Endocrine effects and pharmacokinetic characteristics of a potent new gonadotropin-releasing hormone antagonist (Ganirelix) with minimal histamine-releasing properties: studies in postmenopausal women.

A potent and safe GnRH antagonist has been sought unsuccessfully for the last 2 decades. The recently developed GnRH antagonist RS-26306 or Ganirelix ([N-Ac-D-Nal(2)1,D-pClPhe2,D-Pal(3)3,D-hArg(Et2)6,L-++ +hArg(Et2)8,D-Ala10]GnRH ; Syntex Research, Palo Alto, CA), exhibited high antiovulatory potency and low histamine-releasing properties in preclinical studies. Therefore, we determined the extent to which single sc injections of three doses of RS-26306 (1, 3, and 6 mg) decreased serum concentrations of LH and FSH, the free alpha-subunit of LH/FSH/TSH, PRL, and testosterone in five healthy postmenopausal women. We also examined the pharmacokinetic characteristics of RS-26306 by quantifying serum levels of the drug by RIA. RS-26306 rapidly suppressed serum concentrations of LH, FSH, and free alpha-subunit. RS-26306 (6 mg) maximally decreased serum concentrations (mean +/- SEM) of LH, FSH, and free alpha-subunit by 70.1 +/- 3.6%, 42.3 +/- 2.5%, and 74.6 +/- 3.5%, respectively. RS-26306 also decreased serum testosterone, but not serum PRL, concentrations. RS-26306 concentrations reached peak serum levels at 1.2 +/- 0.3, 1.9 +/- 0.4, and 1.8 +/- 0.5 h, respectively, after 1-, 3-, and 6-mg sc injections. The mean serum half-life values based on the terminal portion of the disappearance curves were 22.8 +/- 2.5 and 26.9 +/- 1.0 h, respectively, after 3- and 6-mg s.c. doses. No systemic side-effects were noted after the administration of RS-26306. Our results demonstrate that the GnRH antagonist RS-26306 has favorable pharmacokinetic characteristics and is a potent suppressor of pituitary gonadotropin secretion in postmenopausal women. These attributes and the lack of systemic side-effects make RS-26306 a promising candidate for future clinical applications.

Concordant suppression of serum immunoreactive luteinizing hormone (LH), follicle-stimulating hormone, alpha subunit, bioactive LH, and testosterone in postmenopausal women by a potent gonadotropin releasing hormone antagonist (detirelix).

The purposes of the current study were 2-fold: 1) to assess the effects of a new antagonistic analog of GnRH [N-Ac-D-Nal(2)1, D-pC1-phe2, D-Trp3, D-hArg (Et2)6, D-Ala10] GnRH, or detirelix (Syntex Research) on gonadotrope function as reflected by serum levels of immuno- and bioassayable LH, and immunoactive FSH and alpha-subunit concentrations in postmenopausal, hypergonadotropic women; and 2) to determine if androgen production in the postmenopausal ovary is gonadotropin dependent. Six normal postmenopausal women were studied. Each volunteer received doses of 1, 5, and 20 mg detirelix sc in a random order separated by at least a 1-week interval. Serum LH, FSH, and alpha-subunit were measured by RIA at frequent intervals for 72 h after each injection. Bioactive LH levels were measured at 0, 24, 48, and 72 h after injection by a mouse Leydig cell bioassay, to permit comparison of biological with immunological LH activity. The steroids testosterone (T) and dehydroepiandrosterone sulfate were measured before injection and 12 (T only), 24 and 48 h after injection of the 20 mg dose. Immunoactive levels of serum LH and FSH were both suppressed in a dose-dependent manner, but LH suppression was greater than that of FSH. Maximum LH suppression (mean +/- SEM) after the 1, 5, and 20 mg doses was 40.2 +/- 7.0%, 63.2 +/- 3.4%, and 75.8 +/- 2.2%, respectively. For the same doses, maximum FSH suppression was 18.0 +/- 6.0%, 25.6 +/- 4.6%, and 39.6 +/- 2.7%. LH levels remained suppressed below baseline for up to 72 h after the 20 mg dose. Bioactive LH changes closely paralleled those of immunoactive LH. Mean LH suppression (area under the serum concentration curve) during the first 24 h after injection was 23.5 +/- 6.2% for the 1-mg dose, 47.2 +/- 4.7% for the 5-mg dose, and 61.0 +/- 2.1% for the 20-mg dose. Mean percent FSH suppression during the first 24 h, calculated in the same manner, was 6.8 +/- 3.9% (1 mg), 14.5 +/- 2.9% (5 mg), and 18.2 +/- 2.6% (20 mg). Serum alpha-subunit concentrations were significantly suppressed by 1 h after dosing with the 5- and 20-mg doses (P less than 0.05), and remained suppressed throughout the 72-h sampling period. Gonadotropin dependence of steroidogenesis in the postmenopausal ovary was suggested by a significant suppression of serum T concentrations after the 20-mg dose of detirelix.(ABSTRACT TRUNCATED AT 400 WORDS)

