Comparative Pharmacokinetics of Antiviral Nucleoside Analogues
Tóm tắt
The recent development of nucleoside analogues with antiviral activity has expanded the small but useful armamentarium for the treatment of certain viral diseases such as the human immunodeficiency virus, cytomegalovirus and others. Their intracellular site of action and need for sequential phosphorylation require that traditional pharmacokinetic parameters be used in conjunction with an understanding of intracellular metabolism when designing dosage regimens. This review summarises the available pharmacokinetic literature for zidovudine, didanosine, zalcitabine, aciclovir, ganciclovir, vidarabine and ribavirin. After oral administration, didanosine, aciclovir and ribavirin are <50% bioavailable and ganciclovir is <6% absorbed. In contrast, zidovudine and zalcitabine are >60% bioavailable, although zidovudine undergoes considerable and variable first-pass hepatic glucuronidation while zalcitabine has no first-pass effect. Zidovudine, zalcitabine and didanosine are absorbed rapidly in the fasted state, with peak plasma concentrations exceeding their respective in vitro antiretroviral inhibitory concentrations. All reviewed agents except ribavirin have a relatively short plasma half-life (≈0.5 to 4h), with each agent demonstrating a different intracellular enzymatic activation scheme. For example, the rate-limiting step for formation of zidovudine triphosphate is the conversion of the monophosphate to the diphosphate, while didanosine is ultimately converted to dideoxyadenosine triphosphate which has the longest intracellular half-life (≈12 to 24h) among these agents. These drugs are not highly protein bound and they distribute into tissues with an apparent volume of distribution at steady-state ranging from 0.3 to 1.2 L/kg. They vary in the extent to which they enter cerebrospinal fluid, ranging from a low of <25% for didanosine to a high of >70% of a concurrent plasma concentration for ribavirin and vidarabine. These agents also vary with regard to degree of renal excretion of the parent drug, with the lowest noted for vidarabine (1 to 3%) and the highest for zalcitabine (≈75%) and ganciclovir (>90%). With the increasing number of clinically useful nucleoside analogues, it is essential for the clinician to appreciate the subtle differences among these agents to ensure that optimal therapeutic outcomes may be attained with minimal toxicity.
Tài liệu tham khảo
Ahluwalia G, Cooney DA, Mitsuya H, Fridland A, Flora KP, et al. Initial studies on the cellular pharmacology of 2′,3′-dideoxyinosine, an inhibitor of HIV infectivity. Biochemical Pharmacology 36: 3797–3800, 1987
Anderson BD, Wugant NB, Xiang T, Waugh WA, Stella VJ. Preformulation solubility and kinetic studies of 2′,3′-dideoxypurine nucleosides: potential anti-AIDS agents. International Journal of Pharmacokinetics 45: 27–37, 1988
Aronoff GR, Szwed JJ, Nelson RL, Marcus EL, Kleit SA. Hypoxanthine-arabinoside pharmacokinetics after adenine arabinoside administration to a patient with renal failure. Antimicrobial Agents and Chemotherapy 18: 212–214, 1980
Baba M, Pauwels R, Balzarini J, Herdewijn P, DeClercq E, et al. Ribavirin antagonises inhibitory effects of pyrimidine 2′,3′-dieoxynucleosides but enhances inhibitory effects of purine 2′3′-dideoxynucleosides on replication of human immunodeficiency virus in vitro. Antimicrobial Agents and Chemotherapy 31: 1613–1617, 1987
Balfour HH. Management of cytomegalovirus disease with antiviral drugs. Reviews of Infectious Disease 12: S849–860, 1990
Balis FM, Pizzo PA, Butler KM, Hawkins ME, Brouwers P, et al. Clinical Pharmacology of 2′,3′-dideoxyinosine in human immunodeficiency virus-infected children. Journal of Infectious Diseases 165: 99–104, 1992
Balis FM, Pizzo PA, Eddy J, Wilfert C, McKinney R, et al. Pharmacokinetics of zidovudine administered intravenously and orally in children with human immunodeficiency virus infection. Journal of Pediatrics 114: 880–884, 1989a
