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Mushtaq M, Fatima K, Ahmad A, Mohamed Ibrahim O, Faheem M, Shah Y. Pharmacokinetic interaction of voriconazole and clarithromycin in Pakistani healthy male volunteers: a single dose, randomized, crossover, open-label study. Front Pharmacol 2023; 14:1134803. [PMID: 37361220 PMCID: PMC10288581 DOI: 10.3389/fphar.2023.1134803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Voriconazole an antifungal drug, has a potential for drug-drug interactions (DDIs) with administered drugs. Clarithromycin is a Cytochromes P450 CYP (3A4 and 2C19) enzyme inhibitor, and voriconazole is a substrate and inhibitor of these two enzymes. Being a substrate of the same enzyme for metabolism and transport, the chemical nature and pKa of both interacting drugs make these drugs better candidates for potential pharmacokinetic drug-drug interactions (PK-DDIs). This study aimed to evaluate the effect of clarithromycin on the pharmacokinetic profile of voriconazole in healthy volunteers. Methods: A single oral dose, open-label, randomized, crossover study was designed for assessing PK-DDI in healthy volunteers, consisting of 2 weeks washout period. Voriconazole, either alone (2 mg × 200 mg, tablet, P/O) or along with clarithromycin (voriconazole 2 mg × 200 mg, tablet + clarithromycin 500 mg, tablet, P/O), was administered to enrolled volunteers in two sequences. The blood samples (approximately 3 cc) were collected from volunteers for up to 24 h. Plasma concentrations of voriconazole were analyzed by an isocratic, reversed-phase high-performance-liquid chromatography ultraviolet-visible detector (RP HPLC UV-Vis) and a non-compartmental method. Results: In the present study, when voriconazole was administered with clarithromycin versus administered alone, a significant increase in peak plasma concentration (Cmax) of voriconazole by 52% (geometric mean ratio GMR: 1.52; 90% CI 1.04, 1.55; p = 0.000) was observed. Similarly, the area under the curve from time zero to infinity (AUC0-∞) and the area under the concentration-time curve from time zero to time-t (AUC0-t) of voriconazole also significantly increased by 21% (GMR: 1.14; 90% CI 9.09, 10.02; p = 0.013), and 16% (GMR: 1.15; 90% CI 8.08, 10.02; p = 0.007), respectively. In addition, the results also showed a reduction in the apparent volume of distribution (Vd) by 23% (GMR: 0.76; 90% CI 5.00, 6.20; p = 0.051), and apparent clearance (CL) by 13% (GMR: 0.87; 90% CI 41.95, 45.73; p = 0.019) of voriconazole. Conclusion: The alterations in PK parameters of voriconazole after concomitant administration of clarithromycin are of clinical significance. Therefore, adjustments in dosage regimens are warranted. In addition, extreme caution and therapeutic drug monitoring are necessary while co-prescribing both drugs. Clinical Trial Registration: clinicalTrials.gov, Identifier NCT05380245.
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Affiliation(s)
- Mehwish Mushtaq
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Kshaf Fatima
- University Medical and Dental College, The University of Faisalabad, Faisalabad, Pakistan
| | - Aneeqa Ahmad
- Punjab Medical College, Faisalabad Medical University, Faisalabad, Pakistan
| | - Osama Mohamed Ibrahim
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Muhammad Faheem
- Department of Pharmacy, University of Swabi, Swabi, Pakistan
| | - Yasar Shah
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
