A unique formulation of sodium bicarbonate buffered pantoprazole powder for oral suspension: perspectives from an active controlled cross-over bioequivalence study

Authors

  • Virukalpatti Gopalratnam Mohan Prasad Department of Gastroenterology, VGM Hospital, Coimbatore, Tamil Nadu, India
  • Anindita Chatterjee Department of Medical Affairs, Alkem Laboratories, Mumbai, Maharashtra, India
  • Radhakrishna Vaddem Department of Bioequivalence, Alkem Laboratories, Mumbai, Maharashtra, India
  • Akhilesh D. Sharma Alkem Laboratories, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20222402

Keywords:

Pantoprazole buffer powder, Peptic ulcer, New formulation, Bioequivalence, Pharmacokinetic

Abstract

Background: The aim was determining bioequivalence between pantoprazole buffered powder for oral suspension and pantoprazole enteric coated tablets under fasting conditions in healthy volunteers.

Methods: In randomized cross-over study, participants were administered a single oral dose of pantoprazole powder as suspension 40 mg (sodium bicarbonate as buffer) or one enteric coated tablet of pantoprazole 40 mg, with 240±2 ml of water as per the randomization schedule in each study period. Blood samples were collected at pre-dose and at 0.33, 0.67, 1, 1.33, 1.67, 2, 2.33, 2.67, 3, 3.33, 3.67, 4, 4.5, 5, 5.5, 6, 7, 8, 9, 10, 12, 14, 16 and 24 hours post-dose. Plasma concentration of pantoprazole was determined with LC-MS and various pharmacokinetic parameters like Cmax, AUC0-t, AUC0-inf were compared between test and reference groups.

Results: Amongst 41 subjects, Cmax (3752.4±1084.6 vs. 3521.7±1099.5 ng/ml) was achieved higher in less Tmax time (1 (0.28) vs. 2.3 (0.83) hrs) with test drug as compared to reference drug. The ratios of geometric least square mean and its 90% confidence interval on log transformed Cmax, AUC0-t and AUC0-inf for pantoprazole fall within the acceptance criteria of 80% to 125%. No adverse events were observed.

Conclusions: Pantoprazole powder for oral suspension 40 mg (sodium bicarbonate as buffer) was well tolerated and bioequivalent with pantoprazole enteric coated tablets IP 40 mg in terms of rate and extent of absorption under fasting conditions. At same time, the shift in AUC to the left with reduction in Tmax with the new formulation is suggestive of faster rate of absorption.

References

Satoh K, Yoshino J, Akamatsu T, Itoh T, Kato M, Kamada T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2015. J Gastroenterol. 2016;51(3):177-94.

Salas M, Ward A, Caro J. Are proton pump inhibitors the first choice for acute treatment of gastric ulcers? A meta-analysis of randomized clinical trials. BMC Gastroenterol. 2002;2:17.

Strand DS, Kim D, Peura DA. 25 years of proton pump inhibitors: a comprehensive review. Gut Liver. 2017;11(1):27-37.

Katz PO. Review article: putting immediate-release proton-pump inhibitors into clinical practice--improving nocturnal acid control and avoiding the possible complications of excessive acid exposure. Aliment Pharmacol Ther. 2005;22(3):31-8.

Tytgat GN. Shortcomings of the first-generation proton pump inhibitors. Eur J Gastroenterol Hepatol. 2001;13(1):29-33.

DeRocker H. The administration of proton-pump inhibitors in little children or patients with difficulties in deglutition. J Pharm Belg. 2009;(3):89-90.

Peura DA, Berardi RR, Gonzalez J, Brunetti L. The value of branded proton pump inhibitors: formulary considerations. P T. 2011;36(7):434-45.

CDSCO. Fact sheet: Fixed dose combinations approved by DCG (I) since 1961 to 28th June 2019. Available at: https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadApprovalNewDrugs/dciApprovedfdc.pdf. Accessed on 10 August 2022.

Kim D, Park MS, Yoo BW, Hong T, Park SJ, Kim CO. The safety, pharmacodynamics, and pharmacokinetics of immediate-release formulation containing esomeprazole 20 mg/sodium bicarbonate 800 mg in healthy adult male. Drug Des Devel Ther. 2019;13:3151-9.

Peters MN, Feldman M, Walsh JH, Richardson CT. Effect of gastric alkalinization on serum gastrin concentrations in humans. Gastroenterology. 1983;85(1):35-9.

Banerjee R, Reddy DN, Guda NM, Kalpala R, Mahurkar S, Darisetty S, et al. Oral buffered esomeprazole is superior to i.v. pantoprazole for rapid rise of intragastric pH: a wireless pH metry analysis. J Gastroenterol Hepatol. 2010;25(1):43-7.

Bigoniya P, Shukla A, Singh CS, Gotiya P. Comparative anti-ulcerogenic study of pantoprazole formulation with and without sodium bicarbonate buffer on pyloric ligated rat. J Pharmacol Pharmacother. 2011;2(3):179-84.

Kearbey J, McGraw T, O’Mullane J, Miller G, Mishra R. Performance differences between Zegerid® and PrilosecTM dosage forms: a comparative bioavailability study. Am J Gastroenterol. 2013;108:561-72.

Jing S, Zhu Y, Liu W, Yang K, Hu L, Deng D, et al. Pharmacokinetics and pharmacodynamics of esomeprazole/sodium bicarbonate immediate-release capsules in healthy Chinese volunteers: a cross-over, randomized controlled trial. Adv Ther. 2021;38(3):1660-76.

Orbelo DM, Enders FT, Romero Y, Francis DL, Achem SR, Dabade TS, et al. Once-daily omeprazole/sodium bicarbonate heals severe refractory reflux esophagitis with morning or nighttime dosing. Dig Dis Sci. 2015;60(1):146-62.

Gerson LB, Mitra S, Bleker WF, Yeung P. Control of intra-oesophageal pH in patients with Barrett's oesophagus on omeprazole-sodium bicarbonate therapy. Aliment Pharmacol Ther. 2012;35(7):803-9.

Higuera-de-la-Tijera F. Efficacy of omeprazole/sodium bicarbonate treatment in gastroesophageal reflux disease: a systematic review. Medwave. 2018;18(2):7179.

Pratha VS, McGraw T, Tobin W. A randomized, crossover pharmacodynamic study of immediate-release omeprazole/sodium bicarbonate and delayed-release lansoprazole in healthy adult volunteers. Pharmacol Res Perspect. 2016;4(3):00238.

Katz PO, Koch FK, Ballard ED, Bagin RG, Gautille TC, Checani GC, et al. Comparison of the effects of immediate-release omeprazole oral suspension, delayed-release lansoprazole capsules and delayed-release esomeprazole capsules on nocturnal gastric acidity after bedtime dosing in patients with night-time GERD symptoms. Aliment Pharmacol Ther. 2007;25(2):197-205.

Center for Drug Evaluation and Research. Fact sheet: Medical review(s). Available at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022456s000medr.pdf. Accessed on 10 August 2022.

Downloads

Published

2022-09-23

Issue

Section

Original Research Articles