Comparison of four basic models of indirect pharmacodynamic responses.

Four basic models for characterizing indirect pharmacodynamic responses after drug administration have been developed and compared. The models are based on drug effects (inhibition or stimulation) on the factors controlling either the input or the dissipation of drug response. Pharmacokinetic parameters of methylprednisolone were used to generate plasma concentration and response-time profiles using computer simulations. It was found that the responses produced showed a slow onset and a slow return to baseline. The time of maximal response was dependent on the model and dose. In each case, hysteresis plots showed that drug concentrations preceded the response. When the responses were fitted with pharmacodynamic models based on distribution to a hypothetical effect compartment, the resulting parameters were dose-dependent and inferred biological implausibility. Indirect response models must be treated as distinct from conventional pharmacodynamic models which assume direct action of drugs. The assumptions, equations, and data patterns for the four basic indirect response models provide a starting point for evaluation of pharmacologic effects where the site of action precedes or follows the measured response variable.

Daily maintenance dose of a long-acting theophylline from a single theophylline serum level.

A single point method has recently been described whereby the daily maintenance dose of theophylline required to achieve a desired steady state serum concentration can be established from a nomogram with the aid of a single blood sample drawn after a test dose. This approach has been validated for intravenous administration and for a rapidly absorbed elixir (coefficient of absorption ka 2.3 h-1) given to children. In order to study whether this method could be applied to a slowly absorbed preparation (ka 0.44 h-1), we gave theophylline (Theo-Dur) to nine adults as a single dose and for one week. In applying a nomogram, we found that a sample taken nine hours after a test dose would more accurately predict the daily dose required to achieve a desired steady state concentration than a sample taken at six hours as has previously been recommended (error nine hours -16.8 percent to +29 percent, six hours -59.7 percent to +29.4 percent).