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Huh KY, Kim E, Lee H, Jeon I, Suh H, Lee J, Lee Y, Yu KS, Lee S. Comparison of the Pharmacokinetics of a Fixed-Dose Combination of Rosuvastatin/Metformin Sustained-Release (10/1000 mg) and Separate Tablets in Healthy Male Subjects. Clin Pharmacol Drug Dev 2020; 10:207-213. [PMID: 32579298 DOI: 10.1002/cpdd.841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/18/2020] [Indexed: 01/09/2023]
Abstract
Fixed-dose combination (FDC) drugs with various dose combinations for the treatment of type 2 diabetes mellitus and dyslipidemia are currently in demand. We compared the pharmacokinetic (PK) profiles of the rosuvastatin/metformin sustained-release (10/1000 mg) FDC and separate tablets and evaluated the effect of food by randomized, open-label, 3-period, 6-sequence crossover studies conducted in healthy male subjects. Subjects were randomly assigned to one of the following treatments: separate tablets of 10 mg rosuvastatin and 1000 mg metformin sustained release in the fed state and the FDC in the fasted and fed states. PK samples were collected up to 72 hours postdose for rosuvastatin, N-desmethyl rosuvastatin, and metformin. The PK parameters were determined using a noncompartmental method, and the geometric mean ratio (GMR) and the 90% confidence interval (CI) of the treatments were calculated. A total of 35 subjects completed the study. The GMR and 90%CI of the peak concentration (Cmax ) and area under the plasma concentration-time curve from time zero to the last measurable concentration (AUClast ) of the FDC and the separate tablets were within the bioequivalence criteria (0.8-1.25) for both rosuvastatin and metformin. The effect of food was statistically significant for both rosuvastatin and metformin but not expected to be of clinical significance.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Eunwoo Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Heechan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Inseung Jeon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Hearan Suh
- Global Research Institute, Bcworld Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Jongsun Lee
- Global Research Institute, Bcworld Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Yunhee Lee
- Global Research Institute, Bcworld Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
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Ghim JL, Phuong NTT, Kim MJ, Kim EJ, Song GS, Ahn S, Shin JG, Kim EY. Pharmacokinetics of fixed-dose combination of atorvastatin and metformin compared with individual tablets. Drug Des Devel Ther 2019; 13:1623-1632. [PMID: 31190741 PMCID: PMC6525001 DOI: 10.2147/dddt.s193254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/07/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aims of this study was to investigate the mutual pharmacokinetic interactions between steady-state atorvastatin and metformin and the effect of food on the fixed-dose combined (FDC) tablet of atorvastatin and metformin extended release (XR). Subjects and methods: Study 1, an open-labeled, fixed sequence, multiple-dose pharmacokinetic drug-drug interaction study, was divided into 2 parts. Atorvastatin (40 mg) or metformin (1,000 mg) XR tablets were administered once daily via mono- or co-therapy for 7 days. Plasma levels of atorvastatin and 2-OH-atorvastatin, were quantitatively determined for 36 h in part A (n=50) while metformin plasma concentration was measured up to 24 h in part B (n=16) after the last dosing. Study 2, a randomized, open-labeled, single-dose, two-treatment, two-period, two-sequence crossover study, involved 27 healthy subjects to investigate the impact of food intake on the pharmacokinetics of a combined atorvastatin/metformin XR 20/500 mg (CJ-30056 20/500 mg) tablet. Results: After multiple doses of mono- or co-therapy of atorvastatin (40 mg) and metformin (1,000 mg) XR, the 90% confidence intervals (CIs) of the geometric mean ratios (GMRs) for the peak plasma concentration at steady state (Cmax,ss) and area under the plasma concentration-time curve during the dosing interval at steady state (AUCτ,ss) were 1.07 (0.94-1.22) and 1.05 (0.99-1.10) for atorvastatin, 1.06 (0.96-1.16) and 1.16 (1.10-1.21) for 2-OH-atorvastatin, and 1.00 (0.86-1.18) and 0.99 (0.87-1.13) for metformin, respectively. Food delayed time to reach maximum concentration (tmax), decreased atorvastatin Cmax by 32% with a GMR (90% CI) of 0.68 (0.59-0.78), and increased metformin AUCt by 56% with a GMR (90% CI) of 1.56 (1.43-1.69). Conclusion: No clinically relevant pharmacokinetic interaction was seen when atorvastatin was co-administered with metformin. Food appeared to change the absorption of atorvastatin and metformin from an FDC formulation. These alterations were in accordance with those described with the single reference drugs when ingested with food.
