Pharmacokinetics and Safety of a Potential Antidementia Compound, CL 275,838, after Multiple Oral Doses in Patients with Dementia of Alzheimer Type or Vascular Dementia.
The multiple-dose pharmacokinetics and safety of a new potential antidementia compound, CL 275,838, were examined in two randomized, double-blind, parallel-group, placebo-controlled studies. The Alzheimer Disease Assessment Scale (ADAS) was employed to preliminarily assess the patients' cognitive and the behavioral profiles. In the first study, nine patients with Alzheimer type or vascular dementia were treated for 2 weeks with daily doses of 50 mg. In the second study, nine other patients, selected with the same inclusion/exclusion criteria and treated following the same experimental design, were given 100 mg day(minus sign1) CL 275,838. At the lower dose, no side effects were detected; in the 100-mg day(minus sign1) study, mild drowsiness (one patient) and moderate agitation (two patients) were observed. Laboratory tests showed no changes in either study, apart from a slight, transient increase in serum bilirubin in one patient given 100 mg. At the dose of 50 mg, no patients showed any modification on the ADAS, whereas three patients given 100 mg showed some improvement. During the 2 weeks of oral dosing, predose plasma concentrations of the parent compounds and its metabolites II and IV increased but not in proportion to the dose, although at both doses, accumulation was essentially complete within 10 days. At 50 mg, the mean steady-state C(max) and C(ss) of the parent compound were similar to those reached in young males after a comparable regimen. Mean steady-state metabolite-to-parent drug ratios were higher in patients than in healthy individuals, although there was wide variation in our patient group. Mean washout t(1/2) of the parent compound (34 h) and its metabolites II (37 h) and IV (41 h) were longer than in young men and were similar in all cases to those observed after single doses in healthy elderly subjects. After 100 mg, mean C(max) and C(ss) of the unchanged compound rose more than proportionally and the apparent t(1/2) tended to rise, compared with the lower dose. Mean steady-state oral clearance decreased, changing the metabolite-to-parent drug ratios, suggesting nonlinear kinetics after several relatively high oral doses. This might explain why the higher dose was less well tolerated.
Caccia
Silvio
S
Laboratory of Drug Metabolism and Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche "Mario Negri," 20157 Milan, Italy.
Confalonieri
Sergio
S
Guiso
Giovanna
G
Lucca
Ugo
U
Tettamanti
Mauro
M
Tiraboschi
Pietro
P
Spagnoli
Alberto
A