Farmacokinetiek van methylprednisolon na intrathecale toediening van methylprednisolonacetaat bij patiënten met postherpetische neuralgie

Translated title of the contribution: Pharmacokinetics of methylprednisolone after intrathecal administration of methylprednisolone acetate in patients with postherpetic neuralgia

P. C.W. Meulenhoff, M. Rijsdijk, M. Hanje, F. T. Delbeke, M. P.H. Van Den Broek, A. F.A.M. Schobben, A. J.M. Van Wijck

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: Treatment of postherpetic neuralgia is difficult and often disappointing. One randomized controlled trial has been published in which intrathecal administration of methylprednisolone acetate was associated with high efficacy. This treatment has not gained widespread clinical acceptance. This poor acceptance might among other reasons be due to the unknown pharmacokinetic profile of methylprednisolone after intrathecal administration. The objective of this study was to determine the pharmacokinetics of methylprednisolone after intrathecal administration of methylprednisolone acetate. DESIGN: The study is a monocenter randomized controlled double-blind trial. METHODS: Patients with intractable postherpetic neuralgia were randomly assigned to receive either lidocaine with intrathecal methylprednisolone acetate or lidocaine alone. Drugs were administered once a week for four weeks. Cerebrospinal fluid samples were taken just before injection and 1, 4 and 8 weeks after the last injection. RESULTS: During 11 months 5 patients were included in the index group. Up to 59 days after injection methylprednisolone and methylprednisolone acetate were detectable in cerebrospinal fluid. Using Nonmem a one compartment population model could be calculated for methylprednisolone. A clearance of 0.084 L/h (± 12%), a distribution volume of 28 L (± 27%) and an elimination half-life of 233 h (± 29%) were found. CONCLUSION: Although safety of intrathecal methylprednisolone acetate remains uncertain, this study confirms previous results that intrathecal methylprednisolone acetate administration is possible. Five patients were treated without serious adverse events. Methylprednisolone acetate in cerebrospinal fluid is converted to methylprednisolone. A relatively long elimination half-life of 233 h was found. Additional data to validate effectiveness of intrathecal methylprednisolone acetate in the treatment of intractable postherpetic neuralgia are required.

Translated title of the contributionPharmacokinetics of methylprednisolone after intrathecal administration of methylprednisolone acetate in patients with postherpetic neuralgia
Original languageDutch
Pages (from-to)29-32
Number of pages4
JournalPharmaceutisch Weekblad
Volume146
Issue number7
Publication statusPublished - 18 Feb 2011

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