Send to

Choose Destination
AAPS J. 2016 May;18(3):678-88. doi: 10.1208/s12248-016-9879-0. Epub 2016 Feb 18.

The Population Pharmacokinetics of D-β-hydroxybutyrate Following Administration of (R)-3-Hydroxybutyl (R)-3-Hydroxybutyrate.

Author information

School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand.
Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
Laboratory of Metabolic Control, NIAAA/NIH, Rockville, Maryland, USA.
School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand.


The administration of ketones to induce a mild ketosis is of interest for the alleviation of symptoms associated with various neurological disorders. This study aimed to understand the pharmacokinetics (PK) of D-β-hydroxybutyrate (BHB) and quantify the sources of variability following a dose of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (ketone monoester). Healthy volunteers (n = 37) were given a single drink of the ketone monoester, following which, 833 blood BHB concentrations were measured. Two formulations and five dose levels of ketone monoester were used. A nonlinear mixed effect modelling approach was used to develop a population PK model. A one compartment disposition model with negative feedback effect on endogenous BHB production provided the best description of the data. Absorption was best described by two consecutive first-order inputs and elimination by dual processes involving first-order (CL = 10.9 L/h) and capacity limited elimination (V max = 4520 mg/h). Covariates identified were formulation (on relative oral bioavailable fraction and absorption rate constant) and dose (on relative oral bioavailable fraction). Lean body weight (on first-order clearance) and sex (on apparent volume of distribution) were also significant covariates. The PK of BHB is complicated by complex absorption process, endogenous production and nonlinear elimination. Formulation and dose appear to strongly influence the kinetic profile following ketone monoester administration. Further work is needed to quantify mechanisms of absorption and elimination of ketones for therapeutic use in the form of ketone monoester.


D-β-hydroxybutyrate; exogenous ketosis; ketone monoester; pharmacokinetics; population models

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The intellectual property covering the uses of ketone bodies and ketone esters are owned by BTG Ltd., the University of Oxford and the National Institutes of Health. Should royalties ever accrue from these patents, Kieran Clarke and Richard L Veech, as inventors, will receive a share of the royalties under the terms prescribed by each institution. Kieran Clarke is a non-executive director of TdeltaS Ltd, a company spun out of the University of Oxford to develop products based on the science of ketone bodies in human nutrition. All authors declare no other conflicts of interest.

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center