Display options
Share it on

J Clin Pharmacol. 2021 Dec;61(12):1626-1637. doi: 10.1002/jcph.1940. Epub 2021 Aug 08.

Population Pharmacokinetics of Viloxazine Extended-Release Capsules in Pediatric Subjects With Attention Deficit/Hyperactivity Disorder.

Journal of clinical pharmacology

Azmi Nasser, Roberto Gomeni, Zhao Wang, Alisa R Kosheleff, Lanyi Xie, Lilian W Adeojo, Stefan Schwabe

Affiliations

  1. Supernus Pharmaceuticals Inc., Rockville, Maryland, USA.
  2. Pharmacometrica, Lieu-dit Longcol, La Fouillade, France.

PMID: 34269426 DOI: 10.1002/jcph.1940

Abstract

Viloxazine extended-release capsules (viloxazine ER; Qelbree) is a novel nonstimulant, recently approved by the US Food and Drug Administration for the treatment of ADHD in pediatrics. Here, we characterize the pharmacokinetics (PK) of viloxazine and its major metabolite, 5-HVLX-gluc, using a population PK model and evaluate the impact of 1-4 days of missed viloxazine ER doses on viloxazine PK. Data from 4 phase 3 trials in pediatric subjects treated with viloxazine ER were used to establish the PK model. Covariate analysis was conducted on the final base model. The impact of 1-4 days of missed doses on steady-state viloxazine PK was evaluated using Monte Carlo simulations. A 1-compartmental linear model with first-order absorption and elimination of the parent drug and first-order metabolite formation and elimination properly described the population PK of viloxazine and 5-HVLX-gluc. Body weight impacted the systemic exposure of viloxazine and 5-HVLX-gluc. Predicted PK parameters at steady state (mean ± standard deviation) in children receiving viloxazine ER were determined. C

© 2021 Supernus Pharmaceuticals, Inc. The Journal of Clinical Pharmacology published by Wiley Periodicals LLC on behalf of American College of Clinical Pharmacology.

Keywords: ADHD; SPN-812; drug holiday; pharmacokinetics; population PK; viloxazine

