title: Evaluation of bioequivalence of highly variable drugs using Monte Carlo simulations. I. Estimation of rate of absorption for single and multiple dose trials using Cmax.
abstract: OBJECTIVE
  A Monte Carlo simulation study was done to investigate the effects of high intrasubject variation in clearance (CL), and volume of distribution (V) on the calculation of the 90% confidence interval (CI) for Cmax for single dose and multiple dose studies.
  
  
  METHODS
  Simulations were done for both immediate release and sustained release scenarios. The simulated data were compared with clinical data from bioequivalence studies performed on indomethacin and verapamil.
  
  
  RESULTS
  Previous reviews and simulations have shown that the probability of failure for the Cmax for single dose studies was always greater than that for multiple dose studies. However, the results for the simulated scenarios currently investigated indicate that if intra-subject (period-to-period) variation in CL and V is high (% CV's above 25%, and 12%, respectively), multiple dose studies can exhibit a higher probability of failure for Cmax than do single dose studies. Furthermore, Cmax values from studies performed with a sustained release scenario are more sensitive to changes in Ka, CL, and V than are results of studies on immediate release products. As an example, the probability of failure for immediate release products in simulated single dose studies is about 11% and 21% when the mean difference in Ka is 10% and 20%, respectively; while, the probability of failure for multiple dose studies is about 36% regardless of the difference in Ka. The corresponding values for the probability of failure for sustained release products were 25%, 53% for single dose studies and 39% for multiple dose studies. The simulations also indicate that changes in the fraction absorbed have a greater effect on the estimation of Cmax in multiple dose regimens than in single dose studies.
  
  
  CONCLUSIONS
  The results from these investigations indicate that multiple dose studies do not necessarily always reduce variability in Cmax.
authors.affiliation: Food and Drug Administration, Center for Drug Evaluation and Research, Rockville, Maryland 20857, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: el-Tahtawy
authors.forename: A J
authors.initials: AJ
authors.lastname: Jackson
authors.forename: T M
authors.initials: TM
authors.lastname: Ludden
mesh_terms: D000042:Absorption; D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000493:pharmacokinetics; D001682:Biological Availability; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000493:pharmacokinetics; D003198:Computer Simulation; D003692:Delayed-Action Preparations; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D007408:Intestinal Absorption; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D013810:Therapeutic Equivalency; D014700:Verapamil / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014700:Verapamil; D007213:Indomethacin