title: Population pharmacokinetic and pharmacodynamic modelling of the effects of nicorandil in the treatment of acute heart failure.
abstract: OBJECTIVE
  The aims of the study were 1) to evaluate the pharmacokinetics of nicorandil in healthy subjects and acute heart failure (AHF) patients and 2) to evaluate the exposure-response relationship with pulmonary arterial wedge pressure (PAWP) in AHF patients and to predict an appropriate dosing regimen for nicorandil.
  
  
  METHODS
  Based on the data from two healthy volunteer and three AHF patient studies, models were developed to characterize the pharmacokinetics and pharmacodynamics of nicorandil. PAWP was used as the pharmacodynamic variable. An asymptotic exponential disease progression model was used to account for time dependent changes in PAWP that were not explained by nicorandil exposure. The modelling was performed using NONMEM version V.
  
  
  RESULTS
  The pharmacokinetics of nicorandil were characterized by a two-compartment model with linear elimination. CL, V1 and V2 in AHF patients were 1.96, 1.39 and 4.06 times greater than in healthy subjects. Predicted plasma concentrations were assumed to have an immediate concentration effect relationship on PAWP. An inhibitory E(max) model with E(max) of -11.7 mmHg and EC(50) of 423 microg l(-1) was considered the best relationship between nicorandil concentrations and PAWP. PAWP decreased independently of nicorandil exposure. This drug independent decline was described by an asymptotic decrease of 6.1 mmHg with a half-life of 5.3 h.
  
  
  CONCLUSIONS
  AHF patients have higher clearance and initial distribution volume of nicorandil compared with healthy subjects. The median target nicorandil concentration to decrease PAWP by 30% is predicted to be 748 microg l(-1), indicating that a loading dose of 200 microg kg(-1) and a maintenance dose of 400 microg kg(-1) h(-1) would be appropriate for the initial treatment of AHF.
authors.affiliation: Department of Clinical Pharmacology, Chugai Clinical Research Center Co., Ltd., Tokyo, Japan. iidastf@chugai-pharm.co.jp
authors.forename: Satofumi
authors.initials: S
authors.lastname: Iida
authors.forename: Haruki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Nicholas H G
authors.initials: NH
authors.lastname: Holford
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D020108:Nicorandil / Q000008:administration & dosage* / Q000493:pharmacokinetics; D017711:Nonlinear Dynamics; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D020108:Nicorandil
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