Balis FM, Pizzo PA, Murphy RF, Eddy J, Jarosinski PF, et al. The pharmacokinetics of zidovudine administered by continuous infusion in children. Annals of Internal Medicine 110: 279–285, 1989b
Balzarini J, Cooney D, Dalal M, Kang GJ, Cupp JE, et al. 2′,3′-Dideoxycytidine: Regulation of its metabolism and anti-retroviral potency by natural pyrimidine nucleosides and by inhibitors of pyrimidine nucleotide synthesis. Molecular Pharmacology 32: 798–806, 1987
Biron KK, Stanat SC, Sorrell JB, Fyfe JA, Keller PM, et al. Metabolic activation of the nucleoside analog 9-{[2-hydroxy-l-hydroxymethyl)ethoxy}guanine in human diploid fibroblasts infected with human cytomegalovirus. Proceedings of the National Academy of Sciences of the United States of America 82: 2473–2477, 1985
Blum MR, Liao SH, deMiranda P. Overview of acyclovir pharmacokinetic disposition in adults and children. American Journal of Medicine 73 (Suppl. A): 186–192, 1982
Blum MR, Liao SHT, Good SS, deMiranda P. Pharmacokinetics and bioavailability of zidovudine in humans. American Journal of Medicine 85 (Suppl. 2A): 189–194, 1988
Boehme RE. Phosphorylation of the antiviral precursor 9-(1,3-dihydroxy-2-propoxymethyl)guanine monophosphate by guanylate kinase isozymes. Journal of Biological Chemistry 259: 12346–12349, 1984
Boelaert J, Schurgers M, Daneels R, Van Landuyt HW, Weatherly BC. Multiple dose pharmacokinetics of intravenous acyclovir in patients on continuous peritoneal dialysis. Journal of Antimicrobial Chemotherapy 20: 69–76, 1987
Brigden D, Bye A, Fowle ASE. Human pharmacokinetics of acyclovir (an antiviral agent) following rapid intravenous injection. Journal of Antimicrobial Chemotherapy 7: 399–404, 1981
Bristol-Myers Squibb Co. Videx package insert. New York, New York, 1991
Broder S. Pharmacodynamics of 2′,3′-dideoxycytidine: an inhibitor of human immunodeficiency virus. American Journal of Medicine 88 (Suppl. 5B): 2S–7S, 1990
Buchanan RA, Kinkel A, Alford CA, Whitley RJ. Plasma levels and urinary excretion of vidarabine after repeated dosing. Clinical Pharmacology and Therapeutics 27: 690–696, 1980
Burgess ED, Gill MJ. Intraperitoneal administration of acyclovir in patients receiving continuous ambulatory peritoneal dialysis. Journal of Clinical Pharmacology 30: 997–1000, 1990
Burroughs Wellcome Co. Zovirax package insert. Research Triangle Park, North Carolina, 1990
Butler KM, Husson RN, Balis FM, Browers P, Eddy J, et al. Dideoxyinosine in children with symptomatic human immunodeficiency virus infection. New England Journal of Medicine 324: 137–144, 1991
Catlin DH, Smith RA, Samuels AI. 14C-Ribavirin: distribution and pharmacokinetic studies in rats, baboons, and man. In Smith & Kirkpatrick (Eds) Ribavirin: a broad spectrum antiviral agent, pp. 83–98, Academic Press Inc., New York, 1980
Chavanet P, Lokiec F, Portier H. Meningeal diffusion of high doses of acyclovir given with probenecid. Journal of Antimicrobial Chemotherapy 26: 294–295, 1990
Chen CH, Cheng YC. Delayed cytotoxicity and selective loss of mitochondrial DNA in cells treated with the anti-human immunodeficiency virus compound 2′,3′-dideoxycytidine. Journal of Biological Chemistry 264: 11934–11937, 1989
Chen CH, Cheng YC. The role of cytoplasmic deoxycytidine kinase in the mitochondrial effects of the anti-human immunodeficiency virus compound, 2′,3′-deoxycytidine. Journal of Biological Chemistry 267: 2856–2859, 1992
Cload PA. A review of the pharmacokinetics of zidovudine in man. Journal of Infection 18: 15–21, 1989
Collins JM, Unadkat JD. Clinical pharmacokinetics of zidovudine: an overview of current data. Clinical Pharmacokinetics 17: 1–9, 1989
Connor J. Ribavirin pharmacokinetics. Pediatric Infectious Disease Journal 9: S91–S92, 1990