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Affiliation(s)
- Jong-Lyul Ghim
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Nguyen Thi Thu Phuong
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea.,Faculty of Pharmacy, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Min Jung Kim
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
| | - Eun-Ji Kim
- CJ HealthCare Co., Ltd, Seoul, Republic of Korea
| | | | - Sangzin Ahn
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
| | - Jae-Gook Shin
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
| | - Eun-Young Kim
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
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van Stee MF, de Graaf AA, Groen AK. Actions of metformin and statins on lipid and glucose metabolism and possible benefit of combination therapy. Cardiovasc Diabetol 2018; 17:94. [PMID: 29960584 PMCID: PMC6026339 DOI: 10.1186/s12933-018-0738-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
Patients with diabetes type 2 have an increased risk for cardiovascular disease and commonly use combination therapy consisting of the anti-diabetic drug metformin and a cholesterol-lowering statin. However, both drugs act on glucose and lipid metabolism which could lead to adverse effects when used in combination as compared to monotherapy. In this review, the proposed molecular mechanisms of action of statin and metformin therapy in patients with diabetes and dyslipidemia are critically assessed, and a hypothesis for mechanisms underlying interactions between these drugs in combination therapy is developed.
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Affiliation(s)
- Mariël F. van Stee
- Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert A. de Graaf
- Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Albert K. Groen
- Amsterdam Diabetes Center and Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Yoon J, Moon SJ, Lee KO, Yoon SH, Jang IJ, Yu KS, Lee S. Comparison ofR(+)-α-lipoic acid exposure afterR(+)-α-lipoic acid 200 mg and 300 mg and thioctic acid 600 mg in healthy Korean male subjects. Transl Clin Pharmacol 2016. [DOI: 10.12793/tcp.2016.24.3.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jangsoo Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Seol Ju Moon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | | | - Seo Hyun Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
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Montoya-Eguía SL, Garza-Ocañas L, Badillo-Castañeda CT, Tamez-de la O E, Zanatta-Calderón T, Gómez-Meza MV, Garza-Ulloa H. Comparative Pharmacokinetic Study Among 3 Metformin Formulations in Healthy Mexican Volunteers: A Single-Dose, Randomized, Open-Label, 3-Period Crossover Study. Curr Ther Res Clin Exp 2015. [DOI: 10.1016/j.curtheres.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Oh JH, Eun Lee J, Jeong Kim Y, Oh TO, Han S, Jeon EK, Shin K, Kim DH, Hye Park C, Lee YJ. Designing of the fixed-dose gastroretentive bilayer tablet for sustained release of metformin and immediate release of atorvastatin. Drug Dev Ind Pharm 2015; 42:340-9. [DOI: 10.3109/03639045.2015.1096279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ju-Hee Oh
- Department of Life and Nanopharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea and
| | - Ji Eun Lee
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Yu Jeong Kim
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Tack-Oon Oh
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - SungKyun Han
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Eun Kyung Jeon
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Kyungmin Shin
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Dong-Hyun Kim
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Chi Hye Park
- R&D Center, CJ HealthCare Co., Ltd., Gyeonggi-Do, Republic of Korea
| | - Young-Joo Lee
- Department of Life and Nanopharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea and
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Chang M, Liu X, Cui D, Liang D, LaCreta F, Griffen SC, Lubin S, Quamina-Edghill D, Boulton DW. Bioequivalence, Food Effect, and Steady-State Assessment of Dapagliflozin/Metformin Extended-release Fixed-dose Combination Tablets Relative to Single-component Dapagliflozin and Metformin Extended-release Tablets in Healthy Subjects. Clin Ther 2015; 37:1517-28. [PMID: 26048185 DOI: 10.1016/j.clinthera.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/24/2015] [Accepted: 05/06/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Simplification of therapeutic regimens for patients with type 2 diabetes mellitus can provide convenience that leads to improved compliance. Dapagliflozin/metformin extended-release (XR) fixed-dose combination (FDC) tablets offer the convenience of once-daily dosing. Two pharmacokinetic (PK) studies were conducted to establish bioequivalence for 2 doses of dapagliflozin/metformin XR FDC versus the same dosage of the individual component (IC) tablets in healthy adults. METHODS Two open-label, randomized, 4-period, 4-arm crossover studies were conducted to assess the bioequivalence and PK properties of dapagliflozin and metformin FDCs in healthy subjects under fed and fasting conditions. Participants received single oral doses or once-daily dosing of dapagliflozin/metformin XR (5 mg/500 mg [study 1] or 10 mg/1000 mg [study 2]) for 4 days in an FDC formulation or corresponding strengths of IC tablets. FINDINGS For both of the studies, dapagliflozin and metformin 5 mg/500 mg or 10 mg/1000 mg FDC tablets were bioequivalent to the respective IC tablets. The 90% CIs of the ratio of the adjusted geometric means for all key PK parameters (Cmax, AUC0-T, and AUC0-∞) were contained within the predefined 0.80 to 1.25 range to conclude bioequivalence for both dapagliflozin and metformin. Once-daily dosing to steady state of each FDC tablet had no effect on the PK properties of dapagliflozin or metformin. When the FDCs were administered with a light-fat meal, there was no effect on metformin PK values and only a modest, nonclinically meaningful effect on dapagliflozin PK values. There were no safety or tolerability concerns. IMPLICATIONS Bioequivalence of the FDCs of dapagliflozin/metformin XR and the ICs was established, and no safety issues of clinical concern were raised.
