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Deng J, Zhu X, Chen Z, Fan CH, Kwan HS, Wong CH, Shek KY, Zuo Z, Lam TN. A Review of Food–Drug Interactions on Oral Drug Absorption. Drugs 2017; 77:1833-1855. [DOI: 10.1007/s40265-017-0832-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Drug-drug interactions between sucroferric oxyhydroxide and losartan, furosemide, omeprazole, digoxin and warfarin in healthy subjects. J Nephrol 2014; 27:659-66. [PMID: 24699894 PMCID: PMC4242982 DOI: 10.1007/s40620-014-0080-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Abstract
Background The novel iron-based phosphate binder sucroferric oxyhydroxide is being investigated for the treatment of hyperphosphatemia. Patients with chronic kidney disease often have multiple comorbidities that may necessitate the daily use of several types of medication. Therefore, the potential pharmacokinetic drug–drug interactions between sucroferric oxyhydroxide and selected drugs commonly taken by dialysis patients were investigated. Methods Five Phase I, single-center, open-label, randomized, three-period crossover studies in healthy volunteers investigated the effect of a single dose of sucroferric oxyhydroxide 1 g (based on iron content) on the pharmacokinetics of losartan 100 mg, furosemide 40 mg, omeprazole 40 mg, digoxin 0.5 mg and warfarin 10 mg. Pharmacokinetic parameters [including area under the plasma concentration–time curve (AUC) from time 0 extrapolated to infinite time (AUC0–∞) and from 0 to 24 h (AUC0–24)] for these drugs were determined: alone in the presence of food; with sucroferric oxyhydroxide in the presence of food; 2 h after food and sucroferric oxyhydroxide administration. Results Systemic exposure based on AUC0–∞ for all drugs, and AUC0–24 for all drugs except omeprazole (for which AUC 0–8 h was measured), was unaffected to a clinically significant extent by the presence of sucroferric oxyhydroxide, irrespective of whether sucroferric oxyhydroxide was administered with the drug or 2 h earlier. Conclusions There is a low risk of drug–drug interactions between sucroferric oxyhydroxide and losartan, furosemide, digoxin and warfarin. There is also a low risk of drug–drug interaction with omeprazole (based on AUC0–∞ values). Therefore, sucroferric oxyhydroxide may be administered concomitantly without the need to adjust the dosage regimens of these drugs.
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Higashi K, Tanaka C, Imanishi K, Sawamoto K, Horikawa T, Ohkawa H, Matsushita R, Sai Y, Miyamoto KI. Influence of Long-term Enteral Nutrition on Pharmacokinetics of Digoxin in Rats. Drug Metab Pharmacokinet 2013; 28:44-52. [DOI: 10.2133/dmpk.dmpk-11-rg-153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ho NF, Merkle HP, Higuchi WI. Quantitative, mechanistic and physiologically realistic approach to the biopharmaceutical design of oral drug delivery systems. Drug Dev Ind Pharm 2008. [DOI: 10.3109/03639048309046315] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lindenberg M, Kopp S, Dressman JB. Classification of orally administered drugs on the World Health Organization Model list of Essential Medicines according to the biopharmaceutics classification system. Eur J Pharm Biopharm 2005; 58:265-78. [PMID: 15296954 DOI: 10.1016/j.ejpb.2004.03.001] [Citation(s) in RCA: 493] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 02/05/2004] [Indexed: 01/01/2023]
Abstract
Since its inception in 1995, the biopharmaceutical classification system (BCS) has become an increasingly important tool for regulation of drug products world-wide. Until now, application of the BCS has been partially hindered by the lack of a freely available and accurate database summarising solubility and permeability characteristics of drug substances. In this report, orally administered drugs on the Model list of Essential Medicines of the World Health Organization (WHO) are assigned BCS classifications on the basis of data available in the public domain. Of the 130 orally administered drugs on the WHO list, 61 could be classified with certainty. Twenty-one (84%) of these belong to class I (highly soluble, highly permeable), 10 (17%) to class II (poorly soluble, highly permeable), 24 (39%) to class III (highly soluble, poorly permeable) and 6 (10%) to class IV (poorly soluble, poorly permeable). A further 28 drugs could be provisionally assigned, while for 41 drugs insufficient or conflicting data precluded assignment to a specific BCS class. A total of 32 class I drugs (either certain or provisional classification) were identified. These drugs can be further considered for biowaiver status (drug product approval based on dissolution tests rather than bioequivalence studies in humans).