Cooley TP, Kunches LM, Saunders CA, Ritter JK, Perkins CJ, et al. Once-daily administration of 2′,3′-dideoxyinosine (ddI) in patients with the acquired immunodeficiency syndrome or AIDS-related complex: results of a Phase I trial. New England Journal of Medicine 322: 1340–1345, 1990
Cooney DA, Ahluwalla G, Mitsuya H, Fridland A, Johnson MA, et al. Initial studies on the cellular pharmacology of 2′,3′-dideoxyadenosine, an inhibitor of HTLV-III infectivity. Biochemical Pharmacology 36: 1765–1768, 1987
Cooney DA, Dalal M, Mitsuya H, McMahon JB, Nadkarni M, et al. Initial studies on the cellular pharmacology of 2′,3′-dideoxycytidine, an inhibitor of HTLV-III infectivity. Biochemical Pharmacology 35: 2065–2068, 1986
Crumpacker C, Bubley G, Lucey D, Hussey S, Connor J, et al. Ribavirin enters cerebrospinal fluid. Lancet 2: 45–46, 1986
Crumpacker CS, Schnipper LE, Zaia JA, Levin MJ. Growth inhibition of herpesviruses isolated from human infections. Antimicrobial Agents and Chemotherapy 15: 642–645, 1979
Davidson RL, Kaufman ER, Crumpacker CS, Schnipper LE. Inhibition of herpes simplex virus transformed and nontrans-formed cells by acycloguanosine: mechanisms of uptake and toxicity. Virology 113: 9–19, 1981
deMiranda P, Blum MR. Pharmacokinetics of acyclovir after intravenous and oral administration. Journal of Antimicrobial Chemotherapy 12 (Suppl. B): 29–37, 1983
deMiranda P, Good SS, Laskin OL, Krasny HC, Connor JD, et al. Disposition of intravenous radioactive acyclovir. Clinical Pharmacology and Therapeutics 30: 662–672, 1981
deMiranda P, Good SS, Yarchoan R, Thomas RV, Blum MR, et al. Alteration of zidovudine pharmacokinetics by probenecid in patients with AIDS or AIDS-related complex. Clinical Pharmacology and Therapeutics 46: 494–500, 1989
Deray G, Diquet B, Martinez F, Vidal AM, Petitclerc T, et al. Pharmacokinetics of zidovudine in a patient on maintenance hemodialysis. New England Journal of Medicine 319: 1606–1607, 1988
Derse D, Cheng YC, Furman PA, St Clair MH, Elion GB. Inhibition of purified human and herpes simplex virus-induced DNA polymerases by 9-(2-hydroxythoxymethyl)guanine triphosphate. Journal of Biological Chemistry 256: 11447–11451, 1981
Dorsky DI, Crumpacker CS. Drugs five years later: acyclovir. Annals of Internal Medicine 107: 859–874, 1987
Drew RH, Weller S, Gallis HA, Walmer KA, Bartlett JA, et al. Bioequivalence assessment of zidovudine (Retrovir) syrup, solution, and capsule formulations in patients infected with human immunodeficiency virus. Antimicrobial Agents and Chemotherapy 33: 1801–1803, 1989
Drusano GL, Yuen GJ, Morse GD, Cooley TP, Seidlin M, et al. Impact of bioavailability on the determination of maximal tolerated dose of 2′,3′-dideoxyinosine (MTD) in Phase I trials. Antimicrobial Agents and Chemotherapy 36: 1280–1283, 1992
Fischl MA, Richman DD, Griceo MH, Gottlieb MS, Volberding PA, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related comples. New England Journal of Medicine 317: 185–191, 1987
Fischl MA, Richman DD, Hansen N, Collier AC, Carey JY, et al. The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type I (HIV) infection: a double-blind placebo-controlled trial. Annals of Internal Medicine 112: 727–737, 1990
Fletcher C, Sawchuck R, Chinnock B, De Miranda P, Balfour HH. Human pharmacokinetics of the antiviral drug DHPG. Clinical Pharmacology and Therapeutics 40: 281–286, 1986
Freidman HM, Grasela T. Adenine arabinoside and allopurinol-possible adverse drug interaction. New England Journal of Medicine 304: 423, 1981
Freitas VR, Smee DF, Chernow M, Boehme R, Matthews TR. Activity of 9-(1,3-dihydroxy-2-propoxymethyl)guanine compared with that of acyclovir against human, monkey, and rodent cytomegaloviruses. Antimicrobial Agents and Chemotherapy 28: 240–245, 1985
Frenkel LM, Brown ZA, Bryson YJ, Corey L, Unadkat JD, et al. Pharmacokinetics of acyclovir in the term pregnancy and neonate. American Journal of Obstetrics and Gynecology 164: 569–576, 1991
