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Oral Bioavailability of Posaconazole in Fasted Healthy Subjects

Comparison Between Three Regimens and Basis for Clinical Dosage Recommendations

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Abstract

Background and objective

Posaconazole is a potent, extended-spectrum triazole antifungal agent currently in clinical development for the treatment of invasive fungal infections. This study was conducted to compare the bioavailability and resulting serum concentrations of posaconazole 800mg following administration of three different dose regimens to fasting adults.

Study design

This was a randomised, open-label, three-way crossover study.

Methods

Subjects fasted 12 hours before and 48 hours after the administration of posaconazole oral suspension (800mg) given as a single dose (regimen A), 400mg every 12 hours (regimen B) or 200mg every 6 hours (regimen C). Plasma posaconazole concentrations were determined for 48 hours after the initial dose and subjects completed a 1-week washout period between treatment regimens. A one-compartment oral model with first-order rate of absorption and first-order rate of elimination was fitted to the plasma concentration-time data. Differences in exposure were investigated by allowing the bioavailability fraction to vary among regimens.

Study participants

A total of 18 healthy men were enrolled in and completed the study.

Main outcome measures and results

Posaconazole relative bioavailability was estimated to be significantly different among regimens (p < 0.0001) and increased with the number of doses, such that regimen B/regimen A = 1.98 ± 0.35, representing a 98% increase, and regimen C/regimen A = 3.20 ± 0.69, or a 220% increase. With use of the one-compartment model, the population steady-state values for area under the concentration-time curve over 24 hours were predicted to be 3900, 7700 and 12 400 μg · h/L, with average plasma concentrations of 162, 320 and 517 μg/L for regimens and C, respectively.

Conclusion

These data suggest that divided daily dose administration (every 12 or 6 hours) significantly increases posaconazole exposure under fasted conditions.

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Acknowledgements

The authors would like to thank the Arkansas Research Medical Testing Center for conducting the study. This work was supported by the Schering-Plough Research Institute.

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Authors and Affiliations

  1. Schering-Plough Research Institute, K-15-2650, 2015 Galloping Hill Rd, Kenilworth, New Jersey, 07033, USA

    Farkad Ezzet,  David Wexler, Rachel Courtney, Gopal Krishna, Josephine Lim & Mark Laughlin

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  1. Farkad Ezzet
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  2. David Wexler
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  3. Rachel Courtney
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  4. Gopal Krishna
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  5. Josephine Lim
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  6. Mark Laughlin
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Correspondence to David Wexler.

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Ezzet, F., Wexler, D., Courtney, R. et al. Oral Bioavailability of Posaconazole in Fasted Healthy Subjects. Clin Pharmacokinet 44, 211–220 (2005). https://doi.org/10.2165/00003088-200544020-00006

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