References

  1. Yu C, Garcia-Olivares J, Candler S, et al. New insights into the mechanism of action of viloxazine: Serotonin and norepinephrine modulating properties. J Exp Pharmacol. 2020;12:285-300. - PubMed
  2. Nasser A, Liranso T, Adewole T, et al. A phase 3, randomized, placebo-controlled trial to assess the efficacy and safety of once-daily SPN-812 (viloxazine extended release) in the treatment of ADHD in school-age children. Clin Ther. 2020;42(8):1452-1466. - PubMed
  3. Nasser A, Liranso T, Adewole T, et al. A phase 3, placebo-controlled trial of once-daily viloxazine extended-release capsules in adolescents with attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2021;41(4):370-380. - PubMed
  4. Nasser A, Liranso T, Adewole T, et al. Once-Daily SPN-812 200 and 400 mg in the treatment of ADHD in school-aged children: a phase III randomized, controlled trial. Clin Ther. 2021;43(4):684-700. - PubMed
  5. Nasser A, Liranso T, Adewole T, et al. A phase 3 placebo-controlled trial of once-daily 400-mg and 600-mg SPN-812 (viloxazine extended-release) in adolescents with ADHD. Psychopharm Bul. 2021;51(2):43-64. - PubMed
  6. Findling RL, Candler S, Nasser A, et al. Viloxazine in the management of CNS disorders: a historical overview and current status. CNS Drugs. 2021;35(6):643-653. - PubMed
  7. Nasser A, Kosheleff AR, Hull JT, et al. Evaluating the likelihood to be helped or harmed after treatment with viloxazine extended-release in children and adolescents with attention deficit/hyperactivity disorder. Int J Clin Pract. 2021;75(8):e14330. - PubMed
  8. Adli M, Baethge C, Heinz A, et al. Is dose escalation of antidepressants a rational strategy after a medium-dose treatment has failed? Eur Arch Psychiatryclin Neurosci. 2005;255(6):387-400. - PubMed
  9. Berney P. Dose-response relationship of recent antidepressants in the short-term treatment of depression. Dialogn Clin Neurosci. 2005;7(3):249. - PubMed
  10. Yu C. Metabolism and in vitro drug-drug interaction assessment of viloxazine. Xenobiotica. 2020;50(11):1285-1300. - PubMed
  11. Wang Z, Kosheleff AR, Adeojo L, et al. Impact of paroxetine, a strong CYP2D6 inhibitor, on SPN-812 (viloxazine extended-release) pharmacokinetics in healthy adults. Clin Pharmacol Drug Develop. 2021; doi: 10.1002/cpdd.948. - PubMed
  12. Wang Z, Adeojo LW, Odebo O, et al. Impact of SPN-812 (Viloxazine Extended-Release) on Select Cytochrome P450 (CYP) Activity and the Evaluation of CYP2D6 Polymorphisms on SPN-812 Pharmacokinetics. Abstract presented at: Society of Biological Psychiatry 2021; Annual Meeting; (Virtual). - PubMed
  13. Aarons L. Population pharmacokinetics: theory and practice. Brit J Clin Pharmacol. 1991;32(6):669. - PubMed
  14. Nasser A, Faison SL, Liranso T, et al. Evaluation of the effect of SPN-812 (viloxazine extended release) on QTc interval in healthy adults. J Clin Psychiatry. 2020;81(6):e1-e6. - PubMed
  15. Faison SL, Fry N, Adewole T, et al. Pharmacokinetics of co-administered viloxazine extended-release (SPN-812) and methylphenidate in healthy adults. Clin Drug Invest. 2020;41(2):149-159. - PubMed
  16. Faison SL, Fry N, Adewole T, et al. Pharmacokinetics of co-administered viloxazine extended-release (SPN-812) and lisdexamfetamine in healthy adults. J Clin Psychopharm. 2021;41(2):155-162. - PubMed
  17. Nasser A, Hull JT, Liranso T, et al. The Effect of viloxazine extended-release capsules on functional impairments associated with attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in four phase 3 placebo-controlled trials. Neuropsychiatr Dis Treat. 2021;17:1751-1762. - PubMed
  18. Vandel B, Vandel S, Jounet J, Blum D. Pharmacokinetics of viloxazine hydrochloride in man. Eur J Drug Metab Pharmacokinet. 1982;7(1):65-68. - PubMed
  19. Evans ND, Godfrey KR, Chapman MJ, Chappell MJ, Aarons L, Duffull SB. An identifiability analysis of a parent-metabolite pharmacokinetic model for ivabradine. J Pharmacokinet Pharmacodynam. 2001;28(1):93-105. - PubMed
  20. Qelbree (Viloxazine Extended-Release Capsules) [prescribing information]. Rockville, MD: Supernus Pharmaceuticals, Inc.; 2021. - PubMed
  21. Jonsson EN, Karlsson MO. Automated covariate model building within NONMEM. Pharmaceut Res. 1998;15(9):1463-1468. - PubMed
  22. R: A language and environment for statistical computing [computer program]. R Foundation for Statistical Computing; 2020. - PubMed
  23. Beal S, Sheiner LB, Boeckmann A, Bauer RJ. NONMEN user's guides (1989-2020). Ellicott City, MD: Icon Development Solutions; 2020. - PubMed
  24. Lindbom L, Pihlgren P, Jonsson EN. PsN-Toolkit-a collection of computer intensive statistical methods for non-linear mixed effect modeling using NONMEM. Comput Methods Programs Biomed. 2005;79(3):241-257. - PubMed
  25. Pisani F, Fazio A, Spina E, et al. Pharmacokinetics of the antidepressant drug viloxazine in normal subjects and in epileptic patients receiving chronic anticonvulsant treatment. Psychopharmacology. 1986;90(3):295-298. - PubMed
  26. Shyu Y-C, Lee S-Y, Yuan S-S, et al. Seasonal patterns of medications for treating attention-deficit/hyperactivity disorder: comparison of methylphenidate and atomoxetine. Clin Ther. 2016;38(3):595-602. - PubMed
  27. Ibrahim K, Vogt C, Donyai P. Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment. Child Adolesc Ment Health. 2016;21(4):192-200. - PubMed
  28. Ibrahim K, Donyai P. Drug holidays from ADHD medication: international experience over the past four decades. J Attention Dis. 2015;19(7):551-568. - PubMed
  29. Boissel J-P, Nony P. Using pharmacokinetic-pharmacodynamic relationships to predict the effect of poor compliance. Clin Pharmacokinet. 2002;41(1):1-6. - PubMed
  30. Osterberg L, Urquhart J, Blaschke T. Understanding forgiveness: minding and mining the gaps between pharmacokinetics and therapeutics. Clin Pharmacol Ther. 2010;88(4):457-459. - PubMed

Publication Types