Furman PA, Fyfe JS, St. Clair MH, Weinhold K, Rideout JL, et al. Phosphorylation of 3′-azido-3′-deoxythymidine and selective interaction of the 5′-triphosphate with human immunodeficiency virus reverse transcriptase. Proceedings of the National Academy of Sciences of the United States of America 83: 8333–8337, 1986
Furman PA, McGuirt PV, Keller PM, Fyfe JA, Elion GB. Inhibition by acyclovir of cell growth and DNA synthesis of cells biochemically transformed with herpesvirus genetic information. Virology 102: 420–430, 1980
Furman PA, St Clair MH, Fyfe JA, Rideout JL, Keller PM, et al. Inhibition of herpes simplex virus-induced DNA polymerase activity and viral DNA replication by 9-(2-hydroxyethoxy-methyl)guanine and its triphosphate. Journal of Virology 32: 72–77, 1979
Gillet JY, Garraffo R, Abrar D, Bongain A, Lapalus P, et al. Fetoplacental passage of zidovudine. Lancet 1: 269–270, 1989
Gitterman SR, Drusano GL, Egorin MJ, Standford HC. Population pharmacokinetics of zidovudine (AZT). Clinical Pharmacology and Therapeutics 48: 161–167, 1990
Glazko AJ, Chang T, Drach JC. Species differences in the metabolic disposition of adenine arabinoside. In Pavan-Langston et al. (Eds) Adenine arabinoside: an antiviral agent, pp. 197–204, Raven Press, New York, 1975
Gnann JW, Barton NH, Whitley RJ. Acyclovir: mechanism of action, pharmacokinetics, safety and clinical applications. Pharmacotherapy 5: 275–283, 1983
Good SS, Reynolds DJ, deMiranda P. Simultaneous quantification of zidovudine and its glucuronide in serum by high-performance liquid chromatography. Journal of Chromatography 431: 123–133, 1988
Granich GG, Eveland MR, Krogstad DJ. Fluorescence polarization immunoassay for zidovudine. Antimicrobial Agents and Chemotherapy 33: 1275–1279, 1989
Gustavson LE, Fukuda EK, Rubio FA, Dunton AW. A pilot study of the bioavailabilty and pharmacokinetics of 2′3′-dideoxycytyidine in patients with AIDS or AIDS-related complex. Journal of Acquired Immunodeficiency Syndromes 3: 28–31, 1990
Hartman NR, Yarchoan R, Pluda JM, Thomas RV, Marczyk KS, et al. Pharmacokinetics of 2′,3′-dideoxyadenosine and 2′,3′-di-deoxyinosine in patients with severe acquired immunodeficiency syndrome. Clinical Pharmacology and Therapeutics 47: 647–654, 1990
Hartman NR, Yarchoan R, Pluda JM, Thomas RV, Marczyk KS, et al. Pharmacokinetics of 2′,3′-dideoxyinosine in patients with severe human immunodeficiency virus infection II: the effects of different oral formulations and the presence of other medications. Clinical Pharmacology and Therapeutics 50: 278–285, 1991
Henry K, Chinnock BJ, Quinn RP, Fletcher CV, deMiranda P, et al. Concurrent zidovudine levels in semen and serum determined by radioimmunoassay in patients with AIDS or AIDS-related complex. Journal of the American Medical Association 259: 3023–3026, 1988
Jacobson MA, deMiranda P, Cederberg DM, Burnette T, Cobb E, et al. Human pharmacokinetics and tolerance of oral ganciclovir. Antimicrobial Agents and Chemotherapy 31: 1251–1254, 1987
Johnson MA, Ahluwalia G, Connelly MC, Cooney DA, Broder S, et al. Metabolic pathways for the activation of the anti-retroviral agent 2′,3′-dideoxyadenosine in human lymphoid cells. Journal of Biological Chemistry 263: 15354–15358, 1988
Johnson MA, Fridland A. Phosphorylation of 2′,3′-dideoxyinosine by cytosolic 5′-nucleotidase of human lymphoid cells. Molecular Pharmacology 35: 291–295, 1989
Kahn JO, Lagakos SW, Richman DD, Cross A, Pettinelli C, et al. A controlled trial comparing continued zidovudine with didanosine in human immunodeficiency virus infection. New England Journal of Medicine 327: 581–587, 1992
Keller PM, Fyfe JA, Beauchamp L. Enzymatic phosphorylation of acyclic nucleoside analogs and correlations with antiherpetic activities. Biochemical Pharmacology 30: 3071–3077, 1981
Kelly JA, Litterst CL, Roth JS, Vistica DT, Poplack DG, et al. The disposition and metabolism of 2′3′-dideoxycytidine, an in vitro inhibitor of human T-lymphotrophic virus type III infectivity, in mice and monkeys. Drug Metabolism and Disposition 15: 595–601, 1987
