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1.
Eur J Clin Pharmacol ; 54(9-10): 773-7, 1998.
Article in English | MEDLINE | ID: mdl-9923583

ABSTRACT

OBJECTIVES: The primary objective was to investigate the possible interference of ethanol on the orlistat effect on inhibition of dietary fat absorption and the possible interference of orlistat on the pharmacokinetics of ethanol. Secondary objectives were to assess the tolerability during concomitant dosing of orlistat and ethanol and to determine the ethanol effect on plasma levels of orlistat. METHODS: This was a double-blind, placebo-controlled, parallel, randomized study performed in 30 (three parallel groups of ten subjects each) healthy normal weight male subjects between the ages of 20 and 30 years. A 5-day run-in period to accustom subjects to a standardized diet of 2500 kcal/day (30% fat) and to establish baseline fecal fat excretion was followed by a 6-day treatment period. Subjects were randomly assigned to one of three treatment groups (A = orlistat 120 mg t.i.d. and ethanol placebo, B = orlistat 120 mg t.i.d. and 40 g ethanol qd on days -1 and 6, and 40 g bid on days 1-5, and C = orlistat placebo tid and 40 g ethanol qd on days -1 and 6, and 40 g b.i.d. on days 1 5). Serial blood samples were collected for determination of ethanol serum concentrations at specified times over 5 h after each dose of ethanol on days -1 and 6, and for determination of orlistat plasma concentrations on days 1, 3, 5, and 6. Feces were collected quantitatively on days -5 through 8 for analysis of fecal fat. RESULTS: The means of baseline-corrected fecal fat excretion values were comparable: 23.7 g for group A (orlistat) and 22.7 g for group B (orlistat and ethanol). No significant difference was found regarding ethanol pharmacokinetic parameters between treatments with orlistat and placebo. No apparent differences existed between the number of plasma samples with measurable orlistat concentrations in groups A and B. CONCLUSION: Concomitant ingestion of social amounts of ethanol did not alter the inhibitory effect of orlistat on dietary fat absorption during short-term treatment (6 days) with orlistat. Short-term treatment with orlistat had no significant influence on ethanol pharmacokinetics.


Subject(s)
Central Nervous System Depressants/pharmacology , Enzyme Inhibitors/pharmacology , Ethanol/pharmacology , Hypolipidemic Agents/pharmacology , Lactones/pharmacology , Lipase/antagonists & inhibitors , Adult , Area Under Curve , Central Nervous System Depressants/pharmacokinetics , Diet , Dietary Fats/metabolism , Double-Blind Method , Drug Interactions , Enzyme Inhibitors/pharmacokinetics , Ethanol/pharmacokinetics , Feces/chemistry , Half-Life , Humans , Hypolipidemic Agents/pharmacokinetics , Intestinal Absorption/drug effects , Lactones/pharmacokinetics , Male , Orlistat
2.
J Clin Pharmacol ; 36(11): 1006-11, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8973989

ABSTRACT

To determine the metabolic profile of minimally absorbed orlistat in obese/overweight patients, an open-label, single-dose study was performed in eight obese/overweight volunteers between 23 and 68 years of age. Each subject received a single oral dose of 360 mg orlistat containing approximately 400 muCi of 14C-labeled orlistat. Serial blood samples were collected at specified times over 10 hours after administration of orlistat for determination of total radioactivity, unchanged orlistat, and major metabolites in the plasma. Urine samples were collected over 24 hours and analyzed to evaluate the urinary recovery of total radioactivity and the profile of orlistat metabolites in the urine. In addition, all fecal samples were collected and analyzed for total radioactivity. Urinary and fecal recovery of the administered dose of total radioactivity were 1.13 +/- 0.50% (24-hour data only) and 96.4 +/- 18.1% (n = 7), respectively. Maximum observed concentration (Cmax) and time to Cmax (tmax) values of plasma total radioactivity were 150 +/- 51 ng.eq/mL and 6.8 +/- 1.5 hrs, respectively. All these parameters obtained in obese/ overweight subjects were similar to those reported previously in healthy subjects. On the basis of the area under the concentration-time curve from 0 to 10 hours (AUC0-10), two major metabolites comprise a total of approximately 42% of the total radioactivity in plasma. The primary metabolite (M1) has a short half-life (approximately 2 hours), whereas the secondary metabolite (M3) disappeared at a slower rate. No strikingly apparent difference in the urinary metabolic profile was observed between two gender groups. It is concluded that the disposition of orlistat appears to be similar between normal and obese/overweight subjects. Of the minimal fraction of the dose that was absorbed systemically, the presence of two major metabolites accounts for approximately 42%.


