Comparison of the pharmacokinetics of diazepam after single and subchronic doses

In seven healthy male volunteers the effects of the pattern of dosing on the pharmacokinetics of diazepam have been studied. A cross-over design was employed that consisted of three parts: a single intravenous dose (0.1 mg/kg), and oral dosing (10 mg/day) for six days followed by an intravenous bolus (0.1 mg/kg) on the seventh day, followed by re-examination of a single intravenous dose after diazepam (D) and its major metabolite desmethyldiazepam (DD) had been completely eliminated. Plasma levels of D and DD were monitored by a specific, sensitive GLC-method. In younger patients (n = 5, age 29 - 35 years) the elimination half-life, T1/2(beta), of D was 33.9 +/- 10.6 h (mean +/- S.D.) after the single dose. The control study gave an almost identical result (35.7 +/- 12.1). After subchronic dosage in all patients T1/2(beta) showed a modest but significant prolongation (paired t-test p less than 0.01) to 52.9 +/- 17.4 h. It was caused by a significant decrease (p = 0.016) in total plasma clearance (Cl), from 26.0 +/- 10.8 ml/min. Older patients (age 43-60 years) showed the same phenomenon. Blood/plasma ratios remained constant indicating no change in protein binding. Biliary excretion of D was measured in five patients with a T-tube. Only negligible amounts (0.3 - 0.4%) of administered D were excreted within 3 days after subchronic dosage, which demonstrates a lack of enterohepatic cycling of D. After multiple administration of D, there was accumulation of DD to levels approximately five times higher than after a single dose. The possibility that the slower elimination of D after subchronic treatment might be caused by DD was also supported by experiments in dogs and rabbits. After pretreating rabbits with DD and maintaining a high DD plasma level, there was prolongation of T1/2(beta) from 2.7 h to 5.2 h, with a corresponding decrease of Cl from 101.6 ml/min to 23.4 ml/min. Similar results were obtained in dogs. It is concluded that the disposition of D is altered by subchronic use and may be regulated by the plasma DD concentration.