Kinkel AW, Buchanan RA. Human Pharmacology. In Pavan-Langston et al. (Eds) Adenine arabinoside: an antiviral agent, pp. 197–204, Raven Press, New York, 1975
Klecker RW, Collins JM, Yarchoan R, Thomas R, Jenkins JF, et al. Plasma and cerebrospinal fluid pharmacokinetics of 3′-azido-3′-deoxythymidine: a novel pyrimidine analog with potential application for the treatment of patients with AIDS and related diseases. Clinical Pharmacology and Therapeutics 41: 407–412, 1987
Klecker RW, Collins JM, Yarchoan RC, Thomas R, McAtee N, et al. Pharmacokinetics of 2′,3′-dideoxycytidine in patients with AIDS and related disorders. Journal of Clinical Pharmacology 28: 837–842, 1988
Knupp CA, Shyu WC, Dolin R, Valentine FT, McLaren C, et al. Pharmacokinetics of didanosine in patients with acquired immunodeficiency syndrome or acquired immunodeficiency syndrome complex. Clinical Pharmacology and Therapeutics 49: 523–535, 1991
Knupp CA, Graziano FM, Dixon RM, Barbhaiya RH. Pharmacokinetic-interaction study of didanosine and ranitidine in patients seropositive for human immunodeficiency virus. Antimicrobial Agents and Chemotherapy 36: 2075–2079, 1992
Koenig S, Gendelmen HE, Orenstein JM, Del Canto ML, Pezeshkpour GH, et al. Detection of AIDS virus in macrophages in brain tissue from AIDS patients with encephalopathy. Science 233: 1089–1093, 1986
Kornhauser DM, Hendrix CW, Nerhood LJ, Petty BG, Woods AS, et al. Probenecid and zidovudine metabolism. Lancet 2: 473–475, 1989
Kramer TH, Gaar GG, Ray CG, Minnich L, Copeland JG, et al. Hemodialysis clearance of intravenously administered ribavirin. Antimicrobial Agents and Chemotherapy 34: 489–490, 1990
Krasny HC, Liao SH, de Miranda P. Influence of hemodialysis on acyclovir pharmacokinetics in patients with chronic renal failure. American Journal of Medicine 73 (Suppl. A): 202–204, 1982
Lake KD, Fletcher CV, Love KR, Brown DC, Joyce LD, et al. Ganciclovir pharmacokinetics during renal impairment. Antimicrobial Agents and Chemotherapy 32: 1899–1900, 1988
Lambert JS, Seidlin M, Reichman RC, Plank CS, Laverty M, et al. 2′,3′-dideoxyinosine (ddI) in patients with the acquired immunodeficiency syndrome or AIDS-related complex. New England Journal of Medicine 322: 1333–1340, 1990
Langtry HD, Campoli-Richards DM. Zidovudine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 37: 408–450, 1989
Larder BA, Darby G, Richman DD. HIV with reduced sensitivity to zidovudine (AZT) isolated during prolonged therapy. Science 243: 1731–1734, 1989
Laskin OL, de Miranda P, King DH, Page DA, Longstreth JA, et al. Effects of probenecid on the pharmacokinetics and elimination of acyclovir in humans. Antimicrobial Agents and Chemotherapy 21: 804–807, 1982a
Laskin OL, Longstreth JA, Hart CC, Scavuzzo D, Kaiman CM, et al. Ribavirin disposition in high-risk patients for acquired immunodeficiency syndrome. Clinical Pharmacology and Therapeutics 41: 546–555, 1987
Laskin OL, Longstreth JA, Whelton A, Krasny HC, Keeney RE, et al. Effect of renal failure on the pharmacokinetics of acyclovir. American Journal of Medicine 73 (Suppl. A): 197–201, 1982b
Lau RJ, Emery MG, Galinsky RE. Unexpected accumulation of acyclovir in breast milk with estimation of infant exposure. Obstetrics and Gynecology 69: 468–471, 1987
Lepage GA, Khaliq A, Gottlieb JA. Studies of 9-beta-D-arabi-nofuranosyladenine in man. Drug Metabolism and Disposition 1: 756–759, 1973
Lertora JJL, Rege AB, Lacour JT, Ferencz N, George WJ, et al. Pharmacokinetics and long term tolerance to ribavirin in asymptomatic patients infected with human immunodeficiency virus. Clinical Pharmacology and Therapeutics 50: 442–449, 1991
Lewis LD, Fowle ASE, Bittiner SB, Bye A, Isaacs PET. Human gastrointestinal absorption of acyclovir from tablet, duodenal infusion and sipped solution. British Journal of Clinical Pharmacology 21: 459–462, 1986