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Ladetto MF, Lázaro-Martínez JM, Devoto TB, Briceño VJ, Castro GR, Cuestas ML. Quantitative determination of voriconazole by thionine reduction and its potential application in a pharmaceutical and clinical setting. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 15:1230-1240. [PMID: 36807654 DOI: 10.1039/d2ay01431a] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Voriconazole (VCZ) is a triazolic drug used to treat serious fungal infections and invasive mycosis and has also been more recently used as a generic antifungal treatment. However, VCZ therapies can cause undesirable side effects and doses must be carefully monitored before administration to avoid or reduce severe toxic effects. Analytical techniques used to quantify VCZ are mostly based on HPLC/UV and often associated with multiple technical steps as well as expensive equipment. The present work aimed to develop an accessible and affordable spectrophotometric technique in the visible range (λ = 514 nm) for the simple quantification of VCZ. The technique was based on VCZ-induced reduction of thionine (TH, red) to leucothionine (LTH, colorless) under alkaline conditions. The reaction showed a linear correlation over the range of 1.00 μg mL-1 to 60.00 μg mL-1 at room temperature, the limits of detection and quantification being 1.93 μg mL-1 and 6.45 μg mL-1, respectively. VCZ degradation products (DPs) according to 1H and 13C-NMR spectrometric determinations not only showed good agreement with the ones previously reported (DP1 and DP2 - T. M. Barbosa, G. A. Morris, M. Nilsson, R. Rittner and C. F. Tormena, RSC Adv., 2017, DOI: 10.1039/c7ra03822d), but also revealed a new degradation product (DP3). Mass spectrometry not only confirmed the presence of LTH as a result of the VCZ DP-induced TH reduction, but also revealed the formation of a novel and stable Schiff base as a reaction product between DP1 and LTH. The latter finding became significant as it stabilizes the reaction for quantification purposes, by hindering LTH ↔TH redox reversibility. This analytical method was then validated according to the ICH Q2 (R1) guidelines, and additionally, it could be demonstrated as applicable for the reliable VCZ quantification in commercially available tablets. Importantly, it also represents a useful tool for detecting toxic threshold concentrations in human plasma from VCZ-treated patients, alerting when these risky limits are exceeded. In this way, this technique independent from sophisticated equipment, highly qualifies as a low-cost, reproducible, trustable, and non-laborious alternative method for VCZ measurements from different matrices.
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Affiliation(s)
- María Florencia Ladetto
- Departamento de Química, Laboratorio de Nanobiomateriales, Facultad de Ciencias Exactas, Centro de Investigación y Desarrollo en Fermentaciones Industriales (CINDEFI), Universidad Nacional de La Plata (UNLP) - CONICET (CCT La Plata), Calle 47 y 115, La Plata, B1900AJI, Buenos Aires, Argentina
- Institute for Research in Microbiology and Medical Parasitology (IMPaM), University of Buenos Aires, CONICET, Buenos Aires, Argentina.
| | - Juan Manuel Lázaro-Martínez
- Departamento de Ciencias Químicas, Facultad de Farmacia y Bioquímica, Instituto de Química y Metabolismo del Fármaco (IQUIMEFA UBA-CONICET), Universidad de Buenos Aires, Argentina
| | - Tomás Brito Devoto
- Institute for Research in Microbiology and Medical Parasitology (IMPaM), University of Buenos Aires, CONICET, Buenos Aires, Argentina.
| | - Víctor J Briceño
- Institute for Research in Microbiology and Medical Parasitology (IMPaM), University of Buenos Aires, CONICET, Buenos Aires, Argentina.
- Institute of Nanobiotechnology (Nanobiotec), University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Guillermo R Castro
- Max Planck Laboratory for Structural Biology, Chemistry and Molecular Biophysics of Rosario (MPLbioR, UNR-MPIbpC), Partner Laboratory of the Max Planck Institute for Biophysical Chemistry (MPIbpC, MPG), Centro de Estudios Interdisciplinarios (CEI) - CONICET, Universidad Nacional de Rosario, Maipú 1065, Rosario, S2000, Santa Fe, Argentina.
- Nanomedicine Research Unit (Nanomed), Center for Natural and Human Sciences (CCNH), Universidade Federal do ABC (UFABC), Santo André, SP, Brazil
| | - María Luján Cuestas
- Institute for Research in Microbiology and Medical Parasitology (IMPaM), University of Buenos Aires, CONICET, Buenos Aires, Argentina.
