Biowaiver monographs for immediate release solid oral dosage forms: Quinidine sulfate

Insights into the Cardiotoxic Effects of Veratrum Lobelianum Alkaloids: Pilot Study

Jervine, protoveratrine A (proA), and protoveratrine B (proB) are Veratrum alkaloids that are presented in some remedies obtained from Veratrum lobelianum, such as Veratrum aqua. This paper reports on a single-center pilot cardiotoxic mechanism study of jervine, proA, and proB in case series. The molecular aspects were studied via molecular dynamic simulation, molecular docking with cardiac sodium channel Na_V1.5, and machine learning-based structure–activity relationship modeling. HPLC-MS/MS method in combination with clinical events were used to analyze Veratrum alkaloid cardiotoxicity in patients. Jervine demonstrates the highest docking score (−10.8 kcal/mol), logP value (4.188), and pK_a value (9.64) compared with proA and proB. Also, this compound is characterized by the lowest calculated IC₅₀. In general, all three analyzed alkaloids show the affinity to Na_V1.5 that highly likely results in cardiotoxic action. The clinical data of seven cases of intoxication by Veratrum aqua confirms the results of molecular modeling. Patients exhibited nausea, muscle weakness, bradycardia, and arterial hypotension. The association between alkaloid concentrations in blood and urine and severity of patient condition is described. These experiments, while primary, confirmed that jervine, proA, and proB contribute to cardiotoxicity by Na_V1.5 inhibition.

An Assessment of Occasional Bio-Inequivalence for BCS1 and BCS3 Drugs: What are the Underlying Reasons?

Despite having adequate solubility properties, bioequivalence (BE) studies performed on immediate release formulations containing BCS1/3 drugs occasionally fail. By systematically evaluating a set of 17 soluble drugs where unexpected BE failures have been reported and comparing to a set of 29 drugs where no such reports have been documented, a broad assessment of the risk factors leading to BE failure was performed. BE failures for BCS1/3 drugs were predominantly related to changes in C_max rather than AUC. C_max changes were typically modest, with minimal clinical significance for most drugs. Overall, drugs with a sharp plasma peak were identified as a key factor in BE failure risk. A new pharmacokinetic term (t½C_max) is proposed to identify drugs at higher risk due to their peak plasma profile shape. In addition, the analysis revealed that weak acids, and drugs with particularly high gastric solubility are potentially more vulnerable to BE failure, particularly when these features are combined with a sharp C_max peak. BCS3 drugs, which are often characterised as being more vulnerable to BE failure due to their potential for permeation and transit to be altered, particularly by excipient change, were not in general at greater risk of BE failures. These findings will help to inform how biowaivers may be optimally applied in the future.

The impact of the EMA change in definition of "dose" on the BCS dose-solubility ratio: a review of the biowaiver monographs

The Biopharmaceutics Classification System (BCS) defines the solubility characteristics of an active pharmaceutical substance based on its dose-solubility ratio: for highly soluble drugs this ratio is less than 250 mL over a defined pH range. Prior to the revision of the European Medicines Agency (EMA, formerly EMEA) guideline in 2010, the "dose" in this ratio was consistently defined by the US FDA, the EMA, and the WHO biowaiver guidelines as the highest dosage strength. However, in the revised EMA guideline, the dose is defined as the highest single dose administered according to the Summary of Product Characteristics. The new EMA criterion for highly soluble may be closer to the actual conditions of use, but it is not in line with the dose that would be used in the in vivo bioequivalence study. This paper evaluates the impact on the BCS classification of the active pharmaceutical ingredients of the published biowaiver monographs and discusses the consequences of the possible change in classification on biowaiver recommendations. Using the current definition of dose by the EMA, the biowaiver recommendations for metoclopramide hydrochloride and verapamil hydrochloride are no longer valid according to EMA criteria. For prednisolone and prednisone, a reevaluation of the biowaiver recommendation, taking into account the usual dosing levels, seems appropriate.

Biowaiver monographs for immediate release solid oral dosage forms: mefloquine hydrochloride

Literature data relevant to the decision to allow a waiver of in vivo bioequivalence (BE) testing for the approval of immediate release solid oral dosage forms containing mefloquine hydrochloride as the only active pharmaceutical ingredient (API) are reviewed. The solubility and permeability data of mefloquine hydrochloride as well as its therapeutic use and therapeutic index, its pharmacokinetic properties, data related to the possibility of excipient interactions and reported BE/bioavailability studies were taken into consideration. Mefloquine hydrochloride is not a highly soluble API. Since no data on permeability are available, it cannot be classified according to the Biopharmaceutics Classification System with certainty. Additionally, several studies in the literature failed to demonstrate BE of existing products. For these reasons, the biowaiver cannot be justified for the approval of new multisource drug products containing mefloquine hydrochloride. However, scale-up and postapproval changes (HHS-FDA SUPAC) levels 1 and 2 and most EU type I variations may be approvable without in vivo BE, using the dissolution tests described in these regulatory documents.

Block of mouse Slo1 and Slo3 K+ channels by CTX, IbTX, TEA, 4-AP and quinidine

pH-regulated Slo3 channels, perhaps exclusively expressed in mammalian sperm, may play a role in alkalization-mediated K⁺ fluxes associated with sperm capacitation. The Slo3 channel shares extensive homology with Ca²⁺- and voltage-regulated BK-type Slo1 K⁺ channels. Here, using heterologous expression in oocytes, we define distinctive differences in pharmacological properties of Slo3 and Slo1 currents, examine blockade in terms of distinct blocking models, and, for some blockers, use mutated constructs to evaluate determinants of block. Slo3 is resistant to block by the standard Slo1 blockers, iberiotoxin, charybdotoxin and extracellular TEA. Slo3 is relatively insensitive to extracellular 4-AP up to 100 mM, while Slo1 is blocked in a voltage-dependent fashion consistent with block on the extracellular side of the channel. Block of both Slo1 and Slo3 by cytosolic 4-AP can be described by open channel block, with Slo3 being ~10–15-fold more sensitive, but exhibiting weaker voltage-dependence of block. The cytosolic concentrations of 4-AP required to block Slo3 make it unlikely that the effects of 4-AP on volume regulation in mammalian sperm is mediated by Slo3. Quinidine was more effective in blocking Slo3 than Slo1. For Slo1, quinidine block was favored by depolarization, irrespective of the side of application. For Slo3, quinidine block was relieved by depolarization, irrespective of the side of application, with strong block by less than 10 μM quinidine at potentials near 0 mV. The unusual voltage-dependence of block of Slo3 by quinidine may result from preferential binding of quinidine to closed Slo3 channels. The quinidine concentrations effective in blocking Slo3 suggest, that in experiments that have examined quinidine effects on sperm, any Slo3 currents would be almost completely inhibited.