The influence of nutrition on the systemic availability of drugs. Part I: Drug absorption

Reduced Food-Effect on Intestinal Absorption of Dronedarone by Self-microemulsifying Drug Delivery System (SMEDDS)

The oral absorption of dronedarone (DRN), a benzofuran derivative with anti-arrhythmic activity, is significantly affected by food intake. The absolute bioavailability of the marketed product (Multaq, Sanofi, U.S.) was about 4% without food, but increased to 15% when administered with a high fat meal. Therefore, to reduce the food-effect on the intestinal absorption of DRN, a novel self-microemulsifying drug delivery system (SMEDDS) was formulated and the comparative in vivo absorption studies with the marketed product were carried out using male beagle dogs either in the fasted or fed state. The SMEDDS consisted of the drug, Labrafil M 1944CS, and Kolliphor EL in a weight ratio of 1 : 1 : 2, rapidly formed a fine oil-in-water emulsion with a droplet size less than 50 nm. An in vivo absorption study revealed that the area-under-curve (AUC0-24 h) and maximal plasma concentration (Cmax) were 10.4-fold (p<0.05) and 8.6-fold (p<0.05) higher, respectively, after the marketed product was orally administered to beagles in the fed state when compared to those in the fasted state. This food-effect were remarkably alleviated by SMEDDS formulation, with AUC0-24 h and Cmax 2.9-fold (p<0.05) and 2.6-fold (p<0.05) higher in the fed state when compared to the fasted state, by facilitating intestinal absorption of DRN in the fasted state. The results of this study suggest that SMEDDS may decrease the differences in oral absorption of DRN between the prandial states, improving therapeutic efficacy as well as patient compliance.

Effect of food on the pharmacokinetics of YH439 and its metabolites in rats

The pharmacokinetics of YH439 and its metabolites were investigated after oral administration of YH439 to rats to investigate the food effect. After oral administration of YH439, its metabolites, M4 and M5 were detected in plasma. YH439 was not detected in the plasma for both fasted and fed rats for all doses studied. The pharmacokinetic parameters of the metabolites were not affected by food at all doses studied. The results of this study indicated that there are no significant food effects on the pharmacokinetics of YH439 and its metabolites in rats.

Physiochemical and physiological mechanisms for the effects of food on drug absorption: the role of lipids and pH

Drugs are absorbed after oral administration as a consequence of a complex array of interactions between the drug, its formulation, and the gastrointestinal (GI) tract. The presence of food within the GI tract impacts significantly on transit profiles, pH, and its solubilization capacity. Consequently, food would be expected to affect the absorption of co-administered drugs when their physicochemical properties are sensitive to these changes. The physicochemical basis by which ingested food/lipids induce changes in the GI tract and influence drug absorption are reviewed. The process of lipid digestion is briefly reviewed and considered in the context of the absorption of poorly water-soluble drugs. The effect of food on GI pH is reviewed in terms of location (stomach, upper and lower small intestine) and the temporal relationship between pH and drug absorption. Case studies are presented in which postprandial changes in bioavailability are rationalized in terms of the sensitivity of the physicochemical properties of the administered drug to the altered GI environment.

Effect of fat substitutes, sucrose polyester and tricarballylate triester, on digitoxin absorption in the rat

The effect of non-absorbable fat substitutes (sucrose polyester (SPE) and tricarballylate triester (TCTE)) on [3H]digitoxin intestinal absorption was studied in the rat using a small intestine in-situ perfusion technique. The effect of SPE and TCTE was compared with that of sunflower oil, oleic acid, and saline. After 120 min perfusion, 5% SPE emulsion significantly reduced (P < 0.001) digitoxin absorption compared with all other treated groups. Five per cent TCTE emulsion had a less marked effect than SPE (P = 0.0002) and did not differ from sunflower oil. No difference was found between saline and 5% oleate emulsion, which did not reduce digitoxin absorption compared with other treated groups (P < 0.02). When taurocholic acid and lipase were added, results for the saline-, TCTE-, and SPE-treated groups were similar to those above, but the sunflower oil-treated group showed significantly enhanced (P < 0.01) digitoxin absorption. Thin-layer chromatography of the lipid phases showed hydrolysis of sunflower oil in the presence of taurocholic acid and lipase, but not of TCTE or SPE. The inhibitory effect of the non-absorbable fat substitutes on digitoxin absorption could be related to drug sequestration by the persistent oil phase constituted by the undigested and then unabsorbed fat substitutes. That part of digitoxin dissolved in the undigested oil phase is consequently unavailable for intestinal absorption.

Pharmacokinetic studies in healthy volunteers in the context of in vitro/in vivo correlations

A multitude of in vivo variables can influence systemic drug absorption after intake of an oral formulation. For the measurement of consistent in vivo parameters within and between pharmacokinetic studies it is of primary importance that such variables be recognized. Consequently, as many variables as possible should be eliminated or controlled by proper study designs to prevent (or minimize) their disturbance of in vitro/in vivo correlations. The possible influences of some important variables are elaborated and discussed in this paper. The influences of food can be anticipated and controlled against the background of gastrointestinal physiology with and without food and its interplay with the dosage form. Food, and also posture and exercise, may influence splanchnic-hepatic blood flow which may substantially affect the absorption of drugs with a high first-pass metabolism. The influence of the discussed variables may be modified by the dosage form of a particular drug. Single dose studies are appropriate for studying immediate release formulations and in the development of controlled release formulations. Multiple dose studies are preferred for the formal validation of controlled release formulations.

The influence of nutrition on the systemic availability of drugs. Part II: Drug metabolism and renal excretion

Plasma concentrations of an active compound vary between individuals and within a subject, even if the same drug dosage is used. These differences are related to variations of drug absorption from the gastrointestinal tract, of presystemic drug metabolism in the intestine or the liver, and of drug elimination from the systemic circulation, for instance by hepatic metabolism or renal excretion. All of these processes can be modified by nutrition. However it is necessary to emphasize the significance of the pharmaceutical formulation for variations of both drug absorption and elimination. The role of nutrition should receive adequate attention during therapeutic use of drugs as well as in drug disposition studies. Recent guidelines for the assessment of the systemic availability of drugs therefore do recommend nutrition to be controlled.