RESUMO
With the advent of the Highly Active Antiretroviral Therapy, the morbidity and the mortality associated to HIV have been considerably reduced. However, 35-40 million people bear the infection worldwide. One of the main causes of therapeutic failure is the frequent administration of several antiretrovirals that results in low patient compliance and treatment cessation. In this work, we have developed an innovative Nanoparticle-in-Microparticle Delivery System (NiMDS) comprised of pure drug nanocrystals of the potent protease inhibitor indinavir free base (used as poorly water-soluble model protease inhibitor) produced by nanoprecipitation that were encapsulated within mucoadhesive polymeric microparticles. Pure drug nanoparticles and microparticles were thoroughly characterized by diverse complementary techniques. NiMDSs displayed an encapsulation efficiency of approximately 100% and a drug loading capacity of up to 43% w/w. In addition, mucoadhesiveness assays ex vivo conducted with bovine gut showed that film-coated microparticles were retained for more than 6 h. Finally, pharmacokinetics studies in mongrel dogs showed a dramatic 47- and 95-fold increase of the drug oral bioavailability and half-life, respectively, with respect to the free unprocessed drug. These results support the outstanding performance of this platform to reduce the dose and the frequency of administration of protease inhibitors, a crucial step to overcome the current patient-incompliant therapy.
Assuntos
Sistemas de Liberação de Medicamentos , Indinavir/administração & dosagem , Indinavir/farmacocinética , Nanopartículas/química , Inibidores de Proteases/administração & dosagem , Inibidores de Proteases/farmacocinética , Adesividade/efeitos dos fármacos , Administração Oral , Alginatos/química , Animais , Bovinos , Quitosana/química , Cães , Relação Dose-Resposta a Droga , Ácido Glucurônico/química , Ácidos Hexurônicos/química , Indinavir/sangue , Indinavir/farmacologia , Nanopartículas/ultraestrutura , Inibidores de Proteases/sangue , Inibidores de Proteases/farmacologia , Espectroscopia de Infravermelho com Transformada de Fourier , Fatores de Tempo , Difração de Raios XRESUMO
The aim of this work is to: (1) assess therapeutic drug monitoring of indinavir (IDV) during clinical routine practice in HIV-infected children, whose antiretroviral treatment includes IDV boosted with ritonavir (RTV), and (2) describe a possible relationship between IDV pharmacokinetics and MDR1 genotypes. In 21 ambulatory pediatric patients receiving IDV plus RTV, IDV plasma levels and MDR1 genotypes on exon 26 (C3435T) were determined. Nine of the 21 patients initially receiving 250 mg/m(2) IDV yielded trough levels below 0.10 microg/ml (median: 0.21, range: 0.04-1.31 microg/ml). When the dosage was increased to 400 mg/m(2) IDV plus 100 mg/m(2) RTV b.i.d., all, except 1 patient, achieved levels above 0.10 microg/ml. Pharmacokinetic analysis showed higher volume of distribution median values related to the C/C genotype in comparison with C/T or T/T genotypes for exon 26 (4.57 vs. 1.20 and 1.50 l/kg, respectively; p = 0.002). Although a higher median value of clearance was observed with the C/C genotype, the difference was not statistically significant (1.43 vs. 0.27 and 0.42 l/h, respectively; p = 0.052). These results may be explained by a reduced absorption of the drug, related with lower plasma IDV levels in patients carrying the C/C genotype in exon 26.
Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/farmacocinética , Indinavir/farmacocinética , Adolescente , Criança , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Quimioterapia Combinada , Éxons , Feminino , Genótipo , Inibidores da Protease de HIV/administração & dosagem , Inibidores da Protease de HIV/uso terapêutico , Humanos , Indinavir/administração & dosagem , Indinavir/uso terapêutico , Masculino , Polimorfismo Genético , Ritonavir/uso terapêutico , Distribuição TecidualRESUMO
Indinavir, a HIV-1 protease inhibitor, showed large inter-individual pharmacokinetic variability. It has been proposed as a substrate of P-glycoprotein (P-gp), an efflux transporter, that may contribute to limit indinavir bioavailability. A liquid formulation of indinavir was developed from indinavir capsules in order to study indinavir pharmacokinetics in healthy volunteers. Compartmental and noncompartmental analysis of indinavir plasma concentrations showed high inter-individual variability in terms of area under the curve (AUC) and maximal plasma concentration (C(max)). A significant negative association between AUC normalized to body weight (AUC x weight) and lymphocyte P-gp activity, using Rh123 efflux assay, was observed (p = 0.008; r = -0.75). AUC normalized to elimination rate constant (AUC x beta) also showed a significant negative relationship with lymphocyte P-gp activity (p = 0.03, r = -0.64). Apparent clearance (CL/[F x weight]) and volume of distribution (VD/[F x weight]) showed a positive correlation with P-gp activity. Conversely, elimination rate constant did not correlate with P-gp activity. Although there is not enough evidence of a correlation between lymphocitary and intestinal function of P-gp, our results suggest a relationship between a P-gp phenotype marker, Rh123 efflux assay in lymphocytes, and indinavir bioavailability.
Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Indinavir/farmacocinética , Leucócitos Mononucleares/metabolismo , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/sangue , Adulto , Disponibilidade Biológica , Feminino , Humanos , Indinavir/sangue , Leucócitos Mononucleares/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
We report the development and validation of a new sensitive, accurate and precise HPLC method with ultraviolet detection for the determination of indinavir sulfate (IND) in human plasma and its application to a bioequivalence study of a new generic formulation. The extraction of IND from plasma samples was achieved by using liquid-liquid extraction with a mean recovery of 73.9 percent. The lower limit of quantification was 0.05 µg/mL. Bioequivalence between the products was determined by calculating 90 percent confidence intervals (CI) for the ratio of Cmax, AUC0-t and AUC0-inf values for the test and reference products, within the 0.80-1.25 interval proposed by ANVISA and FDA. Therefore the medications are bioequivalent and inter-exchangeable.
Foi desenvolvido e validado um novo método, sensível, exato e preciso por Cromatografia a Líquido de Alta Eficiência com detecção em UV para a determinação do sulfato de indinavir (IND) em plasma humano. O fármaco foi extraído do plasma através de extração líquido-líquido obtendo recuperação média de 73.9 por cento, com limite inferior de quantificação de 0.05 µg/mL. O método foi aplicado em estudo de farmacocinética para verificar a bioequivalência entre um novo medicamento genérico e seu produto de referência. A bioequivalência entre os produtos foi determinada calculando-se um intervalo de confiança (IC) de 90 por cento para a razão das médias do produto teste e referência compreendidas entre o intervalo de 0.80-1.25 proposto pela ANVISA e O FDA. Os produtos estudados são bioequivalentes e, portanto, intercambiáveis.
Assuntos
Indinavir/farmacocinética , Plasma/metabolismo , Cromatografia Líquida/métodos , Equivalência TerapêuticaRESUMO
O sulfato de indinavir é um inibidor da protease no ciclo do vírus da imunodeficiência humana (HIV). O objetivo deste trabalho foi o desenvolvimento da formulação, desenvolvimento e avaliação da metodologia para dissolução, estudo micromerítico, transposição de escala industrial, estudo de estabilidade e estudo comparativo para cápsulas de sulfato de indinavir 500 mg (equivalente a 400 mg de indinavir). Para o desenvolvimento farmacotécnico, realizou-se uma planificação qualitativa de diluentes. As metodologias analíticas para peso médio, desintegração, umidade e uniformidade de peso, seguiram The United States Pharmacopeia 28, enquanto que a metodologia utilizada para dissolução foi desenvolvida e avaliada atendendo à Resolução RE nº 899, de 29 de maio de 2003, da Agência Nacional de Vigilância Sanitária (ANVISA). Os resultados demonstraram que a formulação selecionada correspondeu às especificações de controle físico-químico, além de apresentar viabilidade econômica. Os resultados obtidos com o desenvolvimento e avaliação do método para dissolução mostram que o método atende aos requisitos de Boas Práticas de Fabricação e Controle, pois apresentam a reprodutibilidade, a precisão, a robustez e finalmente a confiabilidade requerida para um método analítico. As cápsulas desenvolvidas de sulfato de indinavir, quando comparadas com o medicamento de referência, são equivalentes entre si, frente a diferentes parâmetros avaliados.
Indinavir sulfate is a protease inhibitor in the cycle of the human immunodeficiency virus (HIV). The purpose of this study was the development of formulation, and its evaluation methodology for dissolution, rheological study, scale transposition, stability study and comparative study for indinavir sulfate 500 mg capsules (equivalent to 400 mg of indinavir). A qualitative design of diluents has been performed for the pharmaceutics development. The analytical methodologies for medium weight, disintegration, humidity and uniformity of weight followed The United States Pharmacopeia 28, while the methodology used for dissolution was developed and evaluated in accordance with Resolution RE nº 899, as of May 29, 2003, issued by the Agência Nacional de Vigilância Sanitária [National Agency for Sanitary Surveillance] (ANVISA). The results have evidenced that the selected formulation corresponds to the specifications of physical-chemical control, besides showing its economic feasibility. The results obtained from the development and evaluation of dissolution method have evidenced that the method complies with the requirements of Good Manufacturing and Control Practices, since it shows the reproducibility, the precision, the robustness and finally the reliability required for an analytical method. The developed indinavir sulfate capsules, when compared with the reference drug, are equivalent, in the light of different evaluated parameters.
Assuntos
HIV , Indinavir/farmacocinética , Sulfatos , Química Farmacêutica , Estabilidade de Medicamentos , Dissolução/métodosRESUMO
Twelve children infected with the human immunodeficiency virus were treated orally with indinavir, stavudine, plus didanosine for 12 to 48 weeks. Therapy was limited in some cases by nonadherence, intolerance, toxicity, and virologic failure. Marked increases in CD4+ lymphocyte counts and decreases in plasma human immunodeficiency virus RNA concentrations suggest that the regimen has potent antiviral activity.