Subject(s)
Enzyme Inhibitors/metabolism , Lactones/metabolism , Obesity/metabolism , Absorption , Administration, Oral , Adult , Aged , Body Weight/physiology , Carbon Radioisotopes , Enzyme Inhibitors/pharmacokinetics , Female , Humans , Lactones/pharmacokinetics , Lipase/antagonists & inhibitors , Male , Middle Aged , Orlistat
3.
J Clin Pharmacol ; 36(7): 654-8, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8844449

ABSTRACT

To assess the effect of an orlistat-induced reduction in dietary fat absorption on the pharmacokinetics of phenytoin, a third-party blind, placebo-controlled, randomized, two-way crossover study was performed in 12 healthy volunteers. Each participant received single 300-mg oral doses of phenytoin administered on the fourth day of treatment with 120 mg orlistat (treatment A) or placebo (treatment B) three times a day for 7 days. The two treatments were separated by a 2-week washout period. Serial blood samples were collected before and up to 96 hours after each dose of phenytoin to determine serum concentrations of phenytoin. The 90% confidence intervals (CI) for the ratio of geometric least-squares means for maximum concentration (Cmax) and area under the concentration-time curve (AUC) and for the difference of arithmetic least-squares means for time of maximum concentration (tmax) and elimination rate constant (lambda z) showed the two treatments of phenytoin to be equal by analysis of variance. An approximately 30% reduction in dietary fat absorption induced by orlistat administered at doses of 120 mg three times daily did not significantly alter the pharmacokinetics of a single 300-mg oral dose of phenytoin in healthy volunteers.


Subject(s)
Anticonvulsants/pharmacokinetics , Dietary Fats/pharmacokinetics , Enzyme Inhibitors/pharmacology , Lactones/pharmacology , Phenytoin/pharmacokinetics , Absorption , Adult , Analysis of Variance , Anticonvulsants/blood , Cross-Over Studies , Food-Drug Interactions , Humans , Male , Middle Aged , Orlistat , Phenytoin/blood
4.
J Clin Pharmacol ; 36(7): 647-53, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8844448

ABSTRACT

An open-label, placebo-controlled, randomized, two-way crossover study was performed in 12 healthy volunteers (between 20 and 44 years of age) to assess the effect of orlistat, a gastrointestinal lipase inhibitor that reduces dietary fat absorption and is being developed for weight control in obesity, on the absorption of vitamins A and E. Each participant received a single oral dose of 25,000 IU vitamin A followed 24 hours later by a single oral dose of 400 IU vitamin E on two separate occasions: during oral administration of 120 mg orlistat or placebo three times daily for 9 days. The two treatments were separated by a washout period of at least 2 weeks. Serial blood samples for pharmacokinetic analysis were collected at specified times over 24 hours after each dose of vitamin A for determination of serum concentrations of retinol, and over a period of 5 days after each dose of vitamin E for determination of serum concentrations of alpha-tocopherol, total cholesterol, and triglycerides. Orlistat significantly reduced the absorption of vitamin E (approximately 43% according to maximum concentration and approximately 60% according to area under the concentration-time curve), but not that of vitamin A, at the dose levels studied. The results of this study will aid in the implementation of a vitamin supplementation strategy, should vitamin deficiency occur in patients undergoing orlistat therapy.


