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90
EDITED BY
SARA E. ROSENBAUM
Heart Rate (bpm)
70 SECOND EDITION
50
0 10 20 30 40 50
C (mcg/L)
Dose 1 Dose 2
CONTENTS
Preface xix
Contributors xxi
4 Drug Distribution 71
Sara E. Rosenbaum
4.1 Introduction, 72
4.2 Extent of Drug Distribution, 72
4.2.1 Distribution Volumes, 74
CONTENTS ix
xix
xx PREFACE
interaction (DDI) risk using in vitro data. These models are used increasingly by pharma-
ceutical companies and drug regulators to try to reduce the large health risks and costs posed
by DDIs. While not all readers of the book will need to apply these models profession-
ally, an understanding of this topic will allow students to better understand and appreciate
the mechanism, characteristics, and varied outcome of DDIs. Finally, in order to provide
interested students with a foundation to this latter chapter, the second edition includes an
appendix on basic enzyme kinetics and the mathematical basis of the predictive models.
My colleague at the College of Pharmacy, Dr. Roberta King, an expert in drug metabolism,
collaborated in the preparation of this material. Each of the new chapters is supported by
new interactive computer models.
It is hoped that the second edition of this textbook provides a comprehensive and thor-
ough presentation of all essential topics in the contemporary application of pharmacoki-
netics and pharmacodynamics. While not all chapters will be necessary for the immediate
needs of all audiences, collectively the book should serve as a valuable reference for the
future.
I would like to thank the many scientists who generously gave of their time and provided
me with information and input in many areas. I would especially like to thank Dr. Karthik
Venkatakrishnan for his valuable input on the chapter on predictive models for DDIs. I
would also like to thank and recognize the wonderful work of Pragati Nahar who prepared
the custom color figures in the book, including the figure used on the cover. I would also
like to thank many undergraduate and graduate students at URI who helped in a variety
of ways especially Jamie Chung who provided valuable support for the preparation of the
materials, and Benjamin Barlock and Rohitash Jamwal for their input in the creation of the
simulation models. Finally, I would like to thank Jonathan Rose at Wiley for his patience,
understanding, and responsiveness in the preparation of this edition.
CONTRIBUTORS
Paul Hutson Paul Hutson, whose baccalaureate and master’s degrees are in biochem-
istry and chemistry, respectively, completed an oncology/pharmacokinetics fellowship at
St. Jude Children’s Research Hospital in Memphis. He was a Faculty Member at the Uni-
versity of Illinois for 5 years before moving to the University of Wisconsin School of Phar-
macy in Madison in 1988. He now practices pharmacy with the oncology and palliative
care group at the UW Hospital and Clinics and is an Associate Member of the UW Car-
bone Cancer Center. His three course offerings at the School of Pharmacy are Clinical Phar-
macokinetics, Pediatric Pharmacotherapy, and Dietary Supplements, and he supervises an
Advanced Pharmacy Practice Experience (APPE) in basic pharmacometrics. Dr. Hutson
xxi
xxii CONTRIBUTORS
Dr. Mould Dr. Mould obtained her bachelors degree at Stevens Institute of Technology
in 1984 in Chemistry and Chemical Biology. She received her Ph.D. in Pharmaceutics
and Pharmaceutical Chemistry at The Ohio State University (OSU) in 1989. She spent
26 years as a pharmacokineticist in industry where she specialized in population pharma-
cokinetic/pharmacodynamic modeling and was an Associate Research Professor at George-
town University. She has conducted population PK/PD analyses of hematopoietic agents,
monoclonal antibodies, anticancer and antiviral agents, antipsychotic, cardiovascular, and
sedative/hypnotic agents. Dr Mould is involved in clinical trial simulation and optimal study
design in drug development. She was a member of the Scientific Advisory Group for Phar-
Sight, where she assisted in development of clinical trial simulation software.