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Chanduluru HK, Sugumaran A. Assessment of greenness for the determination of voriconazole in reported analytical methods. RSC Adv 2022; 12:6683-6703. [PMID: 35424637 PMCID: PMC8982219 DOI: 10.1039/d1ra08858k] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/04/2022] [Indexed: 12/30/2022] Open
Abstract
Analytical research with adverse environmental impact has caused a severe rise in concern about the ecological consequences of its strategies, most notably the use and emission of harmful solvents/reagents into the atmosphere. Nowadays, industries are searching for the best reproducible methods. Voriconazole is a second-generation azole derivative used effectively in the treatment of Candida and Aspergillus species infections and oropharyngeal candidiasis in AIDS patients. Recently it has become the drug of choice in treating mucormycosis in several countries, which raises the need for production in large quantities. The present review deals with various recent important analytical techniques used to estimate voriconazole and its combination in pharmaceutical formulations and biological fluids. The methods show their own unique way of analyzing voriconazole in different matrices with excellent linearity, detection, and quantification limits. Additionally, this article deals with methods and solvents analyzed for their impact on the environment. This is followed by estimating the degree of greenness of the methods using various available assessment tools like analytical eco-scale, national environmental method index, green analytical procedure index, and AGREE metrics to confirm the environmental impact. The scores obtained with the evaluation tools depict the quantum of greenness for the reported methods and provide an ideal approach adopted for VOR estimation. Very few methods are eco-friendly, which shows that there is a need for the budding analyst to develop methods based on green analytical principles to protect the environment.
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Affiliation(s)
- Hemanth Kumar Chanduluru
- SRM College of Pharmacy, SRM Institute of Science and Technology Kattankulathur 603203 India +91 7904062599
| | - Abimanyu Sugumaran
- SRM College of Pharmacy, SRM Institute of Science and Technology Kattankulathur 603203 India +91 7904062599
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Mushtaq M, Shah Y, Samiullah , Nasir F, Khan H, Faheem M, Nadeem A, Khan S, Khan SI, Abbas M, Khuda F, Iftikhar T. Determination of Voriconazole in Human Plasma Using RP-HPLC/UV-VIS Detection: Method Development and Validation; Subsequently Evaluation of Voriconazole Pharmacokinetic Profile in Pakistani Healthy Male Volunteers. J Chromatogr Sci 2021. [DOI: 10.1093/chromsci/bmab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
In this research work, an isocratic, reversed-phase high-performance liquid chromatography-ultraviolet/visible detector method was developed for analysis of voriconazole standard (stock-solution) and in plasma samples. Optimization and validation of the method was carried out as per international guidelines. The method offered a simple liquid–liquid extraction technique, which exhibited best recovery of voriconazole along with fluconazole, i.e., internal standard. Different experimental conditions were tried and ultimately, the best outcomes were accomplished utilizing C-18 Perkin-Elmer® column with particulars of 150 mm length, 4.6 mm inner diameter and 5 μm particle size, protected by an RP-18 Perkin-Elmer® Pre-column guard cartridge with specifications of 10 μm particle size, 30 mm length and 4.6 mm inner diameter, utilizing mobile-phase of acetonitrile-water (ACN: H2O) in proportion of 60: 40 v/v, having a flow rate of 1.5 mL/min, and wavelength of 254 nm. All the analytes were observed to be separated in ≤7 min. A linear calibration curve was obtained at concentration range of 01–10 μg/mL of voriconazole. The correlation coefficient of voriconazole was observed to be 0.999, and average recovery (in percent) was 97.4%, whereas the relative standard deviation value was ≤2%. The lower limit of detection was 0.01 μg/mL, whereas, lower limit of quantification was 0.03 μg/mL, respectively. This developed method provided outstanding results of all validation parameters, i.e., recovery, accuracy, selectivity, precision and reproducibility. The method proposed for voriconazole analysis was applied effectively for further research investigation of voriconazole in human-plasma samples (to assess the pharmacokinetic parameters), pharmaceutical formulations and pharmacokinetic drug–drug interaction’s.
