Pharmacokinetics of fluconazole in loggerhead sea turtles (Caretta caretta) after single intravenous and subcutaneous injections, and multiple subcutaneous injections.

Abstract

Superficial and systemic mycotic infections are common among clinically ill sea turtles, which places growing importance on the establishment of pharmacokinetic-based dosage regimens for antifungal drugs. The pharmacokinetic properties of the antifungal drug fluconazole, after intravenous (i.v.) and subcutaneous (s.c.) injections, were studied in juvenile loggerhead sea turtles (Caretta caretta) housed at 23.0-26.5 degrees C. Fluconazole pharmacokinetic properties were further assessed in a multiple-dose s.c. regimen derived from the pharmacokinetic parameters determined in the single-dose study. Pharmacokinetic parameters were calculated, using a two-compartment model, from plasma concentration-time data obtained after single i.v. and s.c. administrations of fluconazole at a dosage of 2.5 mg/ kg body weight in six juvenile sea turtles. Blood samples were collected at intervals through 120 hr after each dose, and the concentration of fluconazole in plasma was measured by reverse-phase high-performance liquid chromatography. The i.v. and s.c. elimination half-lives were 139.5 +/- 36.0 and 132.6 +/- 48.7 hr (mean +/- SD), respectively. Systemic clearance of fluconazole was 8.2 +/- 4.3 ml/kg x hr, and the apparent volume of distribution at steady state was 1.38 +/- 0.29 L/kg. A multiple-dose regimen was derived, which consisted of a loading dose of 21 mg/kg body weight and subsequent doses of 10 mg/kg administered through s.c. injection every 120 hr (5 days). This regimen was administered to four juvenile sea turtles for 10 days, and blood samples were taken to determine peak and trough plasma concentrations of fluconazole. The mean concentrations for the two peak concentrations were 16.9 +/- 1.1 and 19.1 +/- 2.8 microg/ml 4 hr after dosing, and the mean concentrations for the three trough concentrations were 7.2 +/- 2.2, 10.4 +/- 2.7, and 10.7 +/- 2.9 microg/ml 120 hr after dosing. The terminal half-life after the last dose was calculated at 143 hr. Throughout the multiple dosing, fluconazole concentrations remained above approximately 8 microg/ml, a concentration targeted when treating mycotic infections in humans. The results of this study suggest that fluconazole can be effectively administered to sea turtles at a dosage of 10 mg/kg every 5 days after a loading dose of 21 mg/kg.