Currently, Dr Mould is President of Projections Research Inc., a consulting company
offering pharmacokinetic and pharmacometric services. She is also the founder of iDose
LLC, a company that develops systems to individualize doses of drugs that are difficult to
manage. She has published 62 peer-reviewed articles, 16 book chapters, made 97 national
and international presentations, and presented six podium sessions on advanced modeling
and simulation approaches. Dr Mould has authored 97 posters at both national and interna-
tional meetings. She is an Adjunct Professor at the University of Rhode Island (URI), OSU,
and the University of Florida, and teaches an annual class on disease progression modeling
at the National Institutes of Health. Dr Mould taught nine courses (OSU, URI, and SUNY
Buffalo) on specialized aspects of population pharmacokinetic and dynamic modeling. She
is a member of the editorial board for Journal of Pharmacokinetics and Pharmacodynam-
ics, Clinical Pharmacology and Therapeutics, and Clinical Pharmacology and Therapeu-
tics Pharmacometrics and Systems Pharmacology. Dr. Mould is a member of the Board
of Regents for the American College of Clinical Pharmacology and is a Chairman of the
Publications committee for this organization. She is a Fellow of the American College of
Clinical Pharmacology and the American Association of Pharmaceutical Sciences.
Steven C. Sutton Steven (Steev) C. Sutton, B.S. Pharmacy, Ph.D., University of New
England, Portland, Maine Dr. Sutton is an Associate Professor and Chair of Pharmaceu-
tics, College of Pharmacy, University of New England in Portland, Maine. He received his
B.S. in Pharmacy from Massachusetts College of Pharmacy and a Ph.D. in Pharmaceutical
Sciences from the State University of New York at Buffalo, New York. Dr Sutton began
his career in the pharmaceutical industry working for CIBA-Geigy in Ardsley, NY (now
Novartis), for INTERx in Lawrence, KS (then a part of Merck), and for Pfizer in Groton, CT,
before embarking in a second career—that of academia—at the University of New England
College of Pharmacy in Portland in 2009. Dr. Sutton founded the AAPS Oral Absorption
Focus Group and in 2003, he became a Fellow of the AAPS. His research interests include
predicting active pharmaceutical ingredient concentration–time profile in human after oral
administration from chemical structure, modeling, and simulation of oral absorption of low
permeability and/or low aqueous soluble compounds, in vitro—in vivo correlation of orally
CONTRIBUTORS xxiii
Illustrator: Ed Emshwiller
Language: English
Illustrated by Emsh
The arrival bell clanged, and Huyghens jerked up his head to stare at
it. Semper, the eagle, opened icy eyes. He blinked.
Noises. There was a long, deep, contented snore from below.
Something shrieked, out in the jungle. Hiccups. Clatterings, and
organ notes—
The bell clanged again. It was a notice that a ship aloft somewhere
had picked up the beacon beam—which only Kodius Company ships
should know about—and was communicating for a landing. But there
shouldn't be any ships in this solar system just now! This was the only
habitable planet of the sun, and it had been officially declared
uninhabitable by reason of inimical animal life. Which meant sphexes.
Therefore no colony was permitted, and the Kodius Company broke
the law. And there were few graver crimes than unauthorized
occupation of a new planet.
The bell clanged a third time. Huyghens swore. His hand went out to
cut off the beacon—but that would be useless. Radar would have
fixed it and tied it in with physical features like the nearby sea and the
Sere Plateau. The ship could find the place, anyhow, and descend by
day-light.
"The devil!" said Huyghens. But he waited yet again for the bell to
ring. A Kodius Company ship would double-ring to reassure him. But
there shouldn't be a Kodius Company ship for months.
The bell clanged singly. The space phone dial flickered and a voice
came out of it, tinny from stratospheric distortion:
"Calling ground! Calling ground! Crete Line ship Odysseus calling
ground on Loren Two. Landing one passenger by boat. Put on your
field lights."
