hydra alone: three case studies

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Extending the Hydra Head to Create a Pluggable, Extensible Architecture: Diving into the Technology of Hydramata

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Packaging Content for Aggregated and Federated Repositories through APTrust

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Big Data Processing in the Cloud: a Hydra/Sufia Experience

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Issues with Fedora & Hydra, experiences from a research-data-driven implementation

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Ingest into the Digital Preservation Network: Standard Pipelines

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

ICEIRD 2014 : Developing University : SME Collaboration

Konferenssin nimi: ICEIRD 2014 : The 7th International Conference for Entrepreneurship, Innovation and Regional Development. 5–6 June 2014, Nicosia, Cyprus. Julkaisumaa: 196 CY CYP Kypros