Lotterer E, Ruhnke M, Trautmann M, Beyer R, Bauer FE. Decreased and variable systemic availability of zidovudine in patients with AIDS if administered with a meal. European Journal of Clinical Pharmacology 40: 305–308, 1991
Lycke J, Anderson O, Svennerholm B, Appelgren L, Dahlöf C. Acyclovir concentrations in serum and cerebrospinal fluid at steady state. Journal of Antimicrobial Chemotherapy 24: 947–954, 1989
Marx JL. Drug-resistant strains of AIDS virus found. Science 243: 1551–1552, 1989
Matthews T, Boehme R. Antiviral activity and mechanism of action of ganciclovir. Reviews of Infectious Diseases 10: S490–S494, 1988
McGowan JJ, Tomaszdewski JE, Craddock J, Hoth D, Grieshaber CK, et al. Overview of the preclinical development of an antiretroviral drug, 2′3′-dideoxyinosine. Reviews of Infectious Diseases 12 (Suppl. 5): S513–S521, 1990
Merigan TC, Skowron G, Bozette SA, Richman D, Uttamchandani et al. Circulating p24 antigen levels and responses to di-deoxycytidine in human immunodeficiency virus infections: a phase I study. Annals of Internal Medicine 110: 189–194, 1989
Meyer LJ, de Miranda P, Sheth N, Spruance S. Acyclovir in human breast milk. American Journal of Obstetrics and Gynecology 158: 586–588, 1988
Miller WH, Miller RL. Phosphorylation of acyclovir (acycloguanosine) monophosphate by GMP kinase. Journal of Biological Chemistry 255: 7204–7207, 1980
Mindel A, Carney O. Acyclovir malabsorption. British Medical Journal 296: 1605, 1988
Mitsuya H, Broder S. Inhibition of the in vitro infectivity and cytopathic effect of human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) by 2′,3′-dideoxynucleosides. Proceedings of the National Academy of Sciences of the United States of America 82: 7096–7100, 1986
Mitsuya H, Broder S. Strategies for antiviral therapy in AIDS. Nature 325: 773–778, 1987
Morse GD. Zidovudine. Evans et al. (Eds) In Applied pharmacokinetics: principles of therapeutic drug monitoring, 3rd ed., Chapter 19, pp. 1–19, Applied Therapeutics Inc, Vancouver, Washington, 1992a
Morse GD, Lechner JL, Santora JA, Rozek SL. Zidovudine update: 1990. DICP: Annals of Pharmacotherapy 24: 754–760, 1990a
Morse GD, Olson J, Portmore A, Taylor C, Plank C, et al. Pharmacokinetics of orally administered zidovudine among patients with hemophilia and asymptomatic human immunodeficiency virus infection. Antiviral Research 11: 57–66, 1989
Morse GD, Portmore A, O’Donnell A, Barlos L, Plank C, et al. Prolonged elimination of zidovudine detected by radioimmunoassay. Pharmacotherapy 11: 104, 1991
Morse GD, Portmore A, Olson L, Taylor C, Plank C, et al. Multiple-dose pharmacokinetics of oral zidovudine in hemophilia patients with human immunodeficiency virus infection. Antimicrobial Agents and Chemotherapy 34: 394–397, 1990b
Morse GD, Portmore A, Olson J, Taylor C, Plask C, et al. Intravenous and oral pharmacokinetics and coagulation effects of zidovudine in asymptomatic human immunodeficiency virus-infected hemophiliac patients. Antimicrobial Agents and Chemotherapy 36: 2245–2252, 1992b
O’Brien JJ, Campoli-Richards DM. Acyclovir: an updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. Drugs 37: 233–309, 1989
O’Donnell A, Bartos L, Morse GD. Zidovudine distribution into blood components. Abstract. Pharmacotherapy 11: P–39, 1991
Page T, Connor JD. The metabolism of ribavirin in erythrocytes and nucleated cells. International Journal of Biochemistry 22: 379–383, 1990
Parke-Davis, Division of Warner Lambert Co., Vira-A package insert, 1989
Paroni R, Del Puppo M, Borght C, Sirtori CR, Gallikienle M. Pharmacokinetics of ribavirin and urinary excretion of the major metabolite 1,2,4-triazole-3-carboxamide in normal volunteers. International Journal of Clinical Pharmacology Therapeutics and Toxicology 29: 302–307, 1989
Pizzo PA, Butler K, Balis F, Brouwers E, Hawkins M, et al. Di-deoxycytidine alone and in alternating schedule with zidovudine in children with symptomatic human immunodeficiency virus infection. Journal of Pediatrics 117: 799–808, 1990