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Affiliation(s)
- Mehwish Mushtaq
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Yasar Shah
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Samiullah
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Fazli Nasir
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Muhammad Faheem
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
- Department of Pharmacy, University of Swabi, Swabi, Pakistan
| | - Atif Nadeem
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Sundas Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | | | - Muhammad Abbas
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Fazli Khuda
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Tayyaba Iftikhar
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
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Esentürk İ, Balkan T, Özhan G, Döşler S, Güngör S, Erdal MS, Sarac AS. Voriconazole incorporated nanofiber formulations for topical application: preparation, characterization and antifungal activity studies against Candida species. Pharm Dev Technol 2020; 25:440-453. [DOI: 10.1080/10837450.2019.1706563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- İmren Esentürk
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Timuçin Balkan
- Polymer Science and Technology, Istanbul Technical University, Istanbul, Turkey
- TÜPRAS Energy Center (KUTEM), Koç University, Istanbul, Turkey
| | - Gül Özhan
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Sibel Döşler
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Sevgi Güngör
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - M. Sedef Erdal
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Abdulkadir Sezai Sarac
- Polymer Science and Technology, Istanbul Technical University, Istanbul, Turkey
- Nanoscience and Nanoengineering, Istanbul Technical University, Istanbul, Turkey
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Development of a RP-HPLC method for evaluation of in vitro permeability of voriconazole in the presence of enhancers through rat skin. JOURNAL OF SAUDI CHEMICAL SOCIETY 2017. [DOI: 10.1016/j.jscs.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gentry J, Montgerard C, Crandall E, Cruz-Espindola C, Boothe D, Bellah J. Voriconazole Disposition After Single and Multiple, Oral Doses in Healthy, Adult Red-tailed Hawks ( Buteo jamaicensis ). J Avian Med Surg 2014; 28:201-8. [PMID: 25843319 DOI: 10.1647/20-077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Voriconazole is effective for treatment of aspergillosis, a common disease in captive red-tailed hawks ( Buteo jamaicensis ). To determine the disposition and safety of voriconazole after single and multiple, oral doses, 12 adult red-tailed hawks were studied in 2 phases. In phase 1, each bird received a single dose of voriconazole solution (10 mg/kg) by gavage. Blood samples were collected at 0, 0.5, 1, 3, 6, 9, 12, 16, 24, and 36 hours after treatment. In phase 2, each of 8 birds received voriconazole oral solution at 10 mg/kg PO q12h for 14 days. Plasma samples were collected on days 0, 5, and 10 and after the final dose and were processed as in phase 1. Plasma samples were submitted for analysis of voriconazole levels by high-performance liquid chromatography and ultraviolet spectrophotometry and for measurement of selected plasma biochemical parameters. After single dosing, voriconazole concentrations reached a (mean ± SD) peak (Cmax) of 4.7 ± 1.3 μg/mL at 2.0 ± 1.2 hours. The disappearance half-life (t1/2) was 2.8 ± 0.7 hours, and the mean residence time (MRT) was 4.6 ± 0.9 hours. After the last dose at 14 days, the mean Cmax of voriconazole was 4.5 ± 2.7 μg/mL at 2.4 ± 1.1 hours. The t1/2 was 2.1 ± 0.8 hours, and the MRT was 3.5 ± 1.1 hours. Although concentrations of several plasma biochemical parameters were significantly different at study end compared with prestudy concentrations, only plasma creatine kinase activity was outside the reference range. No adverse reactions were observed in any of the birds. After both single and multiple dosing at 10 mg/kg, voriconazole concentrations exceeded the minimum inhibitory concentration to inhibit 90% (MIC90) of Aspergillus species (1 μg/mL) by at least fourfold and remained above the MIC90 for 8.8 ± 1.1 hours after single dosing versus 6.5 ± 1.5 hours after multiple dosing (P = .003). This difference suggests that more frequent dosing (eg, up to q8h) may be necessary to maintain target concentrations during prolonged therapy.
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Theurillat R, Zimmerli S, Thormann W. Determination of voriconazole in human serum and plasma by micellar electrokinetic chromatography. J Pharm Biomed Anal 2010; 53:1313-8. [DOI: 10.1016/j.jpba.2010.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 05/11/2010] [Accepted: 05/12/2010] [Indexed: 12/01/2022]
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Al-Badriyeh D, Li J, Stewart K, Kong DCM, Leung L, Davies GE, Fullinfaw R. Stability of extemporaneously prepared voriconazole ophthalmic solution. Am J Health Syst Pharm 2009; 66:1478-83. [DOI: 10.2146/ajhp080110] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - David C. M. Kong
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
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Adams AIH, Gosmann G, Schneider PH, Bergold AM. LC Stability Studies of Voriconazole and Structural Elucidation of Its Major Degradation Product. Chromatographia 2009. [DOI: 10.1365/s10337-009-1082-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Affiliation(s)
- Zak K. Shihabi
- a Department of Pathology , Wake Forest University School of Medicine , Winston‐Salem, North Carolina, USA
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