Huyghens' mouth dropped open. A Kodius Company ship would be
welcome. A Colonial Survey ship would be extremely unwelcome,
because it would destroy the colony and Sitka and Sourdough and
Faro Nell and Nugget—and Semper—and carry Huyghens off to be
tried for unauthorized colonization and all that it implied.
But a commercial ship, landing one passenger by boat—There were
simply no circumstances under which that would happen. Not to an
unknown, illegal colony. Not to a furtive station!
Huyghens flicked on the landing-field lights. He saw the glare in the
field outside. Then he stood up and prepared to take the measures
required by discovery. He packed the paper work he'd been doing
into the disposal safe. He gathered up all personal documents and
tossed them in. Every record, every bit of evidence that the Kodius
Company maintained this station went into the safe. He slammed the
door. He touched his finger to the disposal button, which would
destroy the contents and melt down even the ashes past their
possible use for evidence in court.
Then he hesitated. If it were a Survey ship, the button had to be
pressed and he must resign himself to a long term in prison. But a
Crete Line ship—if the space phone told the truth—was not
threatening. It was simply unbelievable.
He shook his head. He got into travel garb and armed himself. He
went down into the bear quarters, turning on lights as he went. There
were startled snufflings and Sitka Pete reared himself very absurdly
to a sitting position to blink at him. Sourdough Charley lay on his back
with his legs in the air. He'd found it cooler, sleeping that way. He
rolled over with a thump. He made snorting sounds which somehow
sounded cordial. Faro Nell padded to the door of her separate
apartment—assigned her so that Nugget would not be under-foot to
irritate the big males.
Huyghens, as the human population of Loren Two, faced the work
force, fighting force, and—with Nugget—four-fifths of the terrestrial
nonhuman population of the planet. They were mutated Kodiak
bears, descendants of that Kodius Champion for whom the Kodius
Company was named. Sitka Pete was a good twenty-two hundred
pounds of lumbering, intelligent carnivore. Sourdough Charley would
weigh within a hundred pounds of that figure. Faro Nell was eighteen
hundred pounds of female charm—and ferocity. Then Nugget poked
his muzzle around his mother's furry rump to see what was toward,
and he was six hundred pounds of ursine infancy. The animals looked
at Huyghens expectantly. If he'd had Semper riding on his shoulder,
they'd have known what was expected of them.
"Let's go," said Huyghens. "It's dark outside, but somebody's coming.
And it may be bad!"
He unfastened the outer door of the bear quarters. Sitka Pete went
charging clumsily through it. A forth-right charge was the best way to
develop any situation—if one was an oversized male Kodiak bear.
Sourdough went lumbering after him. There was nothing hostile
immediately outside. Sitka stood up on his hind legs—he reared up a
solid twelve feet—and sniffed the air. Sourdough methodically
lumbered to one side and then the other, sniffing in his turn. Nell
came out, nine-tenths of a ton of daintiness, and rumbled
admonitorily at Nugget, who trailed her closely. Huyghens stood in
the doorway, his night-sighted gun ready. He felt uncomfortable at
sending the bears ahead into a Loren Two jungle at night. But they
were qualified to scent danger, and he was not.
The illumination of the jungle in a wide path toward the landing field
made for weirdness in the look of things. There were arching giant
ferns and columnar trees which grew above them, and the
extraordinary lanceolate underbrush of the jungle. The flood lamps,
set level with the ground, lighted everything from below. The foliage,
then, was brightly lit against the black night-sky—brightly lit enough to
dim-out the stars. There were astonishing contrasts of light and
shadow everywhere.
"On ahead!" commanded Huyghens, waving. "Hup!"
He swung the bear-quarters door shut. He moved toward the landing
field through the lane of lighted forest. The two giant male Kodiaks
lumbered ahead. Sitka Pete dropped to all fours and prowled.
Sourdough Charley followed closely, swinging from side to side.
Huyghens came alertly behind the two of them, and Faro Nell brought
up the rear with Nugget following her closely.