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Affiliation(s)
- Marc Lindenberg
- Department of Pharmaceutical Technology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Singh BN. A quantitative approach to probe the dependence and correlation of food-effect with aqueous solubility, dose/solubility ratio, and partition coefficient (LogP) for orally active drugs administered as immediate-release formulations. Drug Dev Res 2005. [DOI: 10.1002/ddr.20008] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Interactions between food and drugs may inadvertently reduce or increase the drug effect. The majority of clinically relevant food-drug interactions are caused by food-induced changes in the bioavailability of the drug. Since the bioavailability and clinical effect of most drugs are correlated, the bioavailability is an important pharmacokinetic effect parameter. However, in order to evaluate the clinical relevance of a food-drug interaction, the impact of food intake on the clinical effect of the drug has to be quantified as well. As a result of quality review in healthcare systems, healthcare providers are increasingly required to develop methods for identifying and preventing adverse food-drug interactions. In this review of original literature, we have tried to provide both pharmacokinetic and clinical effect parameters of clinically relevant food-drug interactions. The most important interactions are those associated with a high risk of treatment failure arising from a significantly reduced bioavailability in the fed state. Such interactions are frequently caused by chelation with components in food (as occurs with alendronic acid, clodronic acid, didanosine, etidronic acid, penicillamine and tetracycline) or dairy products (ciprofloxacin and norfloxacin), or by other direct interactions between the drug and certain food components (avitriptan, indinavir, itraconazole solution, levodopa, melphalan, mercaptopurine and perindopril). In addition, the physiological response to food intake, in particular gastric acid secretion, may reduce the bioavailability of certain drugs (ampicillin, azithromycin capsules, didanosine, erythromycin stearate or enteric coated, and isoniazid). For other drugs, concomitant food intake may result in an increase in drug bioavailability either because of a food-induced increase in drug solubility (albendazole, atovaquone, griseofulvin, isotretinoin, lovastatin, mefloquine, saquinavir and tacrolimus) or because of the secretion of gastric acid (itraconazole capsules) or bile (griseofulvin and halofantrine) in response to food intake. For most drugs, such an increase results in a desired increase in drug effect, but in others it may result in serious toxicity (halofantrine).
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Affiliation(s)
- Lars E Schmidt
- Department of Clinical Pharmacology Q.7642, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Abstract
A dieta influencia todos os estágios do ciclo da vida, fornecendo nutrientes necessários ao sustento do corpo humano. Alterações de ordem funcional e/ou estrutural, provocadas por doenças e infecções agudas ou crônicas, levam à utilização de medicamentos, cujo objetivo é restaurar a saúde. A via preferencial escolhida para a sua administração é a oral, entre outras razões, por sua comodidade e segurança. O fenômeno de interação fármaco-nutriente pode surgir antes ou durante a absorção gastrintestinal, durante a distribuição e armazenamento nos tecidos, no processo de biotransformação ou mesmo durante a excreção. Assim, é de importância fundamental conhecer os fármacos cuja velocidade de absorção e/ou quantidade absorvida podem ser afetadas na presença de alimentos, bem como aqueles que não são afetados. Por outro lado, muitos deles, incluindo antibióticos, antiácidos e laxativos podem causar má absorção de nutrientes. Portanto, o objetivo do presente artigo é apresentar uma revisão dos diversos aspectos envolvidos na interação fármaco-nutriente.
