Oral bioavailability and in situ absorption of etoposide in rat

Metastable polymorph of etoposide with higher dissolution rate

Etoposide, an anticancer drug, has low oral bioavailability because of low aqueous solubility, slow dissolution rate, and instability in acidic pH. Our objective was to enhance the aqueous solubility and dissolution rate of etoposide by polymorph formation. Preparation of various polymorphs of etoposide was attempted by crystallizing etoposide from organic solvents. Physicochemical properties of the crystals, namely, crystal habit, thermal behavior with hot-stage microscopy, thermal analysis by differential scanning calorimetry, IR spectrum, and solubility and dissolution rates, were examined. Based on the physicochemical characteristics, a metastable polymorph of etoposide was identified when it was crystallized from isopropanol. The metastable polymorph had an equilibrium solubility and intrinsic dissolution rate of 221 micrograms/ml and 16.3 micrograms/min/cm2, respectively; 1.9 and 1.7 times that of etoposide powder at 25 degrees C, respectively.

Inhibition of intestinal P-glycoprotein and effects on etoposide absorption

P-glycoprotein (Pgp) actively pumps a number of antineoplastic drugs, such as etoposide, out of cancer cells and causes multidrug resistance. Pgp is also expressed at the brush-border membrane of the small intestine under normal physiological conditions. We hypothesized that inhibition of intestinal Pgp might decrease the efflux of etoposide from the blood into the intestinal lumen, thereby, increasing the bioavailability of etoposide. The absorption of etoposide was studied using everted gut sacs prepared from rat jejunum and ileum. The addition of C219, a monoclonal antibody of Pgp, at 100 ng/ml or of 0.2 M 5'-adenylylimidodiphosphate, a nonhydrolyzable adenosine triphosphate (ATP) analog, increased the absorption of etoposide. Quinidine, an antiarrythmic agent, has been demonstrated to circumvent multidrug resistance in cell lines, possibly by interfering with Pgp function. Adding quinidine at 1 mg/ml to the everted gut sac increased the absorption of etoposide. In vivo absorption of etoposide was also studied by intraluminal perfusion of the drug in the small intestine of anesthetized rats. Intravenous infusion of quinidine at either 1 or 2 mg/h increased the serum level of etoposide in a dose-dependent manner. Intravenous infusion of etoposide at 0.2 mg/h resulted in luminal exsorption of the drug in the small intestine. The intestinal clearance of etoposide was 41.7 +/- 7.2 ml kg-1, which decreased to 18.4 +/- 3.9 ml kg-1 with the infusion of quinidine at 1 mg/h. The present data confirm that intestinal Pgp mediates the efflux of etoposide and that the use of Pgp-inhibiting agents such as quinidine may increase the bioavailability of etoposide.