Pharmacokinetics of two paediatric artesunate mefloquine drug formulations in the treatment of uncomplicated falciparum malaria in Gabon.

OBJECTIVES: Paediatric drug formulations of artemisinin combination therapies and pharmacokinetic data supporting their use in African children are urgently needed for the effective treatment of young children suffering from falciparum malaria in sub-Saharan Africa. PATIENTS AND METHODS: In this study, the pharmacokinetic characteristics of a novel paediatric granule formulation of artesunate-mefloquine therapy were evaluated in comparison to the standard tablet formulation in the treatment of uncomplicated malaria in paediatric patients. Twenty-four patients were assigned to treatment according to body weight with either a fixed-dose paediatric granule co-formulation (10-20 kg body weight) or a free-dose co-blister tablet formulation of artesunate-mefloquine (>20-40 kg body weight). RESULTS: Median values for C(max) (861 and 930 ng/mL), T(max) (1.5 and 1.5 h) and AUC(0-)(t) (2,050 and 2,470 ng.h/mL) were comparable for dihydroartemisinin in the two groups. Exploratory analysis of mefloquine plasma levels revealed a trend towards higher concentrations in the younger age group during the absorption phase (2,550 and 1,815 ng/mL, 54 h after initiation of treatment, respectively). Median mefloquine concentrations at day 28 were 197 and 343 ng/mL, respectively. CONCLUSIONS: The pharmacokinetic characteristics of the two paediatric dosage forms, i.e. the novel fixed-dose co-formulation and the standard co-blister of artesunate-mefloquine show comparable results in the two treatment groups. The novel fixed-dose paediatric formulation is an interesting option for outpatient treatment of uncomplicated malaria in African children.

Comparative efficacy and tolerability of two sustained-release formulations of diclofenac: results of a double-blind, randomised study in patients with osteoarthritis and a reappraisal of diclofenac's use in this patient population.

OBJECTIVE: To compare the analgesic efficacy and tolerability of a sustained-release pellet formulation of diclofenac (Olfen-100 SR Depocaps, SR-CAP, Mepha Ltd, Aesch, Switzerland) with the standard reference formulation (Voltaren retard 100, SR-TAB, Novartis Pharma AG, Basel, Switzerland), both containing 100 mg diclofenac sodium, in patients with osteoarthritis (OA) of the knee and/or hip. In addition, diclofenac's current place in the symptomatic therapy of OA is briefly reviewed. METHODS: In this 2-week double-blind, active-controlled, non-inferiority trial, 210 OA patients were randomised to receive either SR-CAP once daily or SR-TAB once daily (n = 105 for both groups). The primary efficacy endpoint was the change in visual analogue scale (VAS) pain score (0-100 mm) at rest at Day 14 compared with baseline. Secondary variables included the change in VAS pain score on movement and global assessments of efficacy and tolerability using verbal rating scales (VRS). RESULTS: Between baseline and Day 14, mean +/- SD VAS pain score at rest decreased by 44.4 +/- 18.5 mm in the SR-CAP group (n = 89) compared with 41.2 +/- 19.8 mm in the SR-TAB group (n = 82) based on the per protocol population. Comparable changes were observed in the intention-to-treat population. The lower bound of the 1-sided 97.5% confidence interval was -2.7 mm and greater than the prespecified non-inferiority limit of -10 mm. There was a trend towards a better tolerability with SR-CAP compared with SR-TAB based on mean +/- SD VRS scores (SR-CAP, 0.6 +/- 0.68; SR-TAB, 0.9 +/- 1.0 for assessment by patients; p = 0.063). CONCLUSION: SR-CAP is as effective as and possibly better tolerated than SR-TAB in patients suffering from painful OA.

Assessment of the effect of mefloquine on artesunate pharmacokinetics in healthy male volunteers.

The effect of mefloquine on artesunate pharmacokinetics was assessed in 20 volunteers given artesunate for 3 days, followed > or =21 days later by combination therapy for 3 days. The areas under the concentration-time curve from 0 h to infinity for dihydroartemisinin, the active metabolite of artesunate, were similar on day 3 of the two dosing periods (P = 0.12), implying no interaction.

Bioequivalence study of fluoxetine hydrochloride in healthy volunteers.