Subject(s)
Enzyme Inhibitors/pharmacology , Lactones/pharmacology , Lipids/blood , Vitamin A/pharmacokinetics , Vitamin E/pharmacokinetics , Absorption , Adult , Cross-Over Studies , Female , Humans , Lipid Metabolism , Male , Orlistat , Vitamin A/blood , Vitamin E/blood
5.
J Clin Pharmacol ; 36(7): 659-66, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8844450

ABSTRACT

To assess the effect of orlistat on the pharmacokinetics and pharmacodynamics of warfarin, a third-party blind, placebo-controlled, randomized, two-way crossover study was performed in 12 healthy volunteers. Each participant received single 30-mg oral doses of racemic warfarin sodium (Coumadin; DuPont Pharma, Wilmington, DE) administered on the eleventh day of treatment with 120 mg orlistat (treatment A) and placebo (treatment B) three times a day for 16 days; the two treatments were separated by a 3-week washout period. Serial blood samples were collected before and at appropriate intervals after each dose of warfarin to determine plasma concentrations of R-warfarin and S-warfarin and blood prothrombin time (PT) and plasma Factor VII concentration. In addition, serum concentrations of vitamin K1 and its epoxide and of osteocalcin and its undercarboxylated form were measured before breakfast on days -7, 1, 4, 6, and 10. Equivalent results between treatments with orlistat and placebo were found with regard to all pharmacokinetic parameters of R- and S-warfarin (except for time to maximum concentration of R-warfarin). Pharmacodynamic parameters of warfarin (PT and Factor VII) and vitamin K nutritional status parameters (ratios of vitamin K1 to vitamin K1 epoxide and undercarboxylated osteocalcin to osteocalcin) also were unaltered by orlistat. Orlistat administered at doses of 120 mg three times daily did not significantly alter the pharmacokinetics and pharmacodynamics of a single 30-mg oral dose of warfarin in healthy volunteers.


Subject(s)
Anticoagulants/pharmacokinetics , Enzyme Inhibitors/pharmacology , Lactones/pharmacology , Warfarin/pharmacokinetics , Adult , Analysis of Variance , Anticoagulants/blood , Cross-Over Studies , Humans , Male , Middle Aged , Orlistat , Prothrombin Time , Vitamin K/blood , Vitamin K/metabolism , Warfarin/blood
6.
J Clin Pharmacol ; 36(4): 352-5, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8728349

ABSTRACT

Orlistat, a lipase inhibitor, reduces dietary fat absorption, and thus could potentially alter the absorption of some concomitantly administered drugs, such as the nifedipine gastrointestinal therapeutic system (GITS). To assess the effect of orlistat on the bioavailability of nifedipine GITS, a third party-blind, placebo-controlled, randomized, two-way crossover study was performed in 18 healthy volunteers. Each participant received single 60-mg oral doses of nifedipine GITS (Procardia XL; Pfizer Labs, New York, NY) on the fourth day of treatment with 120 mg of orlistat or placebo three times a day for 6 days. The two treatments were separated by a washout period of at least 1 week. Serial blood samples were collected before and at appropriate intervals after each nifedipine dose to determine plasma concentrations of nifedipine. The 90% confidence intervals for the ratio of geometric least-square means for maximum concentration (C(max)) and area under the concentration-time curve (AUCo-t) and for the difference of arithmetic least-square means for time to maximum concentration (t(max)) indicate that the bioavailability of nifedipine was not altered by treatment with orlistat. Therapeutic doses of 120 mg of orlistat three times daily do not significantly alter the bioavailability of a single 60-mg oral dose of nifedipine GITS in healthy volunteers.


Subject(s)
Calcium Channel Blockers/pharmacokinetics , Enzyme Inhibitors/pharmacology , Lactones/pharmacology , Nifedipine/pharmacokinetics , Administration, Oral , Adult , Analysis of Variance , Biological Availability , Calcium Channel Blockers/administration & dosage , Calcium Channel Blockers/blood , Cross-Over Studies , Delayed-Action Preparations , Drug Interactions , Female , Humans , Hypertension/metabolism , Male , Middle Aged , Nifedipine/administration & dosage , Nifedipine/blood , Orlistat
7.
J Clin Pharmacol ; 36(2): 152-9, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8852391