Plagemann PG, Woffendin C. Dideoxycytidine permeation and salvage by mouse leukemia cells and human erythrocytes. Biochemical Pharmacology 38: 3469–3475, 1989
Portmore A, Morse GD, Hewitt R, Reichman RC. Comparative oral disposition of zidovudine in neutropenic AIDS patients and asymptomatic hemophiliacs. Sixth International Conference on AIDS, San Francisco, Abstract SB.442, 1990
Plunkett W, Benjamin RS, Keating MJ, Freireich EJ. Modulation of 9-beta-d-arabinofuranosyladenine 5′-triphosphate in leukemic cells by 2′-deoxycoformycin during therapy with 9-beta-D-arabinofuranosyladenine. Cancer Research 42: 2092–2096, 1982
Pons JC, Boubon MC, Taburet AM, Singlas E, Chambrin V, et al. Fetoplacental passage of 2′,3′-dideoxyinosine. Lancet 1: 732, 1991
Preiksaitis JK, Lank B, Ng PK, Brox L, LePage GA, et al. Effect of liver disease on pharmacokinetics and toxicity of 9-beta-D-arabinofuranosyladenine-5′phosphate. Journal of Infectious Diseases 144: 358–364, 1981
Roberts RB, Laskin OL, Laurence J, Scavuzzo D, Murray HW, et al. Ribavirin pharmacodynamics in high-risk patients for acquired immunodeficiency syndrome. Clinical Pharmacology and Therapeutics 42: 365–373, 1987
Rolinski B, Wintergerst U, Matuschke A, Füessl, Goebel FD, et al. Evaluation of saliva as a specimen for monitoring therapy in HIV-infected patients. AIDS 5: 858–888, 1991
Sacks SL, Scullard GH, Pollard RB, Gregory PB, Robinson WS, et al. Antiviral treatment of chronic hepatitis B virus infection: pharmacokinetics and side effects of interferon and adenine arabinoside alone and in combination. Antimicrobial Agents and Chemotherapy 21: 93–100, 1982
Sattler FR, Ko R, Antoniskis D, Shields M, Cohen J, et al. Acetaminophen does not impair clearance of zidovudine. Annals of Internal Medicine 114: 937–940, 1991
Schwartz EL, Brechbühl AB, Kahl P, Miller MA, Selwyn PA, et al. Pharmacokinetic interactions of zidovudine and methadone inintravenous drug-using patients with HIV infection. Journal of Acquired Immune Deficiency Syndromes 5: 619–626, 1992
Schwartz PM, Novack J, Shipman C Jr, Drach JC. Metabolism of arabinosyladenine in herpes simplex virus-infected and uninfected cells. Biochemical Pharmacology 33: 2431–2438, 1984
Seidlin M, Iambert JS, Dolia R, Valentine FJ. Pancreatitis and pancreatic dysfunction in patients taking dideoxyinosine. AIDS 6: 831–835, 1992
Shah GM, Winer RL, Krasny HC. Acyclovir pharmacokinetics in a patient on continuous ambulatory peritoneal dialysis. American Journal of Kidney Diseases 7: 507–510, 1986
Shepp DH, Dandliker PS, deMiranda P, Burnette TC, Cederberg DM, et al. Activity of 9-[2-hydroxy-l-(hydroxymethyl) ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia. Annals of Internal Medicine 103: 368–373, 1985
Shope TC, Kauffman RE, Bowman D, Marcus EL. Pharmacokinetics of vidarabine in the treatment of infants and children with infections due to herpesviruses. Journal of Infectious Diseases 148: 721–725, 1983
Shyu WC, Kaupp CA, Pittman KA, Duakle L, Barbhaiya RH. Food-induced reduction in bioavailability of didanosine. Clinical Pharmacology and Therapeutics 50: 503–507, 1991
Singlas E, Borsa Lebas F, parent de Curzon O, Sobel, A, et al. Didanosine pharmacokinetics in patients with normal and impaired renal function: influence of hemodialysis. Antimicrobial Agents and Chemotherapy 36: 1519–1524, 1992
Singlas E, Pioger JC, Taburet AM, Colaneri S, Fillastre JP. Comparative pharmacokinetics of zidovudine (AZT) and its metabolite (G.AZT) in healthy subjects and HIV seropositive patients. European Journal of Clinical Pharmacology 36: 639–640, 1989
Singlas E, Pioger JC, Taburet AM, Colin JN, Fillastre JP. Zidovudine disposition in patients with severe renal impairment: influence of hemodialysis. Clinical Pharmacology and Therapeutics 46: 190–197, 1989