Suppression of pituitary-gonadal function by a potent new luteinizing hormone-releasing hormone antagonist in normal men.

LHRH antagonists compete with endogenous LHRH for binding to receptors on pituitary gonadotrophs and thereby inhibit gonadal function by suppressing gonadotropin secretion. We studied the effects of a recently developed LHRH antagonist on the pituitary-gonadal axis in man. The antagonist Detirelix [( N-Ac-D-Nal(2)1, D-pCl-Phe2,D-Trp3, D-hArg(Et2)6, D-Ala10]LHRH) was given as a single sc injection to nine normal men at three dose levels (5, 10, and 20 mg) at intervals of at least 7 days. Serum FSH, LH, and testosterone levels were measured before treatment, at frequent intervals for 48 h, and 72, 96, and 168 h after administration of the antagonist. Mean serum FSH levels decreased (P less than 0.001) from 6.9 +/- 0.5 (+/- SEM) mIU/mL to nadirs of 4.4 +/- 1.1, 3.6 +/- 0.9, and 4.1 +/- 0.9 after the 5-, 10-, and 20-mg doses, respectively. Serum LH levels decreased (P less than 0.001) from 6.2 +/- 0.3 mIU/mL to nadirs of 3.3 +/- 0.4, 2.8 +/- 0.3, and 2.7 +/- 0.3 after all three doses. Serum testosterone levels decreased (P less than 0.001) in a dose-dependent fashion from 5.1 +/- 0.2 ng/mL to nadirs of 1.3 +/- 0.3, 0.9 +/- 0.3, and 0.6 +/- 0.1 after the same doses. After the initial testosterone decrease, however, escape occurred 12-28 h after the lower doses. The area under the response curve, describing hormone concentrations as a function of time during the study, diminished by 23 +/- 2%, 36 +/- 4%, and 36 +/- 3% for FSH, by 14 +/- 6%, 30% +/- 6%, and 34 +/- 5% for LH, and by 41 +/- 5%, 58 +/- 6%, and 68 +/- 4% for testosterone with the same doses, respectively. The apparent plasma disappearance half-life of Detirelix by RIA was at least 41 h after all three doses. Detirelix elicited only a minor local reaction; no systemic side-effects were observed within the dose range used. These results indicate that this LHRH antagonist is a safe, highly potent inhibitor of the human pituitary-gonadal axis with an exceptionally long duration of action.

Flunisolide metabolism and dynamics of a metabolite.

Flunisolide (6 alpha-fluoro-11 beta,16 alpha,17 alpha,21-tetrahydroxypregna-1,4-diene-3,20-dione 16,17-acetonide) is a potent corticoid used clinically in topical formulations. Three men were given single 2-mg intravenous and oral doses of 14C-labeled flunisolide and plasma and urine concentrations of flunisolide and a major metabolite, 6 beta,11 beta,16 alpha,17 alpha,21-penta-hydroxypregna-1,4-diene-3,20-dione 16,17-acetonide (6 beta-OH metabolite) were determined. Oral flunisolide was metabolized rapidly and extensively to the 6 beta-OH metabolite and to conjugates; comparison in the intravenous dose kinetics suggested significant first-pass metabolism. In a separate study in 12 normal subjects, flunisolide in plasma was quantitated by radioimmunoassay (RIA); average systemic availability was 20%. The apparent volume of distribution (Vd beta) of flunisolide was large and systemic clearance and apparent oral clearance values were high. The 6 beta-OH metabolite had corticoid activities no more than 3 times that of hydrocortisone in rats as measured by thymolytic, anti-inflammatory, and adrenal-suppressive assays, whereas flunisolide had 180 to 550 times the activity of hydrocortisone. These data offer a metabolic explanation for the clinical observation that flunisolide can be administered intranasally and by inhalation in therapeutically effective doses without causing significant reduction in adrenal function.

