Pharmacokinetic properties of remimazolam in subjects with hepatic or renal impairment

• Published in: British journal of anaesthesia : BJA Vol. 127; no. 3; pp. 415 - 423
• Main Authors: Stöhr, Thomas, Colin, Pieter J., Ossig, Joachim, Pesic, Marija, Borkett, Keith, Winkle, Peter, Struys, Michel M.R.F., Schippers, Frank
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2021
• Subjects: benzodiazepine; hepatic impairment; pharmacokinetics; remimazolam; renal impairment; hepatic impairment; pharmacokinetics; remimazolam; benzodiazepine; renal impairment
• ISSN: 0007-0912; 1471-6771; 1471-6771
• DOI: 10.1016/j.bja.2021.05.027

Remimazolam is a new benzodiazepine for procedural sedation and general anaesthesia. The aim of this study was to characterise its pharmacokinetic properties and safety in renally and hepatically impaired subjects. Two separate trials were conducted in patients with hepatic (n=11) or renal impairment (n=11) compared with matched healthy subjects (n=9 and n=12, respectively). The hepatic impairment trial was an open-label adaptive ‘Reduced Design’ trial, using a single bolus of remimazolam 0.1 mg kg−1 i.v., whereas the renal impairment trial was an open-label trial of a single bolus dose of remimazolam 1.5 mg i.v. Remimazolam plasma concentrations over time were analysed by population pharmacokinetic modelling. Remimazolam pharmacokinetic properties were adequately described by a three-compartment, recirculatory model. Exposure in subjects with severe hepatic impairment was 38.1% higher (i.e. clearance was 38.1% lower) compared with healthy volunteers. This increase caused a slightly delayed recovery (8.0 min for healthy, 12.1 min for moderate, and 16.7 min for severe hepatic impairment). With renal impairment, plasma clearance was comparable with that measured in healthy subjects. Simulations of Cmax after a bolus dose of 10 mg showed no relevant impact of hepatic or renal impairment. The overall incidence of adverse events was low, and all adverse events were mild. As Cmax after a remimazolam bolus i.v. was not affected by hepatic or renal impairment, no dose adjustments are required. No unexpected adverse events related to remimazolam were seen in subjects with renal or hepatic impairment. Hepatic impairment trial: ClinicalTrials.gov, NCT01790607 (https://clinicaltrials.gov/ct2/show/NCT01790607). Renal impairment trial: EudraCT Number: 2014-004575-23.