Slucher JT, Kuwahara SK, Hamzeh FM, Lewis LD, Kornhauser DM, et al. Intracellular zidovudine (ZDV) and ZDV phosphates as measured by a validated combined high-pressure liquid chromatography radioimmunoassay procedure. Antimicrobial Agents and Chemotherapy 36: 2473–2477, 1992
Smith RA. Mechanisms of action of ribavirin. In Smith RA & Kirkpatrick W (Eds) Ribavirin: a broad spectrum antiviral agent, Academy Press, New York, 1980
Sommadossi JP, Bevan R, Ling T, Lee F, Mastre B, et al. Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function. Reviews of Infectious Diseases 10 (Suppl. 3): S507–S514, 1988
Starnes MC, Cheng YC. Cellular metabolism of 2′,3′-dideoxycytidine, a compound active against human immunodeficiency virus in vitro. Journal of Biological Chemistry 262: 988–991, 1987
Steffe EM, King JH, Inciardi EJ, Flynn NF, Goldstein E, et al. The effect of acetaminophen on zidovudine metabolism in HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes 3: 691–694, 1990
Stretcher BM. State-of-the-art of zidovudine monitoring. Journal of Clinical Laboratory Analysis 5: 60–68, 1991
Stretcher BN, Pesce AJ, Geisler BA, Vine WH. A coupled HPLC/radioimmunoassay for analysis of zidovudine metabolites in mononuclear cells. Journal of Liquid Chromatography 14: 2261–2272, 1991
Stretcher BN, Pesce AJ, Wermeling JR, Hurtubise PE. In vitro measurement of phosphorylated zidovudine in peripheral blood leucocytes. Therapeutic Drug Monitoring 12: 481–489, 1990
Sullender WM, Arvin AM, Diaz PS, Connor JD, Straube R, et al. Pharmacokinetics of acyclovir suspension in infants and children. Antimicrobial Agents and Chemotherapy 31: 1722–1726, 1987
Swan SK, Munar MY, Wigger MA, Bennett WM. Pharmacokinetics of ganciclovir in a patient undergoing hemodialysis. American Journal of Kidney Diseases 17: 69–72, 1991
Ullman B, Coons T, Rockwell S, McCartan K. Genetic analysis of 2′,3′-dideoxycytidine incorporation into cultured human T lymphoblasts. Journal of Biological Chemistry 263: 12391–12396, 1988
Unadkat JD, Coller AC, Crosby S, Cummings D, Opheim KE, et al. Influence of a high fat meal on zidovudine pharmacokinetics. Journal of Acquired Immune Deficiency Syndromes 4: 229–232, 1990
Unadkat JD, Lopez AA, Schumann L. Transplacental transfer and the pharmacokinetics of zidovudine (ZDV) in the near term pregnant macaque. Proceedings of the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, p. 372, 1988
Volberding PA, Lagakos SW, Koch MA, Pettinelli C, Myers MW, et al. Zidovudine in asymptomatic human immunodeficiency virus infection. New England Journal of Medicine 322: 941–949, 1990
Wade JC, Hintz M, McGuffin RW, Springmeyer SC, Connor JD, et al. Treatment of cytomegalovirus pneumonia with high-dose acyclovir. American Journal of Medicine 73: 249–255, 1982
Watts, DH, Brown ZA, Tartaglione T, Burchett SK, Opheim K, et al. Pharmacokinetic disposition of zidovudine during pregnancy. Journal of Infectious Diseases 163: 226–232, 1991
Whitley R, Alford C, Hess F, Buchanan R. Vidarabine: a preliminary review of its pharmacological properties and therapeutic use. Drugs 20: 267–282, 1980a
Whitley RJ, Soong SJ, Hirsch MS, Karchmer AW, Dolin R, et al. NIAID Collaborative Antiviral Study Group. Herpes simplex encephalitis: vidarabine therapy and diagnostic problems. New England Journal of Medicine 304: 313–318, 1981
Whitley RJ, Tucker BC, Kinkel AW, Barton NH, Pass RF, et al. Pharmacology, tolerance, and antiviral activity of vidarabine monophosphate in humans. Antimicrobial Agents and Chemotherapy 18: 709–715, 1980b
Yarchoan R, Mitsuya H, Thomas RV, Pluda JM. In vivo activity against HIV and favorable toxicity profile of 2′,3′-dideoxyinosine. Science 245: 412–415, 1989
Yarchoan R, Thomas RV, Allain JP, McAtee N, Dubinsky R, et al. Phase I studies of 2′,3′-dideoxycytidine in severe human immunodeficiency virus infection as a single agent and alternating with zidovudine (AZT). Lancet 1: 76–80, 1988