Absorption and metabolism of nafarelin, a potent agonist of gonadotropin-releasing hormone.

Nafarelin, a potent gonadotropin-releasing hormone (GnRH) agonist, was absorbed rapidly into systemic circulation (time to reach peak concentration, 20 to 40 minutes) after intranasal but not after sublingual or vaginal administration. Serum elimination half-life was about 2 hours. Nasal absorption of nafarelin was increased by increasing the concentration of the drug in the dose solution and incorporating sodium glycocholate into the nasal formulation. An optimal formulation providing maximum nasal absorption of nafarelin was one containing 1.75 mg nafarelin per ml and 2% sodium glycocholate. Bioavailability of this nasal formulation relative to a single subcutaneous dose averaged 21%. The metabolism and excretion of nafarelin were determined in three subjects after subcutaneous administration of [14C]-nafarelin. Radioactivity was excreted in approximately equal amounts in urine and stool. Six metabolites accounted for most of the radioactivity in urine. Four metabolites were short peptide fragments of nafarelin and the other metabolites were naphthylalanine and 2-naphthylacetic acid.

Ablation of folliculogenesis in women by a single dose of gonadotropin-releasing hormone agonist: significance of time in cycle.

Effects of single subcutaneous doses (1, 5, 20, and 100 micrograms) of nafarelin, a potent gonadotropin-releasing hormone agonist, on the physiologic events of the human menstrual cycle were studied in 28 normal women. Nafarelin entered the circulation rapidly after injection. Peak concentrations were observed within 1 hour, and the plasma half-life was 4 to 5 hours. Maximal concentrations of luteinizing hormone and follicle-stimulating hormone were reached 3 to 4 hours after nafarelin administration. The magnitude of the gonadotropin responses depended both on the phase of the menstrual cycle (smallest responses during the early follicular phase) and the dose of nafarelin. Nafarelin administration during the early follicular phase delayed ovulation by 4.6 +/- 1.7 (standard deviation) days and prolonged the duration of the menstrual cycle from a pretreatment length of 29.2 +/- 2.1 days to 33.4 +/- 4.0 days (P less than 0.001). When nafarelin was administered shortly before or after ovulation, cycle length was not altered consistently. Administration 5 to 10 days after ovulation resulted in a truncated luteal phase. These observations suggest that the hormonal events triggered by nafarelin during the early follicular phase temporarily arrest the process of selection of the dominant follicle. Repeated intermittent administration of nafarelin or other gonadotropin-releasing hormone agonists in the early follicular phase may prevent follicular maturation and ovulation and may be a practical approach to contraceptive development.

Radioimmunoassay of flunisolide in human plasma.

A simple radioimmunoassay was developed for the measurement of flunisolide in human plasma or serum. Plasma extraction was not required. Antiserums were produced in rabbits by immunization against the flunisolide 21-hemisuccinate-bovine serum albumin conjugate. Cross-reactivities were determined for cortisol and a major metabolite of flunisolide and were 0.02 and 0.06%, respectively. Assay sensitivity is in the 100--200-pg/ml range. Accuracy studies gave regression lines of y = 1.06x, r = 1.00, for a 0.1-ml plasma aliquot and y = 0.99x, r = 0.99, for a 0.2-ml plasma aliquot. The accuracy of the method was estimated to be at least +/- 15%. The method was used to determine plasma concentration-time profiles in human subjects after the administration of a 1.0-mg iv dose.

Radioimmunoassay of oxfendazole in bovine, equine, or canine plasma or serum.

A simple radioimmunoassay was developed for the determination of oxfendazole in plasma. Oxfendazole N-1(3)-valerate was coupled to polylysine via a carbodiimide reaction, and antiserum was developed in rabbits after inoculation with oxfendazole--polylysine conjugate. The assay was developed so that oxfendazole could be measured directly in a 0.1-ml aliquot of diluted or undiluted plasma. With the developed procedure, 200 pg of oxfendazole/ml of plasma can be determined quantitatively. Cross-reactivity was determined for closely related compounds and metabolites. The method was used to determine plasma concentration--time profiles in dogs and calves.

