Development of immediate-release formulation with reliable absorption of rivaroxaban in various meal regimes
Language English Country United States Media print
Document type Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
38738493
PubMed Central
PMC11089494
DOI
10.1111/cts.13820
Knihovny.cz E-resources
- MeSH
- Administration, Oral MeSH
- Biological Availability * MeSH
- Adult MeSH
- Factor Xa Inhibitors pharmacokinetics administration & dosage MeSH
- Food-Drug Interactions * MeSH
- Meals MeSH
- Cross-Over Studies * MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Fasting * MeSH
- Drug Compounding methods MeSH
- Rivaroxaban * pharmacokinetics administration & dosage MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Names of Substances
- Factor Xa Inhibitors MeSH
- Rivaroxaban * MeSH
The bioavailability of rivaroxaban at the higher doses (15 and 20 mg) is considerably reduced when the drug is administered on an empty stomach. This can lead to inadequate anticoagulant effect, and therefore, it is recommended to use the higher doses at fed state. However, proper posology may represent a barrier for some patients. Therefore, the aim of this study was to evaluate innovative rivaroxaban-containing formulations designed to eliminate the food effect to ensure reliable absorption and thus to improve patient adherence with the treatment. Three prototypes (Cocrystal, HPMCP and Kollidon) with rivaroxaban were developed and their bioavailability and food effect in comparison to the reference product was tested in open label, randomized, single oral dose, crossover studies, where test products were administered under fasting and fed conditions and the reference product was administered under fed conditions. Comparable bioavailability for all tested prototypes both under fed and fasting conditions was demonstrated as the 90% confidence intervals of the geometric mean ratios for area under the concentration-time curve remained within the standard acceptance range of 80.00%-125.00%. An innovative immediate release form of rivaroxaban with no food effect on drug bioavailability has been developed, which may represent an important step toward increasing adherence, improving treatment outcome and reducing health care costs.
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Ganetsky M, Babu KM, Salhanick SD, Brown RS, Boyer EW. Dabigatran: review of pharmacology and management of bleeding complications of this novel oral anticoagulant. J Med Toxicol. 2011;7:281‐287. PubMed PMC
Kvasnicka T, Malikova I, Zenahlikova Z, et al. Rivaroxaban—metabolism, pharmacologic properties and drug interactions. Curr Drug Metab. 2017;18:636‐642. PubMed
Escolar G, Carne X, Arellano‐Rodrigo E. Dosing of rivaroxaban by indication: getting the right dose for the patient. Expert Opin Drug Metab Toxicol. 2015;11:1665‐1677. PubMed
Mueck W, Stampfuss J, Kubitza D, Becka M. Clinical pharmacokinetic and pharmacodynamic profile of rivaroxaban. Clin Pharmacokinet. 2014;53:1‐16. PubMed PMC
Chen A, Stecker E, Warden BA. Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc. 2020;9:e017559. PubMed PMC
Mazzone PM, Capodanno D. Low dose rivaroxaban for the management of atherosclerotic cardiovascular disease. J Thromb Thrombolysis. 2023;56:91‐102. PubMed
Food and Drug Administration . Xarelto: highlights of prescribing information; section: Indications and usage. 2021. Accessed July 24, 2023. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/022406s036,202439s036lbl.pdf
Kreutz R. Pharmacodynamic and pharmacokinetic basics of rivaroxaban. Fundam Clin Pharmacol. 2012;26:27‐32. PubMed
Genis‐Najera L, Sanudo‐Maury ME, Moquete T. A single‐blind, randomized, single‐dose, two‐sequence, two‐period, crossover study to assess the bioequivalence between two oral tablet formulations of rivaroxaban 20 mg in healthy Mexican volunteers. Clin Pharmacol Drug Dev. 2022;11:826‐831. PubMed PMC
Hrinova E, Skorepova E, Cerna I, et al. Explaining dissolution properties of rivaroxaban cocrystals. Int J Pharm. 2022;622:121854. PubMed
Kralovicova J, Bartunek A, Hofmann J, et al. Pharmacokinetic variability in pre‐clinical studies: sample study with abiraterone in rats and implications for short‐term comparative pharmacokinetic study designs. Pharmaceutics. 2022;14:643. PubMed PMC
US Department of Health and Human Services Food and Drug Administration, Center for Drug Evaluation and Research (CDER) . Guidance for Industry, Bioanalytical Method Validation. Accessed June 23, 2023. https://www.fda.gov/files/drugs/published/Bioanalytical‐Method‐Validation‐Guidance‐for‐Industry.pdf
Committee for Medicinal Products for Human Use, European Medicines Agency (EMA) . Guideline on Validation of Bioanalytical Methods (EMEA/CHMP/EWP/192217/2009 Rev. 1 Corr. 2.). Accessed June 23, 2023. https://www.ema.europa.eu/en/documents/scientific‐guideline/guideline‐bioanalytical‐method‐validation_en.pdf
Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013;4:91. PubMed PMC
Deshpande CG, Kogut S, Laforge R, Willey C. Impact of medication adherence on risk of ischemic stroke, major bleeding and deep vein thrombosis in atrial fibrillation patients using novel oral anticoagulants. Curr Med Res Opin. 2018;34:1285‐1292. PubMed
Yao X, Abraham NS, Alexander GC, et al. Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc. 2016;5:e003074. PubMed PMC
Beyer‐Westendorf J, Siegert G. Of men and meals. J Thromb Haemost. 2015;13:943‐945. PubMed
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487‐497. PubMed
Dunbar‐Jacob J, Erlen JA, Schlenk EA, Ryan CM, Sereika SM, Doswell WM. Adherence in chronic disease. Annu Rev Nurs Res. 2000;18:48‐90. PubMed
Munger MA, van Tassell BW, LaFleur J. Medication nonadherence: an unrecognized cardiovascular risk factor. MedGenMed. 2007;9:58. PubMed PMC
Leiter MR, Packard KA, Qi Y, Krueger SK. Improved dosing and Administration of Rivaroxaban when prescribed by a cardiologist. Heart Int. 2019;13:24‐27. PubMed PMC
Kushwah V, Arora S, Tamas Katona M, Modhave D, Frohlich E, Paudel A. On absorption modeling and food effect prediction of rivaroxaban, a BCS II drug orally administered as an immediate‐release tablet. Pharmaceutics. 2021;13:283. PubMed PMC
Izuma H, Oka F, Ishihara H, et al. Thrombolysis with rt‐PA under rivaroxaban anticoagulation in a hypertensive rat model of intraluminal middle cerebral artery occlusion. J Stroke Cerebrovasc Dis. 2018;27:2761‐2767. PubMed
U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER) . Guidance for Industry: Estimating the Maximum Safe Starting Dose in Initial Clinical Trials for Therapeutics in Adult Healthy Volunteers. 2005. Accessed December 15, 2023. https://www.fda.gov/media/72309/download