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Study Protocol for a Pilot, Open-Label, Prospective, and Observational Study to Evaluate the Pharmacokinetics of Drugs Administered to Patients during Extracorporeal Circulation; Potential of In Vivo Cytochrome P450 Phenotyping to Optimise Pharmacotherapy

1
Centre for Integrated Preclinical Drug Development, School of Biomedical Sciences, Faculty of Medicine, University of Queensland, 4072 Brisbane, Australia
2
Adult Intensive Care Services, The Prince Charles Hospital, 4032 Chermside, Australia
3
Critical Care Research Group, The Prince Charles Hospital, 4032 Chermside, Australia
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Department of Cardiothoracic Surgery, The Prince Charles Hospital, 4032 Chermside, Australia
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Department of Anesthesia, The Prince Charles Hospital, 4032 Chermside, Australia
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School of Pharmacy, Faculty of Health and Behavioral Sciences, The University of Queensland, 4072 Brisbane, Australia
*
Author to whom correspondence should be addressed.
Methods Protoc. 2019, 2(2), 38; https://doi.org/10.3390/mps2020038
Received: 25 February 2019 / Revised: 5 May 2019 / Accepted: 7 May 2019 / Published: 13 May 2019
Pharmacokinetic alterations of medications administered during surgeries involving cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) have been reported. The impact of CPB on the cytochrome P450 (CYP) enzymes’ activity is the key factor. The metabolic rates of caffeine, dextromethorphan, midazolam, omeprazole, and Losartan to the CYP-specific metabolites are validated measures of in vivo CYP 1A2, 2D6, 3A4, 2C19, and 2C9 activities, respectively. The study aim is to assess the activities of major CYPs in patients on extracorporeal circulation (EC). This is a pilot, prospective, open-label, observational study in patients undergoing surgery using EC and patients undergoing laparoscopic cholecystectomy as a control group. CYP activities will be measured on the day, and 1–2 days pre-surgery/3–4 days post-surgery (cardiac surgery and Laparoscopic cholecystectomy) and 1–2 days after starting ECMO, 1–2 weeks after starting ECMO, and 1–2 days after discontinuation from ECMO. Aforementioned CYP substrates will be administered to the patient and blood samples will be collected at 0, 1, 2, 4, and 6 h post-dose. Major CYP enzymes’ activities will be compared in each participant on the day, and before/after surgery. The CYP activities will be compared in three study groups to investigate the impact of CYPs on EC. View Full-Text
Keywords: extracorporeal circulation; extracorporeal membrane oxygenation; cardiopulmonary bypass; cytochrome P450 (CYP), CYP phenotyping extracorporeal circulation; extracorporeal membrane oxygenation; cardiopulmonary bypass; cytochrome P450 (CYP), CYP phenotyping
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Adiraju, S.K.S.; Shekar, K.; Tesar, P.; Naidoo, R.; Rapchuk, I.; Belz, S.; Fraser, J.F.; Smith, M.T.; Ghassabian, S. Study Protocol for a Pilot, Open-Label, Prospective, and Observational Study to Evaluate the Pharmacokinetics of Drugs Administered to Patients during Extracorporeal Circulation; Potential of In Vivo Cytochrome P450 Phenotyping to Optimise Pharmacotherapy. Methods Protoc. 2019, 2, 38.

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