Nasal absorption of nafarelin acetate, the decapeptide [D-Nal(2)6)]LHRH, in rhesus monkeys. I.

Nafarelin acetate, [D-Nal(2)6]LHRH, a highly potent superagonist of luteinizing hormone-releasing hormone, was given intranasally to six female rhesus monkeys. Absorption was rapid and very reproducible, with peak levels occurring at 15-30 min and a bioavailability of approximately 2% relative to a subcutaneous dose. The nasal dose response was highly nonlinear. The nonlinearity was apparently associated with the absorption phase, since elimination profiles at all doses were similar.

Radioimmunoassay of plasma ethinylestradiol in the presence of circulating norethindrone.

A reliable radioimmunoassay (RIA) for the measurement of ethinylestradiol (EE2) in plasma after the separation of norethindrone (NET) by column chromatography has been developed. The procedure involves diethyl ether extraction, followed by celite column partition chromatography to separate NET from EE2. An antiserum against ethinylestradiol-7-(3-thiopropionic acid)-bovine serum albumin conjugate was employed. Tritiated EE2 was used as the radioligand. The separation of bound from free 3H-EE2 was carried out with dextran-coated charcoal. This RIA procedure was used to measure plasma EE2 at specified time intervals in three women following oral administration of a tablet containing EE2 (0.12 mg) and NET (1.0 mg). The results show that EE2 is rapidly absorbed after oral administration. Peak concentrations of plasma EE2 were reached within 1.0 to 1.5 hours and then declined biphasically. The EE2 alpha phase half-life values in three subjects were 1.5, 2.8 and 3.8 hours. By comparison, the half-life values for the beta phase for the same three women were 6.2, 12.3 and 14.5 hours, respectively. Plasma samples were also analyzed for NET by RIA. The half-life values for the beta phase for EE2 and NET in the three subjects were similar.

PIP: Because of immunological cross-reactions between norethindrone (NET) and ethinyl estradiol (EE) in women taking combined oral contraceptive (OC) formulations, a new radioimmunoassay was designed to measure EE in plasma after the removal of NET by column chromatography; this method proved applicable in measuring plasma levels of EE. The procedure established involves diethyl ether extraction, followed by celite column partition chromatography to divide NET from EE. The antiserum used was against ethinyl-estradiol-7-(3-thiopropionic acid)-bovine serum albumin. The radioligand was tritiated EE. Dextran-coated charcoal method was used to separate bound from free radiolabled EE. 3 women were tested after timed ingestion of an OC containing .12 mg of EE and 1 mg of NET. In these women, the results showed that EE was rapidly absorbed after oral administration. Peak concentrations of plasma EE occurred within 1-1.5 hours and then declined in a biphasic manner. The alpha phase half-life values for EE in the 3 subjects were 1.5, 2.8, and 3.8 hours; the beta phase half-lives for the same 3 women were 6.3, 12.3. and 14.5 hours, respectively. Hence, this radioimmunoassay successfully separated EE from NET for measurement of plasma EE values in humans.

Radioimmunoassay of oxfendazole in sheep fat.

Oxfendazole (methyl 5-(phenylsulfinyl)-2-benzimidazole-carbamate) is a broad spectrum anthelmintic agent designed for use in food-producing animals. A simple radioimmunoassay (RIA) for determination of oxfendazole in plasma was modified for determining oxfendazole in sheep fat. Fat tissue was enzymatically hydrolyzed to an oily residue with collagenase-hyaluronidase, and oxfendazole was then extracted into an acidified aqueous phase. An aliquot of this phase was used directly for RIA. Bound radioactivity was separated from free by using polyethylene glycol-bovine gamma globulin because oils and other components in the aqueous aliquot preclude the use of charcoal for the separation. The lower limit of sensitivity of the assay is 0.003 ppm. Accuracy experiments carried out in the range 0.01-0.5 ppm gave a regression line of y (ng/g) = 0.91 x (ng/g) + 2.89, with r = 0.99. Fat tissue derived from sheep given an oral dose of 6.0 mg/kg was analyzed by this method and by a high pressure liquid chromatographic (HPLC) method. Values obtained by the 2 methods agreed well.

Radioimmunoassay of nafarelin ([ 6-(3-(2-naphthyl)-D-alanine)]-luteinizing hormone-releasing hormone) in plasma or serum.

