A PBPK modeling approach for personalized dose optimization of nicardipine in renal and hepatic dysfunction.

Nicardipine is a calcium channel blocker employed to manage hypertension and angina. It is primarily metabolized in the liver; therefore, hepatic impairment patients may experience drug accumulation, potentially resulting in adverse events. This research aims to design physiologically based pharmacokinetic (PBPK) model capable of accurately predicting the exposure of nicardipine in healthy individuals as well as hepatic and renal impairment patients. An extensive literature review was conducted to retrieve relevant articles and pharmacokinetic (PK) parameters of nicardipine, for integration into the PK-Sim program. The modeling approach incepts with the development of healthy PBPK model, which is subsequently extrapolated to diseased populations to assess the alignment of anticipated and reported concentration-time profiles. The precision of the model was then evaluated through visual predictive checks, mean observed-predicted ratios, and average fold error across relevant PK parameters, which adhered to the predefined 2-fold threshold. The observed exposure of nicardipine in Child-Pugh A was found to be ~ 1.5-fold greater than in a healthy population, highlighting the necessity of dosage adjustment in the cirrhotic population. The developed PBPK models have effectively elucidated the PK alterations of nicardipine in healthy and diseased populations, thus the insights gained from these models can inform tailored dosing regimens for enhancing therapeutic efficacy.