Proton Pump Inhibitors Do Not Affect the Bioavailability of a Novel Liquid Formulation of Levothyroxine

OBJECTIVE

This study evaluates the impact of a representative proton pump inhibitor (PPI) (omeprazole), administered simultaneously or staggered, on the pharmacokinetics of levothyroxine (LT4) solution (Tirosint-SOL).

METHODS

This was a randomized, 3-way crossover, comparative bioavailability study in 36 healthy adults under fasting conditions. Omeprazole 40 mg delayed-release capsule was administered once daily from Day 1 to 6 (mornings, Treatment-A; evenings, Treatment-B; none, Treatment-C) to increase and stabilize gastric pH. In the morning of Day 5, a single dose of LT4 solution 600 mcg was administered. Blood samples were collected 0 to 48 hours post-LT4 administration. Noncompartmental pharmacokinetic parameters were calculated for total serum thyroxine using baseline-corrected data. Maximum concentration (Cmax) and area under the concentration-time curve (AUC0-48) were included in an analysis of variance to obtain geometric mean ratios and 90% confidence intervals.

RESULTS

For both comparisons (A/C and B/C), geometric mean ratios and 90% confidence intervals for all parameters were within the equivalence boundaries (80%-125%), indicating bioequivalence: for A/C, AUC0-48 98.98% [94%-104%], and Cmax 91.68% [87%-97%]; for B/C, AUC0-48 98.94% [95%-103%], and Cmax 94.90% [90%-100%]. Median Tmax (time associated with Cmax) was similar across treatments.

CONCLUSION

This study demonstrated that Tirosint-SOL bioavailability is unaffected by coadministration of a representative PPI, given simultaneously or staggered by about 12 hours, compared to administration of LT4 solution alone. For hypothyroid patients on PPI therapy, administration of LT4 solution may reduce variations in thyroid stimulating hormone levels related to intermittent use of acid-reducing drugs and consequently the need for dose adjustments.

A Novel Levothyroxine Solution Results in Similar Bioavailability Whether Taken 30 or Just 15 Minutes Before a High-Fat High-Calorie Meal

Background: Levothyroxine (LT4) sodium is a standard treatment for hypothyroidism. Its absorption and bioavailability when taken as a tablet have been shown to be significantly decreased with concomitant food ingestion. Therefore, LT4 formulations are recommended to be taken on an empty stomach, at least 30, ideally 60, minutes before breakfast, potentially affecting adherence to therapy. A novel LT4 solution (Tirosint^®-SOL) has been shown to result in a faster absorption process than tablets or soft-gel capsule formulations. The objective of this trial was to evaluate the bioavailability of this preparation taken 15 minutes before a high-fat high-calorie meal in comparison with the minimally recommended 30-minute interval. Methods: Thirty-six (33 completers, 24 males and 9 females) healthy volunteers participating in the randomized study took 600 mcg of LT4 oral solution, single doses after a 10-hour fast, 15 or 30 minutes before a high-fat, high-calorie, FDA-approved standardized meal in a controlled research setting. We measured serum total thyroxine using Liquid Chromatography with Tandem Mass Spectrometry at baseline and multiple time points up to 72 hours after LT4 administration. The predefined equivalence boundaries for the extent of exposure reflected by the area under the curve (AUC) were 80-125%. The washout period was at least 35 days. Results: The geometric mean ratios and confidence intervals (CIs) for the baseline-adjusted extent of exposure represented by AUCs truncated at both 48 and 72 hours after dosing (AUC_0-48: 90% [90% CI 86-94]; and AUC_0-72: 92% [90% CI 87-97]) were within the prespecified equivalence boundaries. The baseline-adjusted peak concentration was also clinically similar (C_max: 85% [90% CI 80-90]). The median t_max was 1.5 hours in each group. The rate of adverse events was similar between groups. Conclusions: We observed no significant difference in the pharmacokinetic properties of a novel LT4 solution administered 15 and 30 minutes before a high-fat high-calorie meal in normal subjects. Further research is needed to evaluate (a) the differences in overall bioavailability at other time points (including immediately premeal) and (b) the real-world effectiveness of this preparation in newly proposed administration conditions to optimize treatment outcomes in hypothyroid patients.

An integrated approach in a municipal WWTP: anaerobic codigestion of sludge with organic waste and nutrient removal from supernatant

Co-digestion appears to be an interesting solution to increase the biogas production of poorly performing under-loaded digesters of waste activated sludge. In the Florence WWTP anaerobic codigestion could increase nitrogen and phosphorus loading rates and thus lower the nutrient removal efficiency. In order to develop an integrated solution to upgrade the Florence WWTP, the different process units were tested in experimental plants. Anaerobic codigestion with source-collected organic solid waste in a pilot-scale bioreactor showed an increase of GPR from 0.15 to 0.45 Nl biogas/l/d with 23% of organic waste loaded. Autotrophic nitrogen removal was carried out in two lab-scale pilot plants which were fed with a real anaerobic supernatant after phosphate removal via struvite formation. The nitritation MBBR has been working for one year at steady-state conditions with a perfect nitrite/ammonium ratio equal to 1:1. Anammox biomass enrichment was performed in a suspended biomass SBR and the specific nitrogen removal rate increased from 1.7 to 58 gN/kgVSS/d in 375 days.

Oxidative processes for olive mill wastewater treatment

The present work describes an experimental study carried out in order to investigate the efficiency and feasibility of physical (lime coagulation) and advanced oxidation processes (Ozone and Fenton's process) for olive oil mill wastewater treatment. Particular attention was paid to the degradation of both organic and phenolic compounds. Lime coagulation reaches maximum removal at a pH of 12, with a TP (total polyphenols) and COD reduction of 37 and 26%, respectively. Ozone oxidation is also pH-dependent, showing the higher removal efficiency (91% for TP and 19% for COD) with an initial pH value of 12. Experimental results show a lower efficiency of Fenton's process than ozone in TP removal, reaching a maximum value of 60%. Oxidation trials carried out on gallic and p-coumaric synthetic solutions confirmed ozone and Fenton's efficiency at degrading phenolic compounds. Biological trials, both aerobic and anaerobic, highlighted a significant increase of biodegradability of treated OMW samples if compared to the untreated ones. Respirometric tests showed an increase in BOD of about 20% and anaerobic batch tests provided a methane production up to eight times higher.

Olive mill wastewater treatment: an experimental study

Olive oil production, one of the main agro-industries in Mediterranean countries, generates significant amounts of olive mill wastewaters (OMWs), which represent a serious environmental problem, because of their high organic load, the acidic pH and the presence of recalcitrant and toxic substances such as phenolic and lipidic compounds (up to several grams per litre). In Italy, traditional disposal on the soil is the most common way to discharge OMWs. This work is aimed at investigating the efficiency and feasibility of AOPs and biological processes for OMW treatment. Trials have been carried out on wastewaters taken from one of the largest three-phase mills of Italy, located in Quarrata (Tuscany), as well as on synthetic solutions. Ozone and Fenton's reagents applied both on OMWs and on phenolic synthetic solutions guaranteed polyphenol removal efficiency up to 95%. Aerobic biological treatment was performed in a batch reactor filled with raw OMWs (pH = 4.5, T = 30 degrees C) without biomass inoculum. A biomass rich of fungi, developed after about 30 days, was able to biodegrade phenolic compounds reaching a removal efficiency of 70%. Pretreatment of OMWs by means of oxidation increased their biological treatability.