ABSTRACT
OBJECTIVE: To assess the potential effects of food on the pharmacokinetics and tolerability/safety of ximelagatran, an oral direct thrombin inhibitor developed for the prevention and treatment of thromboembolic disease that is rapidly bioconverted to its active form, melagatran. DESIGN AND STUDY PARTICIPANTS: In two open-label, randomised, crossover studies, healthy male and female volunteers received oral ximelagatran as a single 24mg tablet (study 1, n = 30) or a single 36mg tablet (study 2, n = 50). Potential effects of food on the pharmacodynamics (activated partial thromboplastin time; APTT) of the 36mg tablet were also investigated in study 2. RESULTS: For the 24mg tablet, the 90% confidence intervals (CIs) and least-squares mean estimates for the ratio of the tablet with food to the tablet without food fell within the predefined bounds demonstrating no effect on area under the melagatran concentration-time curve (AUC ratio = 0.94 [90% CI 0.90, 0.99]) or maximum plasma concentration (C(max) ratio = 0.88 [90% CI 0.82, 0.95]). The same result was observed for the 36mg tablet (AUC ratio = 1.07 [90% CI 1.03, 1.12]; C(max) ratio = 1.05 [90% CI 0.98, 1.12]). Melagatran AUC normalised for differences in bodyweight was comparable between women and men administered the 24mg or 36mg tablet without food. In addition, food did not clinically significantly alter the melagatran-induced prolongation of the APTT of the 36mg tablet. Ximelagatran was well tolerated with or without food. CONCLUSION: The pharmacokinetics (AUC, C(max)), pharmacodynamics (APTT) and tolerability of melagatran after administration of oral ximelagatran tablets were not affected by food.
ABSTRACT
OBJECTIVE: To investigate whether crushed or dissolved tablets of the oral direct thrombin inhibitor ximelagatran are bioequivalent to whole tablet administration. Ximelagatran is currently under development for the prevention and treatment of thromboembolic disorders. RESEARCH DESIGN AND METHODS: This was an open-label, randomised, three-period, three-treatment crossover study in which 40 healthy volunteers (aged 20-33 years) received a single 36-mg dose of ximelagatran administered in three different ways: I swallowed whole, II crushed, mixed with applesauce and ingested and III dissolved in water and administered via nasogastric tube. RESULTS: The plasma concentrations of ximelagatran, its intermediates and the active form melagatran were determined. Ximelagatran was rapidly absorbed and the bioavailability of melagatran was similar after the three different administrations, fulfilling the criteria for bioequivalence. The mean area under the plasma concentration-versus-time curve (AUC) of melagatran was 1.6 micromol.h/L (ratio 1.01 for treatment II/I and 0.97 for treatment III/I), the mean peak concentration (C(max)) was 0.3 micromol/L (ratio 1.04 for treatment II/I and 1.02 for treatment III/I) and the mean half-life (t(1/2)) was 2.8 h for all treatments. The time to C(max) (t(max)) was 2.2h for the whole tablet and approximately 0.5 h earlier when the tablet was crushed or dissolved (1.7-1.8 h), due to a more rapid absorption. The study drug was well tolerated as judged from the low incidence and type of adverse events reported. CONCLUSION: The present study showed that the pharmacokinetics (AUC and C(max)) of melagatran were not significantly altered whether ximelagatran was given orally as a crushed tablet mixed with applesauce or dissolved in water and given via nasogastric tube.
