J. Laurin et al., Peripheral link model as an alternative for pharmacokinetic-pharmacodynamic modeling of drugs having a very short elimination half-life, J PHARMA PH, 28(1), 2001, pp. 7-25
Attempts to obtain estimates of pharmacokinetic-pharmacodynamic (PK-PD) par
ameters for mivacurium with traditional central link models were unsuccessf
ul in many patients. We hypothesized that a link model with the peripheral
compartment would be more appropriate for mivacurium in view of its extreme
ly rapid plasma clearance and its potential elimination by tissue pseudocho
linesterases. For validation purposes, the peripheral link model was applie
d to other neuromuscular blocking agents (NMBA), i.e., atracurium and doxac
urium which have respectively an intermediate and a long elimination half-l
ife. Assuming peripheral elimination in PK-PD modeling was investigated but
found to have no impact on the estimation of PK-PD parameters. Our results
indicate that, for drugs having intermediate and long elimination half-liv
es, EC50 values are similar with either the central or peripheral link mode
l. For mivacurium, a peripheral link model enables PK-PD modeling in all su
bjects, with more precision in the PK-PD parameter estimates and a better f
itting of the effect data when compared to the central link model. For thes
e reasons, a peripheral link model should be preferred for mivacurium.