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Affiliation(s)
- Ming Chang
- Bristol-Myers Squibb, Princeton, New Jersey
| | - Xiaoni Liu
- Bristol-Myers Squibb, Princeton, New Jersey
| | - Dapeng Cui
- ICON Development Solutions, San Antonio, Texas
| | - Dan Liang
- ICON Development Solutions, San Antonio, Texas
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Chitnis SD, Han Y, Yamaguchi M, Mita S, Zhao R, Sunkara G, Kulmatycki K. Population pharmacokinetic modeling and noncompartmental analysis demonstrated bioequivalence between metformin component of metformin/vildagliptin fixed-dose combination products and metformin immediate-release tablet sourced from various countries. Clin Pharmacol Drug Dev 2015; 5:40-51. [PMID: 27119577 DOI: 10.1002/cpdd.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/27/2015] [Accepted: 03/19/2015] [Indexed: 01/09/2023]
Abstract
Metformin is the first-line pharmacotherapy choice for treating type-2 diabetes mellitus, alone or in combination with other antidiabetic drugs. During the development of immediate-release (IR) metformin containing novel fixed-dose combination (FDC) products, several health-authorities require sponsors to demonstrate bioequivalence between FDC products and the country-sourced metformin for market approval. Eight bioequivalence studies that compared metformin/vildagliptin FDC product (test) to metformin IR tablet sourced from various countries (reference) were conducted. A population pharmacokinetic (PPK) analysis of pooled metformin concentration-time data was performed to evaluate whether country-sourced metformin is a significant covariate. The PPK analysis demonstrated that there was no clinically relevant effect of metformin source or race/ethnicity on metformin pharmacokinetics. Also, noncompartmental analysis conducted showed that 90%CI of geometric mean ratios of test to reference metformin formulations, calculated for maximum-concentration and exposure parameters, were within the 80%-125% criteria, indicating comparable metformin exposure regardless of the country-sourced metformin IR formulation. These results are consistent with the biopharmaceutics properties of metformin and provide scientific evidence that after assessing in vitro dissolution of novel FDC formulation, additional bioequivalence studies with multiple countries' reference products may not be required once bioequivalence is established with 1 country-sourced IR metformin formulation.
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Affiliation(s)
| | - Yi Han
- Novartis Institutes for BioMedical Research, Shanghai, China
| | | | | | - Rong Zhao
- Novartis Institutes for BioMedical Research, Shanghai, China
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Katsiki N, Athyros VG, Karagiannis A. Single-pill combinations: a therapeutic option or necessity for vascular risk treatment? J Drug Assess 2013; 2:67-71. [PMID: 27536439 PMCID: PMC4937652 DOI: 10.3109/21556660.2013.801605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 02/06/2023] Open
Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, ThessalonikiGreece
| | - Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, ThessalonikiGreece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, ThessalonikiGreece
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Nakano M, Shirotake S. Construction of a three-dimensional model of cardiovascular disease and deployment of a new method of fostering patient adherence to instruction. Patient Prefer Adherence 2013; 7:579-87. [PMID: 23836964 PMCID: PMC3699347 DOI: 10.2147/ppa.s45012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND For the patient-oriented medical services, it is important to assist the patient in understanding the management of cardiovascular diseases. The strategy of medication instruction is particularly important to enhance medication adherence. OBJECTIVE AND METHODS The original model was newly constructed and covers multiple factors, including those related to renin-angiotensin, metabolism of glucose and lipids, blood coagulation, and the organic basis of the disease. The four factors of cardiovascular diseases and their relationship with the disease state are expressed in the form of a tetrahedral model. RESULTS AND DISCUSSION This disease model illustrates in points, lines, surfaces, and spaces that the factors combine with each other and result in a pathological condition, as determined by the degree of involvement of each factor in a discontinuous manner. The model helps cardiovascular patients to understand visually that there is more than one pathological condition. Our model allowed patients to quickly comprehend the complex pharmacotherapy of cardiovascular diseases by presenting the information in the form of a three-dimensional structure. Lifestyle-related diseases, including cardiovascular diseases, involve complicated factors and require careful pharmacotherapy which is tailored to individual patient needs. In this regard, the development of instructional tools is particularly effective. CONCLUSION The three-dimensional model shows optimum treatment by correctly considering both the quantity and quality of the four pathological factors associated with cardiovascular diseases. Appropriate patient compliance instruction based on life guidance is thought to be essential in the treatment of cardiovascular diseases.
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Affiliation(s)
- Masuyo Nakano
- Department of Pharmaco-Therapeutics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Nogami Pharmacy, Machida City, Tokyo, Japan
| | - Shoichi Shirotake
- Department of Pharmaco-Therapeutics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Correspondence: Shoichi Shirotake, Department of Pharmaco-Therapeutics, Graduate School of Medicine, Yokohama City University, Fuku-ura 3–9, Kanazawa-ku, Yokohama, 236-0004, Japan Tel +81 45 787 2705, Email
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