ABSTRACT

To assess the influence of orlistat, a lipase inhibitor, on the absorption of beta-carotene, an open-label, parallel, placebo-controlled, randomized, two-way crossover study was performed in 48 healthy volunteers between the ages of 19 and 58 years. Each subject received a single oral dose of 0, 30, 60, or 120 mg beta-carotene (12 subjects per dose level) on the fourth day of treatment with orlistat (120 mg) or placebo 3 times a day for 6 days. The treatments were separated by a washout period of at least 5 weeks. Serial blood samples were collected before and at appropriate intervals after administration of beta-carotene to determine plasma concentrations of unchanged beta-carotene. Short-term (3 to 6 days) treatment with orlistat did not alter endogenous profiles of beta-carotene in plasma. When beta-carotene was given during orlistat treatment, its absorption was reduced by approximately one-third. This reduction was consistent for all three dose levels of beta-carotene studied; however, the results for the 30-mg dose level were subject to greater variability, particularly for area under the concentration-time curve (AUC). It was concluded that two thirds of a supplemental dose of beta-carotene will be absorbed during orlistat treatment; this may be sufficient to achieve physiologic levels of beta-carotene with an appropriate dose of beta-carotene, should supplementation be needed in obese patients who have developed beta-carotene deficiency during therapy with orlistat.


Subject(s)
Antioxidants/pharmacokinetics , Enzyme Inhibitors/pharmacokinetics , Lactones/pharmacology , beta Carotene/pharmacokinetics , Absorption/drug effects , Administration, Oral , Adult , Antioxidants/analysis , Cross-Over Studies , Dietary Fats/pharmacokinetics , Dose-Response Relationship, Drug , Drug Interactions , Enzyme Inhibitors/pharmacology , Female , Humans , Lactones/pharmacokinetics , Lipase/antagonists & inhibitors , Male , Middle Aged , Orlistat , Placebos , Reference Values , Reproducibility of Results , beta Carotene/blood
8.
J Clin Pharmacol ; 35(11): 1103-8, 1995 Nov.
Article in English | MEDLINE | ID: mdl-8626884

ABSTRACT

Orlistat, a lipase inhibitor, acts locally in the gastrointestinal tract. Systemic absorption is not required for its efficacy, but knowledge of the extent of its systemic absorption is important for its safe use in obese patients, the intended target population. Pharmacokinetic screening was carried out by monitoring plasma concentrations of unchanged orlistat in 25 phase 1 studies (including two mass balance studies) in normal and obese healthy volunteers. The results of these studies indicate an extremely low degree of systemic absorption for orlistat when administered with a hypocaloric, well-balanced diet with 20% to 30% of calories derived from fat (50-80 gm). To further characterize the pharmacokinetics and excretion pathways of orlistat, two mass balance studies using 14C-labeled orlistat were conducted. After oral dosing of radiolabeled orlistat with a fatty meal (28-30 gm fat), almost the entire dose was recovered from fecal samples; little was found in plasma and urine. It is concluded that systemic absorption of orlistat is negligible; at a clinically efficacious dose level, orlistat is unlikely to produce systemic lipase inhibition.


Subject(s)
Lactones/pharmacokinetics , Lipase/antagonists & inhibitors , Lipase/pharmacokinetics , Clinical Trials, Phase I as Topic , Feces , Female , Humans , Lactones/blood , Lactones/urine , Lipase/blood , Lipase/urine , Male , Orlistat
9.
J Clin Pharmacol ; 35(8): 840-3, 1995 Aug.
Article in English | MEDLINE | ID: mdl-8522642

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.


Subject(s)
Dietary Fats/metabolism , Digoxin/pharmacokinetics , Enzyme Inhibitors/pharmacology , Lactones/pharmacology , Lipase/antagonists & inhibitors , Adolescent , Adult , Cross-Over Studies , Digoxin/administration & dosage , Digoxin/blood , Humans , Intestinal Absorption , Male , Orlistat
10.
J Clin Pharmacol ; 35(5): 521-5, 1995 May.
Article in English | MEDLINE | ID: mdl-7657854

