Famciclovir clinical pharmacology

# Clinical Pharmacology

## Pharmacokinetic
Famciclovir is the diacetyl 6-deoxy analog of the active antiviral compound Penciclovir. Following oral administration famciclovir undergoes rapid and extensive metabolism to Penciclovir and little or no famciclovir is detected in plasma or urine. Penciclovir is predominantly eliminated unchanged by the kidney. Therefore, the dose of FAMVIR needs to be adjusted in patients with different degrees of renal impairment .

### Pharmacokinetics in adults
Absorption and Bioavailability: The absolute bioavailability of Penciclovir is 77  8% as determined following the administration of a 500 mg famciclovir oral dose and a 400 mg Penciclovir intravenous dose to 12 healthy male subjects.
Penciclovir concentrations increased in proportion to dose over a famciclovir dose range of 125 mg to 1000 mg administered as a single dose. Table 5 shows the mean pharmacokinetic parameters of Penciclovir after single administration of FAMVIR to healthy male volunteers.
Following oral single-dose administration of 500 mg famciclovir to 7 patients with herpes zoster, the AUC (mean  SD), Cmax, and tmax were 12.11.7 mcg hr/mL, 4.00.7 mcg/mL, and 0.70.2 hours, respectively. The AUC of Penciclovir was approximately 35% greater in patients with herpes zoster as compared to healthy volunteers. Some of this difference may be due to differences in renal function between the 2 groups.
There is no accumulation of Penciclovir after the administration of 500 mg famciclovir three times daily for 7 days.
Penciclovir Cmax decreased approximately 50% and tmax was delayed by 1.5 hours when a capsule formulation of famciclovir was administered with food (nutritional content was approximately 910 Kcal and 26% fat). There was no effect on the extent of availability (AUC) of Penciclovir. There was an 18% decrease in Cmax and a delay in tmax of about 1 hour when famciclovir was given 2 hours after a meal as compared to its administration 2 hours before a meal. Because there was no effect on the extent of systemic availability of Penciclovir, FAMVIR can be taken without regard to meals.
Distribution: The volume of distribution (Vd) was 1.080.17 L/kg in 12 healthy male subjects following a single intravenous dose of Penciclovir at 400 mg administered as a 1-hour intravenous infusion. Penciclovir is <20% bound to plasma proteins over the concentration range of 0.1 to 20 mcg/mL. The blood/plasma ratio of Penciclovir is approximately 1.
Metabolism: Following oral administration, famciclovir is deacetylated and oxidized to form Penciclovir. Metabolites that are inactive include 6-deoxy Penciclovir, monoacetylated Penciclovir, and 6-deoxy monoacetylated Penciclovir (5%, <0.5% and <0.5% of the dose in the urine, respectively). Little or no famciclovir is detected in plasma or urine. An in vitro study using human liver microsomes demonstrated that cytochrome P450 does not play an important role in famciclovir metabolism. The conversion of 6-deoxy Penciclovir to Penciclovir is catalyzed by aldehyde oxidase. Cimetidine and promethazine, in vitro inhibitors of aldehyde oxidase, did not show relevant effects on the formation of Penciclovir in vivo .
Elimination: Approximately 94% of administered radioactivity was recovered in urine over 24 hours (83% of the dose was excreted in the first 6 hours) after the administration of 5 mg/kg radiolabeled Penciclovir as a 1-hour infusion to 3 healthy male volunteers. Penciclovir accounted for 91% of the radioactivity excreted in the urine.
Following the oral administration of a single 500 mg dose of radiolabeled famciclovir to 3 healthy male volunteers, 73% and 27% of administered radioactivity were recovered in urine and feces over 72 hours, respectively. Penciclovir accounted for 82% and 6-deoxy Penciclovir accounted for 7% of the radioactivity excreted in the urine. Approximately 60% of the administered radiolabeled dose was collected in urine in the first 6 hours.
After intravenous administration of Penciclovir in 48 healthy male volunteers, mean  SD total plasma clearance of Penciclovir was 36.66.3 L/hr (0.480.09 L/hr/kg). Penciclovir renal clearance accounted for 74.58.8% of total plasma clearance.
Renal clearance of Penciclovir following the oral administration of a single 500 mg dose of famciclovir to 109 healthy male volunteers was 27.77.6 L/hr. Active tubular secretion contributes to the renal elimination of Penciclovir.
The plasma elimination half-life of Penciclovir was 2.00.3 hours after intravenous administration of Penciclovir to 48 healthy male volunteers and 2.30.4 hours after oral administration of 500 mg famciclovir to 124 healthy male volunteers. The half-life in 17 patients with herpes zoster was 2.81.0 hours and 2.71.0 hours after single and repeated doses, respectively.

### Special populations
Geriatric patients: Based on cross study comparison, Penciclovir AUC was 40% higher and Penciclovir renal clearance was 22% lower in elderly subjects (n=18, age 65-79 years) as compared with younger subjects. Some of this difference may be due to differences in renal function between the 2 groups. No famciclovir dosage adjustment based on age is recommended unless renal function is impaired 
Patients with renal impairment: In subjects with varying degrees of renal impairment, apparent plasma clearance, renal clearance, and the plasma-elimination rate constant of Penciclovir decreased linearly with reductions in renal function, after both single and repeated dosing . A dosage adjustment is recommended for patients with renal impairment .
Patients with hepatic impairment: Mild or moderate hepatic impairment had no effect on the extent of availability (AUC) of Penciclovir . No dosage adjustment is recommended for patients with mild or moderate hepatic impairment. The effect of severe hepatic impairment on the pharmacokinetics of Penciclovir has not been evaluated.
HIV-infected patients: Following oral administration of a single dose of 500 mg famciclovir to HIV-positive patients, the pharmacokinetic parameters of Penciclovir were comparable to those observed in healthy subjects.
Gender: The pharmacokinetics of Penciclovir were evaluated in 18 healthy male and 18 healthy female volunteers after single-dose oral administration of 500 mg famciclovir. AUC of Penciclovir was 9.31.9 mcg hr/mL and 11.12.1 mcg hr/mL in males and females, respectively. Penciclovir renal clearance was 28.58.9 L/hr and 21.84.3 L/hr, respectively. These differences were attributed to differences in renal function between the 2 groups. No famciclovir dosage adjustment based on gender is recommended.
Race: A retrospective evaluation was performed to compare the pharmacokinetic parameters obtained in black and Caucasian subjects after single and repeat once-daily, twice-daily, or three times-daily administration of famciclovir 500 mg. Data from a study in healthy volunteers (single dose), a study in subjects with varying degrees of renal impairment (single and repeat dose) and a study in subjects with hepatic impairment (single dose) did not indicate any significant differences in the pharmacokinetics of Penciclovir between black and Caucasian subjects.