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Pharmacokinetics of nelfinavir in human immunodeficiency virus-infected infants

CAPPARELLI, EDMUND V. PHARMD; SULLIVAN, JOHN L. MD; MOFENSON, LYNNE MD; SMITH, ELIZABETH MD; GRAHAM, BOBBIE BS; BRITTO, PAULA MS; BECKER, MARK I. PHARMD; HOLLAND, DIANNE MPHIL; CONNOR, JAMES D. MD; LUZURIAGA, KATHERINE MD; AND THE PEDIATRIC ACTG 356 INVESTIGATORS

Pediatric Infectious Disease Journal: August 2001 - Volume 20 - Issue 8 - pp 746-751
Original Studies

Background. Nelfinavir dosed at ∼20 to 30 mg/kg three times a day (TID) in older children provides exposure similar to 750 mg TID in adults. However, the pharmacokinetics (PK) of nelfinavir in infants who are <2 years of age is not well-described. The objective of this study was to determine the pharmacokinetics of nelfinavir in infants <2 years of age.

Methods. Nelfinavir concentrations were evaluated in 22 HIV-infected infants between 15 days and 2 years of age receiving nelfinavir as part of Pediatric ACTG Study 356. Nelfinavir therapy was initiated at ∼25 mg/kg TID (n = 18) or ∼55 mg/kg twice a day (n = 4) and given in combination with nevirapine, stavudine and lamivudine. PK samples were obtained predose and 1.5 and 4 h postdose at ∼6-month intervals. Eight infants (all ≤3 months of age) also had intensive PK samples collected at Week 1.

Results. The median apparent clearance in the infants with intensive pharmacokinetic sampling was 2.7 liters/h/kg (range, 1.8 to ≥10) and was similar between twice a day and TID dosing cohorts. Overall nelfinavir concentrations at all collection times were lower in these infants than previously reported in older pediatric patients.

Conclusions. Nelfinavir concentrations in infants are highly variable and lower than those seen in adult or older pediatric populations receiving labeled dosing. Therefore it is necessary to further evaluate nelfinavir safety, effectiveness and pharmacokinetics at higher doses than used among other pediatric populations.

From the Departments of Pediatrics (EVC, DH, JCD) and Pharmacy II (EVC), University of California, San Diego, La Jolla, CA; the Departments of Pediatrics and Molecular Medicine, University of Massachusetts, Worcester, MA (JLS, KL); National Institute of Child Health and Human Development (LM) and National Institute of Allergy and Infectious Diseases (ES) , National Institutes of Health, Bethesda, MD; Frontier Science and Technology Research Foundation, Inc., Amherst, NY (BG); Statistical Data Analysis Center, Harvard School of Public Health, Boston, MA (PB); and Agouron Pharmaceuticals Inc., La Jolla, CA (MIB).

Accepted for publication March 30, 2001.

Reprints not available.

© 2001 Lippincott Williams & Wilkins, Inc.