Fluoxetine hydrochloride (CAS 59333-67-4) is a selective serotonin reuptake inhibitor (SSRI) widely used as antidepressant drug. The aim of the present trial was to assess the bioequivalence of a new formulation of the drug (test formulation) as compared to a reference product from the Swiss market. Both drugs were available as 20 mg dispersible tablets. The trial was performed according to a two-period, two-sequence, balanced, randomised, single-dose design with a wash-out phase of at least 56 days. The two formulations were tested in 30 male healthy volunteers. A specific highly sensitive bioassay in tandem mass spectrometry allowed to set the limit of quantification to 100 pg/ml for fluoxetine and norfluoxetine. Average t(max) was 5.4 h for fluoxetine and 71-80 h for norfluoxetine. The peak concentration was on average 14 ng/ml for fluoxetine and 10.5 ng/ml for norfluoxetine. Half-life was on average 48-50 h for fluoxetine and 130-138 h for norfluoxetine. AUC infinity for fluoxetine and norfluoxetine were on average 790 and 2800 ng x ml(-1) x h, respectively. All these figures demonstrate that plasma concentration-time profiles of fluoxetine and norfluoxetine are quite different. Applied statistical tests, suggested by operating guidelines, demonstrated bioequivalence of the test formulation and the reference formulation. The conclusion on bioequivalence was based on both fluoxetine and norfluoxetine results. 90 % confidence Intervals for Cmax, AUCt and AUC infinity (fluoxetine and norfluoxetine) were within the acceptance range (0.80-1.25) and t(max), processed with a non-parametric test, did not show any statistically significant difference between test and reference formulation. Safety and tolerability proved to be similarly good with both test and reference formulation. In conclusion, the present trial has demonstrated bioequivalence of the test and the reference formulation, both consisting of fluoxetine hydrochloride dispersible tablets.

Determination of the transdermal bioavailability of a newly developed diclofenac sodium patch in comparison with a reference preparation.

Two different transdermal diclofenac (CAS 15307-86-5) formulations (Olfen Patch 140 mg diclofenac sodium as test preparation and 180 mg diclofenac epolamine plaster, equivalent to 140 mg diclofenac sodium, as reference preparation) were investigated in 24 healthy male and female volunteers in order to compare the transdermal bioavailability between both treatments following topical multiple dose administration. Subjects were applied 2 plasters of test and reference formulation at a dose interval of 12 h for 4 consecutive days. Test and reference preparation were administered in randomised sequence at a marked spot at the left upper arm under non-fasting conditions. For determination of diclofenac concentrations, pre-dose (trough) values were taken during steady-state build-up and during the period of switch-over between both preparations on days 1-3 and 5-7. Blood samples for pharmacokinetic profiling were taken on days 4 and 8 at pre-defined time points up to 24 h following drug administration (after the 7th resp. 15th dose). Treatments were not separated by a wash-out phase. Considering the short half-life of diclofenac, it was appropriate that a switch-over design was chosen without wash-out periods between treatments. Diclofenac plasma concentrations were determined by means of a validated LC-MS/MS method (limit of detection: 0.06 ng/ml; lower limit of quantification: 0.15 ng/ml). For the test preparation, maximum plasma concentrations of 3.36 ng/ml (C(max, 0-12)), 3.73 ng/ml (C(max, 12-24)) and 3.84 ng/ml (C(max, 0-24)) as well as areas under the plasma concentration-time curve (AUC) of 31.11 ng x h/ml (AUC(0-12), 34.83 ng x h/ml (AUC(12.24)) and 65.94 ng x h/ml (AUC(0-24)) were determined. For the reference preparation, these values were 1.55 ng/ml (C(max, 0-12)), 1.45 ng/ml (C(max, 12-24) and 1.57 ng/ml (C(max, 0-24)) as well as 13.28 ng x h/ml (AUC(0-12)), 12.68 ng x h/ml (AUC(12-24)) and 25.96 ng x h/ml (AUC(0-24)). For the test preparation, peak-to-trough fluctuations (% PTF) of 34.78% (% PTF(0-12)), 38.50% (% PTF(12-24)) and 43.68% (% PTF(0-24)) were observed. Corresponding values for the reference preparation were 35.82% (% PTF(0-12), 31.36% (% PTF(12-24)) and 40.55% (% PTF(0-24)). In order to evaluate comparable bioavailability of both preparations, 90% confidence intervals of the test/reference ratios were determined. Thereby, for all dose intervals considered and all AUC parameters calculated, the extent of diclofenac absorption from the test preparation markedly exceeds those values obtained for the reference preparation. Likewise, maximum plasma concentrations, as a measure for the rate of absorption, were higher after the test preparation. With respect to peak-to-trough fluctuation of plasma diclofenac levels, both plaster preparations were comparable for the morning dose interval 0-12 h as well as for the 0-24 h period.