It was an excellent military formation for progress through dangerous
jungle. Sourdough and Sitka were advance-guard and point,
respectively, while Faro Nell guarded the rear. With Nugget to look
after, she was especially alert against attack from behind. Huyghens
was, of course, the striking force. His gun fired explosive bullets
which would discourage even sphexes, and his night-sight—a cone of
light which went on when he took up the trigger-slack—told exactly
where they would strike. It was not a sportsmanlike weapon, but the
creatures of Loren Two were not sportsmanlike antagonists. The
night-walkers, for example—But night-walkers feared light. They
attacked only in a species of hysteria if it were too bright.
Huyghens moved toward the glare at the landing field. His mental
state was savage. The Kodius Company station on Loren Two was
completely illegal. It happened to be necessary, from one point of
view, but it was still illegal. The tinny voice on the space phone was
not convincing, in ignoring that illegality. But if a ship landed,
Huyghens could get back to the station before men could follow, and
he'd have the disposal safe turned on in time to protect those who'd
sent him here.
But he heard the faraway and high harsh roar of a landing-boat rocket
—not a ship's bellowing tubes—as he made his way through the
unreal-seeming brush. The roar grew louder as he pushed on, the
three big Kodiaks padding here and there, sniffing thoughtfully,
making a perfect defensive-offensive formation for the particular
conditions of this planet.
He reached the edge of the landing field, and it was blindingly bright,
with the customary divergent beams slanting skyward so a ship could
check its instrument landing by sight. Landing fields like this had been
standard, once upon a time. Nowadays all developed planets had
landing grids—monstrous structures which drew upon ionospheres
for power and lifted and drew down star ships with remarkable
gentleness and unlimited force. This sort of landing field would be
found where a survey-team was at work, or where some strictly
temporary investigation of ecology or bacteriology was under way, or
where a newly authorized colony had not yet been able to build its
landing grid. Of course it was unthinkable that anybody would attempt
a settlement in defiance of the law!
Already, as Huyghens reached the edge of the scorched open space,
the night-creatures had rushed to the light like moths on Earth. The
air was misty with crazily gyrating, tiny flying things. They were
innumerable and of every possible form and size, from the white
midges of the night and multi-winged flying worms to those revoltingly
naked-looking larger creatures which might have passed for plucked
flying monkeys if they had not been carnivorous and worse. The
flying things soared and whirred and danced and spun insanely in the
glare. They made peculiarly plaintive humming noises. They almost
formed a lamp-lit ceiling over the cleared space. They did hide the
stars. Staring upward, Huyghens could just barely make out the blue-
white flame of the space-boat's rocket through the fog of wings and
bodies.
"Hah!" said the just-landed man. "Where are the robots? What in all
the nineteen hells are these creatures? Why did you shift your
station? I'm Roane, here to make a progress report on your colony."
Huyghens said:
"What colony?"
"Loren Two Robot Installation—" Then Roane said indignantly, "Don't
tell me that that idiot skipper dropped me at the wrong place! This is
Loren Two, isn't it? And this is the landing field. But where are your
robots? You should have the beginning of a grid up! What the devil's
happened here and what are these beasts?"
Huyghens grimaced.
"This," he said politely, "is an illegal, unlicensed settlement. I'm a
criminal. These beasts are my confederates. If you don't want to
associate with criminals you needn't, of course, but I doubt if you'll
live till morning unless you accept my hospitality while I think over
what to do about your landing. In reason, I ought to shoot you."
Faro Nell came to a halt behind Huyghens, which was her proper
post in all out-door movement. Nugget, however, saw a new human.
Nugget was a cub, and, therefore, friendly. He ambled forward
ingratiatingly. He was four feet high at the shoulders, on all fours. He
wriggled bashfully as he approached Roane. He sneezed, because
he was embarrassed.
His mother overtook him swiftly and cuffed him to one side. He
wailed. The wail of a six-hundred-pound Kodiak bear-cub is a
remarkable sound. Roane gave ground a pace.
"I think," he said carefully, "that we'd better talk things over. But if this
is an illegal colony, of course you're under arrest and anything you
say will be used against you."
