Clinical Pharmacokinetics and Pharmacodynamics of Drugs in the Central Nervous System

Clin Pharmacokinet. 2018 Sep;57(9):1059-1074. doi: 10.1007/s40262-018-0632-y.


Despite contributing significantly to the burden of global disease, the translation of new treatment strategies for diseases of the central nervous system (CNS) from animals to humans remains challenging, with a high attrition rate in the development of CNS drugs. The failure of clinical trials for CNS therapies can be partially explained by factors related to pharmacokinetics/pharmacodynamics (PK/PD), such as lack of efficacy or improper selection of the initial dosage. A focused assessment is needed for CNS-acting drugs in first-in-human studies to identify the differences in PK/PD from animal models, as well as to choose the appropriate dose. In this review, we summarize the available literature from human studies on the PK and PD in brain tissue, cerebrospinal fluid, and interstitial fluid for drugs used in the treatment of psychosis, Alzheimer's disease and neuro-HIV, and address critical questions in the field. We also explore newer methods to characterize PK/PD relationships that may lead to more efficient dose selection in CNS drug development.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Biomarkers / analysis
  • Brain / drug effects*
  • Brain / metabolism
  • Central Nervous System Agents / cerebrospinal fluid
  • Central Nervous System Agents / pharmacokinetics*
  • Central Nervous System Agents / pharmacology*
  • Computer Simulation
  • Drug Development
  • Extracellular Fluid / chemistry
  • Humans
  • Intracellular Fluid / chemistry
  • Models, Biological*
  • Tissue Distribution


  • Biomarkers
  • Central Nervous System Agents