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Melia AT, Zhi J, Koss-Twardy SG, Min BH, Smith BL, Freundlich NL, Arora S, Passe SM. The influence of reduced dietary fat absorption induced by orlistat on the pharmacokinetics of digoxin in healthy volunteers. J Clin Pharmacol 1995; 35:840-3. [PMID: 8522642 DOI: 10.1002/j.1552-4604.1995.tb04128.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To assess the influence of an orlistat-induced reduction in dietary fat absorption on the pharmacokinetics of digoxin, an open-label, placebo-controlled, randomized, two-way crossover study was performed in 12 healthy volunteers. Each subject received single 0.4-mg doses of digoxin (soft gelatin capsules) administered orally on the fourth day of orlistat (120 mg three times daily for 6 days) and placebo (three times daily for 6 days) treatment, separated by at least an 11-day washout period. Serial blood samples were collected before and at appropriate intervals after each digoxin dose to determine plasma concentrations of unchanged digoxin. The 90% confidence intervals for the ratio of geometric least-squares means (for Cmax, AUC0-48, AUC0-t, and AUC) and for the difference of arithmetic least-squares means (for tmax and lambda z) indicate that the pharmacokinetics of digoxin was not altered by treatment with orlistat. This results suggests that a approximately 30% reduction in dietary fat absorption will not change the efficacy of digoxin in cardiac patients.
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Affiliation(s)
- A T Melia
- Hoffmann-La Roche Inc., Nutley, New Jersey 07110-1199, USA
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Watson AD, Church DB, Emslie DR, Baggot JD, Griffin DL. Effect of ingesta and of tablets of different strengths on the systemic availability of digoxin in normal dogs. Res Vet Sci 1995; 58:203-5. [PMID: 7659841 DOI: 10.1016/0034-5288(95)90102-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The plasma concentrations of digoxin were measured in eight normal dogs given digoxin on four occasions, using three different feeding regimens and tablets of two strengths. Although ingesta tended to slow the absorption of digoxin, the systemic availability of the drug, based on measurements of Cmax, tmax and AUC did not differ when digoxin tablets were given with canned food, with dry food, or without food. However, some of the pharmacokinetic characteristics and smaller individual variations with the dry food regimen would be considered advantageous for maintenance therapy. Tablets containing 62.5 micrograms or 250 micrograms of digoxin had a similar relative bioavailability. The peak plasma digoxin concentrations were higher in female dogs, and the trends in other data also suggested that the systemic availability of digoxin was better in female dogs.
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Affiliation(s)
- A D Watson
- Department of Veterinary Clinical Sciences, University of Sydney, New South Wales, Australia
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Tsutsumi K, Nakashima H, Kotegawa T, Nakano S. Influence of food on the absorption of beta-methyldigoxin. J Clin Pharmacol 1992; 32:157-62. [PMID: 1613126 DOI: 10.1002/j.1552-4604.1992.tb03821.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nine healthy subjects received 0.2 mg of beta-methyldigoxin (beta-MD) orally in the fasting state, 30 minutes after and before a standard breakfast. The time-to-peak serum glycoside concentration was delayed and the peak concentration was lower in the postprandial state compared with the other regimens (P less than .01). The absorption rate constant was significantly reduced when beta-MD was given after a meal (1.55 +/- 1.75 hr-1) than before a meal (5.54 +/- 2.16 hr-1) and in the fasting state (5.22 +/- 3.06 hr-1)(P less than .01). Although the area under the serum glycoside concentration-time curve and the cumulative urinary excretion (CUE) of beta-MD, digoxin, and total drug (beta-MD plus digoxin) was not significantly different between three regimens, the CUE infinity tended to be smaller in the postprandial state compared with before a meal. The results indicate that the timing of drug administration in relation to a meal is an important factor leading to the fluctuations of serum glycoside concentration after oral beta-MD, which might be of some clinical importance.
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Affiliation(s)
- K Tsutsumi
- Department of Clinical Pharmacology and Therapeutics, Medical College of Oita, Japan
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Johnson BF, Rodin SM, Hoch K, Shekar V. The effect of dietary fiber on the bioavailability of digoxin in capsules. J Clin Pharmacol 1987; 27:487-90. [PMID: 2821081 DOI: 10.1002/j.1552-4604.1987.tb03054.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sixteen healthy volunteers were regularly given 0.4 mg of digoxin daily as two capsules with breakfast. After ten days during which breakfast was supplemented with 11 g of bran fiber, steady-state predose mean serum digoxin was lower (0.89 +/- 0.19 versus 0.84 +/- 0.18 ng/mL, P less than .05) and mean 24-hour area under curve determination was lower (30.5 +/- 6.1 versus 28.4 +/- 6.0 ng X hr/mL, P less than .05) than during the control period without bran. Height and time of peak serum digoxin, and 24-hour urinary digoxin were not significantly different. The 6 to 7% reduction in digoxin absorption from capsules is less than that reported from tablets and is probably clinically unimportant.