ABSTRACT

To assess the influence of orlistat on the pharmacokinetics and pharmacodynamics (the blood glucose-lowering effect) of glyburide, an open-label, placebo-controlled, randomized, two-way crossover study was done in 12 healthy male volunteers. Each subject received single 5-mg oral doses of glyburide (Micronase; The Upjohn Company, Kalamazoo, MI) on the fifth day of treatment with placebo (treatment A) and 80-mg orlistat (treatment B) three times a day for 4 1/3 days; the two treatments were separated by a five-day washout period. Serial blood samples were collected before and at appropriate intervals after each glyburide dose to determine plasma concentrations and blood glucose levels. Values of Cmax and AUC of glyburide showed an equality of the two treatments by the analysis of variance. There was an apparent correlation between blood glucose level and the logarithm of plasma glyburide concentration; this relationship appeared to not be altered when glyburide was administered with orlistat. In conclusion, orlistat administered at doses of 80-mg three times daily does not significantly alter the pharmacokinetics and blood glucose-lowering effect of a single 5-mg oral dose of glyburide in healthy volunteers.


Subject(s)
Glyburide/pharmacokinetics , Lactones/pharmacology , Lipase/antagonists & inhibitors , Adult , Blood Glucose/drug effects , Blood Glucose/metabolism , Cross-Over Studies , Diet, Atherogenic , Fasting/metabolism , Glyburide/pharmacology , Humans , Intestinal Absorption , Lipase/pharmacology , Male , Orlistat
11.
Clin Pharmacol Ther ; 56(5): 530-6, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7955817

ABSTRACT

To characterize the plasma concentration-effect relationship of flumazenil in the presence of a predefined midazolam level, a double-blind, placebo-controlled, randomized two-way crossover study was conducted in nine healthy male subjects. After reaching a criterion level of midazolam-induced depression of the Digit Symbol Substitution Test (DSST), volunteers received a dose of flumazenil (1.0 mg) or placebo over 1 minute, with the infusion of midazolam continued. Blood samples were collected, simultaneously with the DSST assessment, at predetermined intervals and were assayed for flumazenil and/or midazolam plasma concentrations. Pharmacokinetic-pharmacodynamic modeling techniques were used to estimate the equilibration rate constant (keo) between plasma concentration and effect for flumazenil; a sigmoidal maximum-effect model was used to relate the DSST score to the flumazenil plasma concentration. Flumazenil exhibited a rapid onset (the half-life of equilibration between drug concentration in the blood and drug effect was 3.3 minutes) and short duration of action (the flumazenil plasma concentration causing half-maximal effect was 7.4 ng/ml, which was reached about 1 hour after dosing). The results of this study also show the competitive nature of flumazenil as a midazolam antagonist.


Subject(s)
Flumazenil/pharmacology , Flumazenil/pharmacokinetics , Midazolam/antagonists & inhibitors , Psychomotor Performance/drug effects , Adult , Cross-Over Studies , Double-Blind Method , Flumazenil/blood , Humans , Male , Midazolam/blood
12.
Clin Pharmacol Ther ; 56(1): 82-5, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8033498

ABSTRACT

Orlistat, an inhibitor of gastrointestinal lipases, limits the absorption of ingested fat and could become a potential treatment for obesity. This analysis was performed to elucidate the relationship between orlistat dose and intensity of inhibition of dietary fat absorption (assessed by measuring fecal fat excretion). In 11 phase I double-blind, placebo-controlled, parallel-group randomized studies, a total of 171 subjects received oral daily doses that ranged from 30 to 1200 mg orlistat or matching placebo three times a day for 9 to 10 days. The results of the daily mean fecal fat excretion percentage (relative to ingested fat) were correlated to the orlistat daily dose. A simple maximum-effect model that included a basal value was used to fit the dose-response relationship for all evaluable subjects. The mean maximum percentage of ingested fat excreted in the feces was approximately 32% during orlistat administration compared with 5% during placebo administration. The orlistat daily dose that produced 50% of the maximum effect was 98 mg/day. The model-fitting suggests the existence of a steep portion of the dose-response curve up to approximately 400 mg/day, with a subsequent tendency to plateau at higher doses. Such an analysis was instrumental in identifying appropriate doses to be used in therapeutic trials for weight loss in obese patients.


Subject(s)
Feces/chemistry , Lactones/pharmacology , Lipase/antagonists & inhibitors , Lipid Metabolism , Obesity/metabolism , Adult , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Male , Middle Aged , Orlistat , Reference Values , Retrospective Studies
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