
Abstract Purpose Adefovir (as dipivoxil) was selected as a probe drug in a previous transporter cocktail phenotyping study to assess renal organic anion transporter 1 (OAT1), with renal clearance (CLR) as the primary parameter describing renal elimination. An approximately 20% higher systemic exposure of adefovir was observed when combined with other cocktail components (metformin, sitagliptin, pitavastatin, and digoxin) compared to sole administration. The present evaluation applied a population pharmacokinetic (popPK) modeling approach to describe adefovir pharmacokinetics as a cocktail component in more detail. Methods Data from 24 healthy subjects were reanalyzed. After establishing a base model, covariate effects, including the impact of co-administered drugs, were assessed using forward inclusion then backward elimination. Results A one-compartment model with first-order absorption (including lag time) and a combination of nonlinear renal and linear nonrenal elimination best described the data. A significantly higher apparent bioavailability (73.6% vs. 59.0%) and a lower apparent absorption rate constant (2.29 h−1 vs. 5.18 h−1) were identified in the combined period compared to the sole administration period, while no difference was seen in renal elimination. The population estimate for the Michaelis-Menten constant (Km) of the nonlinear renal elimination was 170 nmol/L, exceeding the observed range of adefovir plasma maximum concentration, while the maximum rate (Vmax) of nonlinear renal elimination was 2.40 µmol/h at the median absolute estimated glomerular filtration rate of 105 mL/min. Conclusion The popPK modeling approach indicated that the co-administration primarily affected the apparent absorption and/or prodrug conversion of adefovir dipivoxil, resulting in the minor drug-drug interaction observed for adefovir as a victim. However, renal elimination remained unaffected. The high Km value suggests that assessing renal OAT1 activity by CLR has no relevant misspecification error with the cocktail doses used.
Male, Adult, Digoxin, Metformin/administration ; Digoxin/pharmacokinetics [MeSH] ; Models, Biological [MeSH] ; OAT1-mediated drug-drug interactions ; Male [MeSH] ; Organophosphonates/administration ; Nonlinear renal elimination ; Drug Interactions [MeSH] ; Organophosphonates/pharmacokinetics [MeSH] ; Phenotype [MeSH] ; Sitagliptin Phosphate/pharmacokinetics [MeSH] ; Adefovir ; Adenine/analogs ; Female [MeSH] ; Metformin/pharmacokinetics [MeSH] ; Adult [MeSH] ; Humans [MeSH] ; Middle Aged [MeSH] ; Adenine/pharmacokinetics [MeSH] ; Metformin/blood [MeSH] ; Organic Anion Transport Protein 1/metabolism [MeSH] ; Adenine/administration ; Population pharmacokinetics ; Digoxin/blood [MeSH] ; Research ; Young Adult [MeSH] ; Digoxin/administration ; Biological Availability [MeSH] ; Organic Anion Transport Protein 1/genetics [MeSH] ; Organophosphonates/blood [MeSH], Research, Adenine, Sitagliptin Phosphate, Organophosphonates, Biological Availability, Middle Aged, Models, Biological, Metformin, Young Adult, Organic Anion Transport Protein 1, Phenotype, Humans, Female, Drug Interactions
Male, Adult, Digoxin, Metformin/administration ; Digoxin/pharmacokinetics [MeSH] ; Models, Biological [MeSH] ; OAT1-mediated drug-drug interactions ; Male [MeSH] ; Organophosphonates/administration ; Nonlinear renal elimination ; Drug Interactions [MeSH] ; Organophosphonates/pharmacokinetics [MeSH] ; Phenotype [MeSH] ; Sitagliptin Phosphate/pharmacokinetics [MeSH] ; Adefovir ; Adenine/analogs ; Female [MeSH] ; Metformin/pharmacokinetics [MeSH] ; Adult [MeSH] ; Humans [MeSH] ; Middle Aged [MeSH] ; Adenine/pharmacokinetics [MeSH] ; Metformin/blood [MeSH] ; Organic Anion Transport Protein 1/metabolism [MeSH] ; Adenine/administration ; Population pharmacokinetics ; Digoxin/blood [MeSH] ; Research ; Young Adult [MeSH] ; Digoxin/administration ; Biological Availability [MeSH] ; Organic Anion Transport Protein 1/genetics [MeSH] ; Organophosphonates/blood [MeSH], Research, Adenine, Sitagliptin Phosphate, Organophosphonates, Biological Availability, Middle Aged, Models, Biological, Metformin, Young Adult, Organic Anion Transport Protein 1, Phenotype, Humans, Female, Drug Interactions
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