Chemistry Reference
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Figure 7.1 Time course of CNS effect following oral dosing.
(8-43 L kg 1 ), resulting in long elimination half-lives (16 to 430 h) and slow
time to maximal compound concentration (T max ) (typically 4-8 h after oral
dosing). 11 Oral CNS microdialysis studies in rodents conducted at Pfizer
demonstrated that systemic T max broadly correlated with time to peak central
5-HT levels, as shown for fluoxetine in Figure 7.1, 12 suggesting that reducing
T max could lead to more rapid elevation in central 5-HT, consistent with our
goal of achieving rapid onset of effect.
The delayed T max of lipophilic amines such as the SSRIs has been explained
as being due to the extensive distribution of high V D compounds into the liver
after they are absorbed, 13 which results in a slow hepatic transit time. Targeting
compounds with lower V D should therefore lead to compounds with more rapid
T max . As the half-life of a compound in vivo is described by eqn (7.1), where Cl P
is plasma clearance, reducing the V D would also help achieve a shorter t 1/2 : 14
t 1=2 ¼ 0:693 V D
Cl P
ð 7:1 Þ
Another way of decreasing the half-life is to increase clearance, but there is a
limit to how high the clearance can be without adversely affecting bioavailability
(F), as shown by eqn (7.2) (Cl H is hepatic clearance and Q h is hepatic blood flow):
F ¼ 1 Cl H
Q h
ð 7:2 Þ
Using these equations helped us set a realistic target for both volume of distri-
bution and clearance. Aiming for a minimum oral bioavailability of 50% and
assuming a compound is fully absorbed and mainly cleared by the liver
(Cl P ¼ Cl H ) provides a maximum acceptable clearance number of 10mL
min 1 kg 1 (taking a liver blood flow value of 20mLmin 1 kg 1 for man). Using
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