A procedure which is suitable for the radioimmunoassay (RIA) of nafarelin [( 6-(3-(2-naphthyl)-D-alanine)]-luteinizing hormone-releasing hormone) in plasma or serum at concentrations as low as 50 pg/ml is described. Antiserum was prepared by replacing the pyroglutamyl portion of nafarelin with glutaric acid, coupling the product to keyhole limpet hemocyanin, and immunizing rabbits with the resulting conjugate. At a dilution of 1:30,000 the binding was approximately 50%. The antibodies did not cross react with luteinizing hormone-releasing hormone. For RIA, 125I-labeled analyte was used as the tracer and charcoal was used to separate the free and the bound fractions. No purification of samples was required prior to RIA. Accuracy of the method was assessed by adding known quantities of nafarelin to nafarelin-free plasma and determining the ratio of measured to added analyte. Linear regression analysis for the concentration range 0.050-5.00 ng/ml yielded a regression equation of y = 1.01x - 0.066 and a correlation coefficient of 0.997. At 0.050 ng/ml the CV was 11.3% (interassay). Additional validation was obtained from an in vivo study in which [3H]nafarelin was administered to monkeys and plasma profiles were determined by RIA, by high-performance liquid chromatography (HPLC), and by an HPLC-radiochemical method. The results obtained by RIA agreed well with those obtained by the HPLC methods.

Radioimmunoassay of ganirelix in plasma or serum.

A procedure for the radioimmunoassay (RIA) of ganirelix in plasma or serum at concentrations as low as 0.050 ng/ml is described. Antiserum was produced by coupling the N-terminus glycyl analog of ganirelix to BSA by a carbodiimide reaction and immunizing rabbits with this conjugate. The antiserum did not crossreact with LHRH or with various ganirelix peptide fragments. For RIA, 125I labeled ganirelix was used as the tracer and a double antibody procedure was used to separate the free and bound fractions. No purification of the analyte was required prior to RIA. Accuracy of the method was assessed by adding known quantities of ganirelix to ganirelix-free plasma and determining the ratio of measured to added analyte. Linear regression analysis for the concentration range 0.050-50.0 ng/ml yielded a regression equation of y = 0.97x + 0.18, r = 0.999, where x is the amount added and y is the amount measured. Additional validation was obtained from an in vivo study in which [3H]-ganirelix was administered to monkeys and plasma clearance profiles were determined by RIA and an HPLC-radiochemical method. The results were in agreement within experimental error of the two methods. Linear regression analysis of the comparative data gave the equation y = 0.92x + 33.7, r = 0.980, where x is the amount measured by RIA and y is the amount measured by HPLC-radiochemical analysis.

Radioimmunoassay of detirelix ([ N-Ac-D-Nal(2)1,D-p-Cl-Phe2,D-Trp3, D-hArg(Et)6(2),D-Ala10]-luteinizing hormone-releasing hormone) in plasma or serum.

A procedure for the radioimmunoassay (RIA) of detirelix in plasma or serum at concentrations as low as 0.15 ng/ml is described. Antiserum was produced by deacetylation of the N-terminus amino groups of detirelix and coupling this analog to bovine serum albumin with a carbodiimide and immunizing rabbits with the resultant conjugate. For RIA, 125I-labeled detirelix was used as the tracer and a double antibody procedure was used to separate the free and bound fractions. No purification of samples was required prior to RIA. Accuracy of the method was assessed by adding known quantities of detirelix to detirelix-free plasma and determining the ratio of measured to added analyte. Linear regression analysis for the concentration range 0.15-150.0 ng/ml yielded a regression equation of y = 0.88 X +1.46 and a correlation coefficient of 0.996. Additional validation was obtained from an in vivo study in which [14C]detirelix was administered to monkeys and plasma clearance profiles were determined by RIA and an HPLC-radiochemical method. The RIA results were in good agreement with those obtained by the HPLC method.

Disposition of detirelix, a potent luteinizing hormone-releasing hormone antagonist, in rats and monkeys.

