Preclinical pharmacokinetics, pharmacology and toxicology of lisdexamfetamine: a novel d-amphetamine pro-drug.

Lisdexamfetamine dimesylate (LDX) is a novel pro-drug of d-amphetamine that is currently used for the treatment of attention-deficit/hyperactivity disorder in children aged ≥ 6 years and adults. LDX is enzymatically cleaved to form d-amphetamine following contact with red blood cells, which reduces the rate of appearance and magnitude of d-amphetamine concentration in the blood and hence the brain when compared with immediate-release d-amphetamine at equimolar doses. Thus, the increase of striatal dopamine efflux and subsequent increase of locomotor activity following d-amphetamine is less prominent and slower to attain maximal effect following an equimolar dose of LDX. Furthermore, unlike d-amphetamine, the pharmacodynamic effects of LDX are independent of the route of administration underlining the requirement to be hydrolyzed by contact with red blood cells. It is conceivable that these pharmacokinetic and pharmacodynamic differences may impact the psychostimulant properties of LDX in the clinic. This article reviews the preclinical pharmacokinetics, pharmacology, and toxicology of LDX. This article is part of the Special Issue entitled 'CNS Stimulants'.

Long-term treatment with lanthanum carbonate reduces mineral and bone abnormalities in rats with chronic renal failure.

BACKGROUND: Lanthanum carbonate (FOSRENOL(®), Shire Pharmaceuticals) is an effective non-calcium, non-resin phosphate binder for the treatment of hyperphosphataemia in patients with chronic kidney disease (CKD). In this study, we used a rat model of chronic renal failure (CRF) to examine the long-term effects of controlling serum phosphorus with lanthanum carbonate treatment on the biochemical and bone abnormalities associated with CKD-mineral and bone disorder (CKD-MBD). METHODS: Rats were fed a normal diet (normal renal function, NRF), or a diet containing 0.75% adenine for 3 weeks to induce CRF. NRF rats continued to receive normal diet plus vehicle or normal diet supplemented with 2% (w/w) lanthanum carbonate for 22 weeks. CRF rats received a diet containing 0.1% adenine, with or without 2% (w/w) lanthanum carbonate. Blood and urine biochemistry were assessed, and bone histomorphometry was performed at study completion. RESULTS: Treatment with 0.75% adenine induced severe CRF, as demonstrated by elevated serum creatinine. Hyperphosphataemia, hypocalcaemia, elevated calcium × phosphorus product and secondary hyperparathyroidism were evident in CRF + vehicle animals. Treatment with lanthanum carbonate reduced hyperphosphataemia and secondary hyperparathyroidism in CRF animals (P < 0.05), and had little effect in NRF animals. Bone histomorphometry revealed a severe form of bone disease with fibrosis in CRF + vehicle animals; lanthanum carbonate treatment reduced the severity of the bone abnormalities observed, particularly woven bone formation and fibrosis. CONCLUSIONS: Long-term treatment with lanthanum carbonate reduced the biochemical and bone abnormalities of CKD-MBD in a rat model of CRF.

Dietary administration in rodent studies distorts the tissue deposition profile of lanthanum carbonate; brain deposition is a contamination artefact?

Lanthanum carbonate is a non-calcium phosphate binder used to control hyperphosphataemia in patients with chronic kidney disease who are undergoing dialysis. Ultrastructurally, lanthanum ions are too large to traverse the tight junctions in the blood-brain barrier, yet tissue distribution studies using dietary administration have reported low concentrations in rodent brain, raising concern about accumulation. To investigate this, tissue lanthanum concentrations were measured in rats given the same lanthanum carbonate dose via powdered diet or oral gavage (838 and 863 mg/kg/day). Additional rats were dosed intravenously with lanthanum chloride (0.03 mg/kg/day), a route enabling much higher plasma lanthanum concentrations. After 28 days, median lanthanum concentrations in liver, bone, kidney and heart showed a direct relationship with those in plasma (highest after intravenous and lowest after dietary dosing). In contrast, brain concentrations were dramatically higher after dietary administration (< or =500 ng/g), compared to the other routes (LLOQ of 11 ng/g). An identical skewed pattern was noted for skin, a tissue readily contaminated in powdered diet studies. These data indicate that brain deposition is a contamination artefact caused by transfer of lanthanum from cranial skin to brain as animals are manipulated during autopsy. Dietary administration should be avoided in distribution studies of trace elements due to the high contamination risk.