Initial volume of a drug before it reaches the volume of distribution: Pharmacokinetics of F(ab′)2 antivenoms and other drugs

Fast disappearance of F(ab′)2 antivenoms from the plasma compartment [Sevcik et al., 2004. Modelling Tityus scorpion venom and antivenom pharmacokinetics. Evidence of active immunoglobulin G's F(ab′)2 extrusion mechanism from blood to tissues. Toxicon 44, 731–734; Vazquez et al., 2005. Pharmacokinetics of a F(ab′)2 scorpion antivenom in healthy human volunteers. Toxicon 46, 797–805] suggests a quick time course to reach its final distribution volume. An equation was developed to describe how the volume occupied by a drug in the body grows with time. As discussed in the paper this equation is free of some shortcomings of an equation developed for the same purpouse by Niazi [1976. Volume of distribution as a function of time. J. Pharm. Sci. 65, 452–454]. Fluorescence microscopy showed that the rapid initial decay in plasmatic F(ab′)2 concentration may be related to uptake of F(ab′)2 by vascular endothelium which, in combination with accumulation in the vascular wall connective tissue, may produce an intermediate plateau in F(ab′)2Vsl(t), which reached its final value after 10 h. The Vsl(t) equation predicts that the plasma concentration half-time of decay has little use to estimate how a drug distributes through the body to exert its action, and predicts that, in some instances, intermediate plateaus in the time course of Vsl(t) exist. Data from the literature showed that the kinetic considerations for Vsl(t) also apply to clevidipine, digoxin, digitoxin, lidocaine and thiopentone.