Huyghens grimaced again.
"Right," he said. "But now if you'll walk close to me, we'll head back to
the station. I'd have Sourdough carry your bag—he likes to carry
things—but he may need his teeth. We've half a mile to travel." He
turned to the animals. "Let's go!" he said commandingly. "Back to the
station! Hup!"
Grunting, Sitka Pete arose and took up his duties as advanced point
of a combat team. Sourdough trailed, swinging widely to one side and
another. Huyghens and Roane moved together. Faro Nell and Nugget
brought up the rear. Which, of course, was the only relatively safe
way for anybody to travel on Loren Two, in the jungle, a good half
mile from one's fortress-like residence.
But there was only one incident on the way back. It was a night-
walker, made hysterical by the lane of light. It poured through the
underbrush, uttering cries like maniacal laughter.
Sourdough brought it down, a good ten yards from Huyghens. When
it was all over, Nugget bristled up to the dead creature, uttering cub-
growls. He feigned to attack it.
His mother whacked him soundly.
II
There were comfortable, settling-down noises below. The bears
grunted and rumbled, but ultimately were still. The glare from the
landing field was gone. The lighted lane through the jungle was dark
again. Huyghens ushered the man from the space boat up into his
living quarters. There was a rustling stir, and Semper took his head
from under his wing. He stared coldly at the two humans. He spread
monstrous, seven-foot wings and fluttered them. He opened his beak
and closed it with a snap.
"That's Semper," said Huyghens. "Semper Tyrannis. He's the rest of
the terrestrial population here. Not being a fly-by-night sort of
creature, he didn't come out to welcome you."
Roane blinked at the huge bird, perched on a three-inch-thick perch
set in the wall.
"An eagle?" he demanded. "Kodiak bears—mutated ones you say,
but still bears—and now an eagle? You've a very nice fighting unit in
the bears."
"They're pack animals, too," said Huyghens. "They can carry some
hundreds of pounds without losing too much combat efficiency. And
there's no problem of supply. They live off the jungle. Not sphexes,
though. Nothing will eat a sphex, even if it can kill one."
He brought out glasses and a bottle. He indicated a chair. Roane put
down his traveling bag. He took a glass.
"I'm curious," he observed. "Why Semper Tyrannis? I can understand
Sitka Pete and Sourdough Charley as names. The home of their
ancestors makes them fitting. But why Semper?"
"He was bred for hawking," said Huyghens. "You sic a dog on
something. You sic Semper Tyrannis. He's too big to ride on a
hawking glove, so the shoulders of my coats are padded to let him
ride there. He's a flying scout. I've trained him to notify us of sphexes,
and in flight he carries a tiny television camera. He's useful, but he
hasn't the brains of the bears."
Roane sat down and sipped at his glass.
"Interesting ... very interesting! But this is an illegal settlement. I'm a
Colonial Survey officer. My job is reporting on progress according to
plan, but nevertheless I have to arrest you. Didn't you say something
about shooting me?"
Huyghens said doggedly:
"I'm trying to think of a way out. Add up all the penalties for illegal
colonization and I'd be in a very bad fix if you got away and reported
this set-up. Shooting you would be logical."
"I see that," said Roane reasonably. "But since the point has come up
—I have a blaster trained on you from my pocket."
Huyghens shrugged.
"It's rather likely that my human confederates will be back here before
your friends. You'd be in a very tight fix if my friends came back and
found you more or less sitting on my corpse."
Roane nodded.
"That's true, too. Also it's probable that your fellow terrestrials
wouldn't co-operate with me as they have with you. You seem to have
the whip hand, even with my blaster trained on you. On the other
hand, you could have killed me quite easily after the boat left, when
I'd first landed. I'd have been quite unsuspicious. So you may not
really intend to murder me."
Huyghens shrugged again.
"So," said Roane, "since the secret of getting along with people is that
of postponing quarrels—suppose we postpone the question of who