Dear Lei,
I feel your pain, cuz I have also battled with models with stubborn flip-flop 
and I started concocting all sort of codes similar to yours to prevent it - you 
can probably find some desperate posts of mine about this on NMUSERS :).

In my experience, the only code that sort of works without causing too many 
side-effects is the one that prevents flip-flop of the typical values (the 
THETAs). Unfortunately, this does not work every time, but all the other codes 
accounting for individual parameters (such as the one you propose) introduce 
funny correlations between the parameters and the ETAs, they reshape the 
between-subject variability, and they may end up causing more trouble than they 
solve.
In your case with nonlinear clearance, it may be even more complicated than 
usual.

In my experience, the best option is to use priors on ka and volume, even 
weakly informative. These should help stabilising your model. Adding priors may 
seem "artificial", but if you think about it, it is doing exactly what you are 
trying to achieve with all these tricky codes. One cannot solve the flip-flop 
problem only with data from oral administration, the only way is to add 
external information, like the fact that you expect ka to be larger than ke, or 
include IV data that helps you identify the correct value of volume. With the 
priors you do just that, and in a more natural way than "cheating" NONMEM with 
funny codes.

Good luck!
Paolo


On 2015/07/08 22:41, Lei Diao wrote:
Dear NONMEM Users,

I have a popPK model for which the Ka is constrained to be larger than Ke at 
the individual level to avoid flip-flop. The question is that if there is an 
additional nonlinear clearance component (M-M), how should I constrain between 
the absorption rate (KA) and terminal phase elimination rate (KE) since 
nonlinear clearance causes the KE to change with time? Is there any reference 
on this topic?

KA and KE constraining in the absence of nonlinear clearance in NM code:

KE=((K+K23+K32)-SQRT((K+K23+K32)*(K+K23+K32)-4*K*K32))/2

KA=KE+THETA(5)*EXP(ETA(3))

Thanks a lot for your input!

Lei Diao
Biogen


--
------------------------------------------------
Paolo Denti, PhD
Pharmacometrics Group
Division of Clinical Pharmacology
Department of Medicine
University of Cape Town

K45 Old Main Building
Groote Schuur Hospital
Observatory, Cape Town
7925 South Africa
phone: +27 21 404 7719
fax: +27 21 448 1989
email: [email protected]<mailto:[email protected]>
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