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Affiliation(s)
- B F Johnson
- Division of Clinical Pharmacology, University of Massachusetts Medical Center, Worcester 01605
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Abstract
The influence of drug-drug and drug-food interactions affecting the absorption of orally administered medication is reviewed. Drug-drug interactions can be classified in terms of indirect effects by one drug on gastrointestinal tract physiology influencing the absorption of other drugs, or direct interactions involving altered pH, adsorption, absorption, or chelation. Most, but not all, drug-drug interactions result in reduced or delayed systemic drug availability. Drug-food interactions may result in reduced, delayed, or increased systemic drug availability. The absorption of only a small number of drugs is unaffected by concomitant food intake. The degree of interaction and whether it positively or negatively affects drug absorption depends on a number of factors including the physical and chemical nature of the drug, the formulation, the type of meal, and the time interval between eating and dosing. Mechanisms of drug-food interactions are not well characterised. They clearly involve both direct and indirect factors in a similar fashion to drug-drug interactions, but indirect factors probably predominate. Reduced or delayed drug absorption is generally attributed, at least in part, to delayed stomach-emptying due to food. Increased absorption may also result from delayed stomach-emptying facilitating greater drug dissolution before it passes from the stomach into the small intestine. Increased bioavailability of some drugs, e.g. propranolol, metoprolol and labetalol, may be related to reduced presystemic clearance. The potential clinical implications of drug-drug and drug-food interactions must be taken into account with oral medications in order to minimise variations in systemic drug availability and hence in clinical efficacy.
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Bergdahl B, Bogentoft C, Jonsson UE, Magnusson JO. Fasting and postprandial absorption of digoxin from a microencapsulated formulation. Eur J Clin Pharmacol 1983; 25:207-10. [PMID: 6628502 DOI: 10.1007/bf00543792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The absorption of digoxin from a capsule preparation containing a large number of small, enteric-coated granules of the glycoside (Preparation CR) was compared in 10 volunteers with that from a rapidly dissolving tablet (Preparation L). Plasma and urine digoxin concentrations were measured by radioimmunoassay. In the fasting state, after a loading dose of digoxin (0.76 mg), peak plasma concentrations were significantly (p less than 0.001) lower after CR (2.0 +/- 0.5 nmol/l, mean +/- SD) than L (4.7 +/- 1.1 nmol/l). Peak concentrations after CR were significantly (p less than 0.001) delayed compared to L (3.3 +/- 0.6 h vs 1.1 +/- 0.4 h). Also, postprandial peak plasma concentrations at steady state, were significantly (p less than 0.01) lower after CR (1.0 +/- 0.3 nmol/l) than L (2.7 +/- 0.5 nmol/l), and the peak concentrations occurred later (3.9 +/- 1.7 h vs 1.4 +/- 0.9 h). The area under the plasma concentration-time curves was smaller (p less than 0.01) for CR (17.7 +/- 5.9 nmol X 1(-1) X h) than for L (22.4 +/- 4.1 nmol X 1(-1) X h), and so was the amount of drug excreted in urine (174 +/- 25 micrograms vs 190 +/- 31 micrograms; p less than 0.005). Thus, the absorption rate of digoxin from the enteric-coated formulation was markedly reduced but at the cost of a variable reduction in the amount absorbed.
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George S, Dauwe K, McBurney A, Ward J. The influence of food intake on the bioavailability of timegadine, a novel non-steroidal anti-inflammatory drug. Br J Clin Pharmacol 1983; 15:495-8. [PMID: 6849788 PMCID: PMC1427812 DOI: 10.1111/j.1365-2125.1983.tb01537.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The effects of food ingestion on the absorption of timegadine, a recently synthesised non-steroidal anti-inflammatory drug, was studied in ten healthy volunteers. It was found that food enhanced the absorption of timegadine as shown by increased peak plasma concentrations (Cmax), decreased time taken to achieve these concentrations (tmax), and increased area under the plasma concentration time curve (AUC).
