Physiologically-based pharmacokinetic model for Fentanyl in support of the development of Provisional Advisory Levels

- We develop a Fentanyl PBPK model for relating external dose to internal levels.
- We calibrate the model to oral and inhalation exposures using > 50 human datasets.
- Model predictions are in good agreement with the available pharmacokinetic data.
- The model can be used for extrapolating across routes, doses and exposure durations.
- We illustrate how the model can be used for developing Provisional Advisory Levels.

Provisional Advisory Levels (PALs) are tiered exposure limits for toxic chemicals in air and drinking water that are developed to assist in emergency responses. Physiologically-based pharmacokinetic (PBPK) modeling can support this process by enabling extrapolations across doses, and exposure routes, thereby addressing gaps in the available toxicity data. Here, we describe the development of a PBPK model for Fentanyl - a synthetic opioid used clinically for pain management - to support the establishment of PALs. Starting from an existing model for intravenous Fentanyl, we first optimized distribution and clearance parameters using several additional IV datasets. We then calibrated the model using pharmacokinetic data for various formulations, and determined the absorbed fraction, F, and time taken for the absorbed amount to reach 90% of its final value, t90. For aerosolized pulmonary Fentanyl, F = 1 and t90 < 1 min indicating complete and rapid absorption. The F value ranged from 0.35 to 0.74 for oral and various transmucosal routes. Oral Fentanyl was absorbed the slowest (t90 ~ 300 min); the absorption of intranasal Fentanyl was relatively rapid (t90 ~ 20-40 min); and the various oral transmucosal routes had intermediate absorption rates (t90 ~ 160-300 min). Based on these results, for inhalation exposures, we assumed that all of the Fentanyl inhaled from the air during each breath directly, and instantaneously enters the arterial circulation. We present model predictions of Fentanyl blood concentrations in oral and inhalation scenarios relevant for PAL development, and provide an analytical expression that can be used to extrapolate between oral and inhalation routes for the derivation of PALs.