The disposition of detirelix, a potent luteinizing hormone-releasing hormone (LHRH) antagonist, was studied in rats and monkeys. After a single 300-microgram/kg intravenous dose in rats, the plasma elimination t1/2 was 1.6 hr and the plasma clearance was 3.3 ml/min/kg. In the monkey, the mean t1/2 and plasma clearance were 7.1 hr and 1.3 ml/min/kg, respectively, after an 80-microgram/kg intravenous dose. Long plasma t1/2 values of 18.7 and 31.6 hr were observed after single 0.2- and 1.0-mg/kg subcutaneous doses in the monkey, suggesting the possibility of subcutaneous depot formation at the injection site. Biliary excretion was the predominant route of elimination of detirelix in both species. Less than 10% of the detirelix was excreted renally. A major metabolite, isolated from the rat bile, was the 1-4 tetrapeptide fragment of detirelix. This metabolite was formed by enzymatic hydrolysis of the Ser4-Tyr5 bond, one of the only two peptide bonds in detirelix not containing a D-amino acid.

A Radioimmunoassay Procedure for the Determination of the Antiviral Nucleoside DHPG (9-[(l,3-Dihydroxy-2-propoxy)-methyl]guanine) in Plasma or Serum.

A procedure is described that is suitable for the radioimmunoassay (RIA) of 9-[(l,3-dihydroxy-2-propoxy)-methyl]guanine (DHPG) in plasma or serum at concentrations as low as 0.7 ng/ml (2.75 × 10(-9) M). Antiserum was prepared by coupling DHPG monohemisuccinate to bovine serum albumin and immunizing rabbits with the resulting conjugate. The antibodies did not show significant cross-reactivities with structurally related endogenous compounds. For RIA, tritium-labeled DHPG was used as the tracer and charcoal-dextran was used to separate the free and bound fractions. No purification of samples was required prior to RIA. The accuracy of the method was assessed by adding known quantities of DHPG to DHPG-free plasma and determining the ratio of measured to added analyte. Linear regression analysis for the concentration range 0.0007 to 15.0 µg/ml yielded the following equation; y = 0.90 x + 0.033 (r = 0.999). Additional validation was obtained from studies in which DHPG was administered to a monkey, mice, dogs, and rats, and plasma-clearance profiles were determined by RIA and high-performance liquid chromatography (HPLC). The results obtained by RIA were in good agreement with those obtained by HPLC.

Pulmonary delivery of detirelix by intratracheal instillation and aerosol inhalation in the briefly anesthetized dog.

Pulmonary delivery of the decapeptide detirelix was studied in briefly anesthetized dogs and the pharmacokinetics were examined following intravenous administration, intratracheal instillation, and aerosol inhalation. Detirelix administrations to the lung gave plasma profiles that were extended over two days, and that differed markedly from those of similarly sized peptides. Absorption from the lung after instillation was slow (Tmax = 6.5 +/- 3.6 h) with a relative bioavailability of 29 +/- 10%. Administration of detirelix-containing aerosols resulted in similar plasma profiles as for administration by instillation. Compartmental and non-compartmental methods of pharmacokinetic analysis indicated no faster absorption from aerosols than from instilled solutions; an absorption rate limiting process may be an explanation. Plasma profiles were not affected by the use of detirelix liquid crystal favoring formulations or destabilizing formulations, and suggested that in situ liquid crystal formation was not an explanation for the slow absorption. No significant changes in pharmacokinetics or systemic uptake were observed during the five-month period of repeated pulmonary administrations. Histopathologic examination revealed the lungs to be essentially normal.

Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function.

The pharmacokinetics of ganciclovir was evaluated in 21 patients with life- or sight-threatening cytomegalovirus infections. Thirteen patients had normal renal function and eight patients had various degrees of renal insufficiency. Most patients received 5 mg of ganciclovir/kg as a 1-hour intravenous infusion twice daily for periods of up to 2 weeks. Quantification of ganciclovir was assessed by high-performance liquid chromatography and radioimmunoassay. In patients with normal renal function, a biexponential decay of ganciclovir from plasma was observed, with an initial distribution half-life (t1/2) of 0.76 +/- 0.67 hour and a terminal elimination t1/2 of 3.60 +/- 1.40 hours. A large fraction of the administered dose was excreted in urine, and total clearance of ganciclovir correlated well with creatinine clearance. In patients with renal insufficiency who were receiving 5 mg of ganciclovir/kg, the terminal elimination t1/2 of ganciclovir was markedly increased (11.50 +/- 3.90 hours), as compared with values obtained in patients with normal renal function. Hemodialysis efficiently reduced levels of ganciclovir in plasma by approximately 53.0% +/- 11.5%, a finding that indicates this drug should be administered after dialysis.