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Abstract
A absorção de drogas pode, às vezes, ser consideravelmente alterada conforme as condições em que são ingeridas, ou seja, em jejum ou junto com alimentos ou fluidos. Além disso, alguns componentes alimentares não devem ser ingeridos com certas drogas por apresentarem efeitos adversos. O presente trabalho aborda essas interações e incompatibilidades existentes entre as drogas e os alimentos.
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Walden RJ, Hernandez R, Witts D, Graham BR, Prichard BN. Effect of food on the absorption of hydralazine in man. Eur J Clin Pharmacol 1981; 20:53-8. [PMID: 7308273 DOI: 10.1007/bf00554667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Single oral doses of hydralazine (Apresoline) 50 mg were administered on two occasions to eight healthy volunteers when fed and fasting. Blood and saliva samples were taken at intervals after dosing and analysed for drug. Heart rate and blood pressure were measured before and at intervals after dosing, at rest, after tilt and exercise. Plasma hydralazine levels showed wide inter-individual variation. The areas under the plasma concentration-time curve (0-8 h), the height of the peak plasma levels and the time to peak were not significantly different between the fed and fasting state. Salivary hydralazine levels were readily measurable but showed little correlation with plasma levels. The heart rate and pulse pressure were increased after drug both at rest, supine and erect, and after exercise for between 6 and 8 h.
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Sheiner LB, Benet LZ, Pagliaro LA. A standard approach to compiling clinical pharmacokinetic data. JOURNAL OF PHARMACOKINETICS AND BIOPHARMACEUTICS 1981; 9:59-127. [PMID: 7014827 DOI: 10.1007/bf01059343] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A standard format for a Clinical Pharmacokinetic Summary is proposed. It consists of a heading, tables, notes, and references for each drug reviewed. The table presents a unified and logical set of clinically useful population pharmacokinetic parameters. They concern four major areas: absorption, distribution, elimination, and the relationship of concentration to effect. Within each major group, parameters dealing with extents and rates of processes are given. Each such parameter is really two: a population mea value (for example, average volume of distribution) and the standard deviation of individual values about this mean. The first value allows individual predictions of dosage or drug level to be made; the second allows computation of the likely proximity of subsequently observed quantities to those predictions. The table presents single consensus values for each population parameter, rather than a list of values. A procedure for computing these consensus values, and for revising them in the light of new data, or reinterpreted old data, is given. Examples of Summaries are given. The method appears applicable to a variety of drugs. We suggest our approach as a standard one for preparing Clinical Pharmacokinetic Summaries, and urge our colleagues to consider it for that purpose.
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Levy RH, Cenraud B, Loiseau P, Akbaraly R, Brachet-Liermain A, Guyot M, Gomeni R, Morselli PL. Meal-dependent absorption of enteric-coated sodium valproate. Epilepsia 1980; 21:273-80. [PMID: 6769666 DOI: 10.1111/j.1528-1157.1980.tb04073.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The effect of meals on valproic acid (VPA) absorption from an enteric coated (EC) formulation was investigated. In study I, six adult normal volunteers received a single 500 mg dose of sodium valproate in randomized treatments: fasting (A), with a meal (B) or 3 hours after a meal (C). There were significant differences between treatments in the latency period (Lp) defined as the time during which measured concentrations of VPA were less than 1 microgram/ml. Lp values for treatments A, B and C were: 1.67 +/- 1.25 hr, 6.75 +/- 3.98 hr and 7.63 +/- 3.15 hr respectively. In study II, six subjects (five from study I) received in a randomized fashion a 400 mg intravenous bolus dose of VPA and a 500 mg EC VPA tablet, 3 hours after a meal. The mean Lp value was 8.1 +/- 1.6 hr and the mean bioavailability was 100%. Clearance, volume of distribution and half-life values obtained after intravenous dosing were comparable to literature values. These results indicate that food intake delays but does not decrease the extent of absorption of VPA from an enteric coated formulation.
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