Pharmacokinetics and relative bioavailability of clofazimine in relation to food, orange juice and antacid

David E. Nix, Rodney D. Adam, Barbara Auclair, Todd S. Krueger, Paul G. Godo, Charles A. Peloquin

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Clofazimine is potentially useful for the treatment of disease due to multidrug resistant Mycobacterium tuberculosis, as well as leprosy and certain chronic skin diseases. Its pharmacokinetics have been incompletely characterized. This study was conducted to explore issues relating to bioavailability in the presence of food, orange juice, and antacid. Methods: A 5 drug regimen consisting of clofazimine, cycloserine, ethionamide, para-aminosalicyclic acid, and pyridoxime was administered to healthy subjects four times using a four period cross-over design with two weeks washout between treatments. Subjects also received orange juice, a high fat meal, aluminum/magnesium antacid, or only water in random order with the drug regimen. The pharmacokinetics of clofazimine were assessed using individual- and population-based methods and relative bioavailability compared to fasting administration was determined. Results: Clofazimine exhibited a sometimes prolonged and variable lag-time and considerable variability in plasma concentrations. From the population analysis (one-compartment model), the mean oral clearance was 76.7l/h (CV=74.2%) and mean apparent volume of distribution was 1470l (CV=36.3%). The first-order absorption rate constant ranged from 0.716 to 1.33h-1 (pooled CV=61.7%). Residual (proportional) error was 49.1%. Estimates of bioavailability compared to fasting administration were 145% (90% CI, 107-183%) for administration with high fat food, 82.0% (63.2-101%) for administration with orange juice, and 78.5% (55.1-102%) for administration with antacid. Conclusion: Administration of clofazimine with a high fat meal provides the greatest bioavailability, however, bioavailability is associated with high inter- and intra-subject variability. Both orange juice and aluminum-magnesium antacid produced a reduction in mean bioavailability of clofazimine.

Original languageEnglish (US)
Pages (from-to)365-373
Number of pages9
JournalTuberculosis
Volume84
Issue number6
DOIs
StatePublished - 2004

Fingerprint

antacids
Clofazimine
Antacids
orange juice
Biological Availability
pharmacokinetics
bioavailability
Pharmacokinetics
Food
Fats
meals (menu)
Aluminum
Magnesium
fasting
aluminum
Meals
Fasting
magnesium
cycloserine
Ethionamide

Keywords

  • Bioavaibility
  • Clofazimine
  • Food-effect
  • Pharmacokinetics

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Microbiology
  • Immunology and Allergy
  • Infectious Diseases
  • veterinary(all)

Cite this

Pharmacokinetics and relative bioavailability of clofazimine in relation to food, orange juice and antacid. / Nix, David E.; Adam, Rodney D.; Auclair, Barbara; Krueger, Todd S.; Godo, Paul G.; Peloquin, Charles A.

In: Tuberculosis, Vol. 84, No. 6, 2004, p. 365-373.

Research output: Contribution to journalArticle

Nix, David E. ; Adam, Rodney D. ; Auclair, Barbara ; Krueger, Todd S. ; Godo, Paul G. ; Peloquin, Charles A. / Pharmacokinetics and relative bioavailability of clofazimine in relation to food, orange juice and antacid. In: Tuberculosis. 2004 ; Vol. 84, No. 6. pp. 365-373.
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T1 - Pharmacokinetics and relative bioavailability of clofazimine in relation to food, orange juice and antacid

AU - Nix, David E.

AU - Adam, Rodney D.

AU - Auclair, Barbara

AU - Krueger, Todd S.

AU - Godo, Paul G.

AU - Peloquin, Charles A.

PY - 2004

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N2 - Background: Clofazimine is potentially useful for the treatment of disease due to multidrug resistant Mycobacterium tuberculosis, as well as leprosy and certain chronic skin diseases. Its pharmacokinetics have been incompletely characterized. This study was conducted to explore issues relating to bioavailability in the presence of food, orange juice, and antacid. Methods: A 5 drug regimen consisting of clofazimine, cycloserine, ethionamide, para-aminosalicyclic acid, and pyridoxime was administered to healthy subjects four times using a four period cross-over design with two weeks washout between treatments. Subjects also received orange juice, a high fat meal, aluminum/magnesium antacid, or only water in random order with the drug regimen. The pharmacokinetics of clofazimine were assessed using individual- and population-based methods and relative bioavailability compared to fasting administration was determined. Results: Clofazimine exhibited a sometimes prolonged and variable lag-time and considerable variability in plasma concentrations. From the population analysis (one-compartment model), the mean oral clearance was 76.7l/h (CV=74.2%) and mean apparent volume of distribution was 1470l (CV=36.3%). The first-order absorption rate constant ranged from 0.716 to 1.33h-1 (pooled CV=61.7%). Residual (proportional) error was 49.1%. Estimates of bioavailability compared to fasting administration were 145% (90% CI, 107-183%) for administration with high fat food, 82.0% (63.2-101%) for administration with orange juice, and 78.5% (55.1-102%) for administration with antacid. Conclusion: Administration of clofazimine with a high fat meal provides the greatest bioavailability, however, bioavailability is associated with high inter- and intra-subject variability. Both orange juice and aluminum-magnesium antacid produced a reduction in mean bioavailability of clofazimine.

AB - Background: Clofazimine is potentially useful for the treatment of disease due to multidrug resistant Mycobacterium tuberculosis, as well as leprosy and certain chronic skin diseases. Its pharmacokinetics have been incompletely characterized. This study was conducted to explore issues relating to bioavailability in the presence of food, orange juice, and antacid. Methods: A 5 drug regimen consisting of clofazimine, cycloserine, ethionamide, para-aminosalicyclic acid, and pyridoxime was administered to healthy subjects four times using a four period cross-over design with two weeks washout between treatments. Subjects also received orange juice, a high fat meal, aluminum/magnesium antacid, or only water in random order with the drug regimen. The pharmacokinetics of clofazimine were assessed using individual- and population-based methods and relative bioavailability compared to fasting administration was determined. Results: Clofazimine exhibited a sometimes prolonged and variable lag-time and considerable variability in plasma concentrations. From the population analysis (one-compartment model), the mean oral clearance was 76.7l/h (CV=74.2%) and mean apparent volume of distribution was 1470l (CV=36.3%). The first-order absorption rate constant ranged from 0.716 to 1.33h-1 (pooled CV=61.7%). Residual (proportional) error was 49.1%. Estimates of bioavailability compared to fasting administration were 145% (90% CI, 107-183%) for administration with high fat food, 82.0% (63.2-101%) for administration with orange juice, and 78.5% (55.1-102%) for administration with antacid. Conclusion: Administration of clofazimine with a high fat meal provides the greatest bioavailability, however, bioavailability is associated with high inter- and intra-subject variability. Both orange juice and aluminum-magnesium antacid produced a reduction in mean bioavailability of clofazimine.

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KW - Food-effect

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