Arzneimittelforschung 2011; 61(4): 247-251
DOI: 10.1055/s-0031-1296195
Anticoagulants · Antithrombotics · Antivaricosis Drugs · Blood Flow Stimulants
Editio Cantor Verlag Aulendorf (Germany)

Relative bioavailability of prasugrel free base in comparison to prasugrel hydrochloride in the presence and in the absence of a proton pump inhibitor

Dan Seiler
1   Helm AG, Hamburg, Germany
,
Karlheinz Doser
1   Helm AG, Hamburg, Germany
,
Isam Salem
2   International Pharmaceutical Research Center (IPRC), Amman, Jordan
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2011 (online)

Abstract

Prasugrel (CAS 150322-43-3), an inhibitor of platelet activation and aggregation, is indicated to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome. If a proton pump inhibitor is co-administered with prasugrel, a pH dependent salt-to-base conversion rate of prasugrel could become clinically meaningful. In an open-label, randomized, four-period, 2 × two-way crossover study, the relative bioavailability of tablets containing prasugrel free base compared to prasugrel hydrochloride (originator product) both in the presence and in the absence of the proton pump inhibitor lansoprazole (CAS 103577-45-3) was investigated. In the absence of lansoprazole, the extent of absorption (AUC) of prasugrel free base was about 8–9 % lower, while the rate of absorption (Cmax) after administration of prasugrel free base was 20 % lower when compared to prasugrel hydrochloride. When lansoprazole was used to raise the pH level in the upper gastro-intestinal tract, AUC was decreased by 25 % after administration of prasugrel hydrochloride and by 41 % after prasugrel free base. In addition, the peak plasma levels were decreased by 52 % and 72 %, respectively (geometric means). The relative bioavailability of the prasugrel free base compared to prasugrel hydrochloride, both in the presence and in the absence of the proton pump inhibitor lansoprazole, differs so much that most probably a generic formulation containing prasugrel free base will not be equivalent in all aspects to the originator product.

 
  • References

  • 1 Asai F, Konse T, Suoidachi A, Ixeda T. CS-747, a new platelet ADP receptor antagonist. Annu Rep Sankyo Res Lab. 1999; 51: 1-44
  • 2 Williams ET, Jones KO, Ponsler GD, Lowery SM, Perkins EJ, Wrighton SA et al. The biotransformation of prasugrel, a new thienopyridine prodrug, by the human carboxyles-terases 1 and 2. Drug Metab Dispos. 2008; 36 (7) 1227-32
  • 3 Foster CJ, Prosser DM, Agans JM, Zhai Y, Smith MD, Lachowicz JE et al. Molecular identification and characterization of the platelet ADP receptor targeted by thienopyridine antithrombotic drugs. J Clin Invest. 2001; 107: 1591-8
  • 4 Small DS, Kothare P, Yuen E, Lachno DR, Li YG, Winters KJ, Farid NA, Ni L et al. The pharmacokinetics and pharmacodynamics of prasugrel in healthy Chinese, Japanese, and Korean subjects compared with healthy Caucasian subjects. Eur J Clin Pharmacol. 2007; 36 (2) 127-35
  • 5 Farid NA, Smith RL, Gillespie TA, Rash TJ, Blair PE, Kurihara A et al. The disposition of prasugrel, a novel thienopyridine, in humans. Drug Metab Dispos. 2007; 35: 1096-104
  • 6 Small DS, Farid NA, Li YG, Ernest CS, Winters KJ, Salazar DE et al. Pharmacokinetics and pharmacodynamics of prasugrel in subjects with moderate liver disease. J Clin Pharm Ther. 2009; 36 (5) 575-83
  • 7 Anon: Committee for proprietary medicinal products. Scientific Discussion. Efient, International Non-Proprietary Name (INN): Prasugrel. EMEA/117561/2009. The European Agency for the Evaluation of Medicinal Products, London, 2009.
  • 8 Tran M, Tafreshi J, Pai RG. Review article: combination of Clopidogrel and proton pump inhibitors: implications for clinicians. J Cardiovasc Pharmacol Ther. 2010; 36 (4) 326-37
  • 9 Farid NA, Mcintosh M, Garafolo F, Wong E, Shwajch A, Kennedy M et al. Determination of the active and inactive metabolites of prasugrel in human plasma by liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom. 2007; 21: 169-79
  • 10 Guidance for industry, Bioanalytical Method Validation, US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER), May 2001.
  • 11 Ali T, Roberts DN, Tierney WM. Long-term safety concerns with proton pump inhibitors. Am J Med. 2009; 36 (10) 896-903
  • 12 Ahrens D, Chenot JF, Behrens G, Grimmsmann T, Kochen MM. Appropriateness of treatment recommendations for PPI in hospital discharge letters. Eur J Clin Pharmacol. 2010; 36 (12) 1265-71
  • 13 Blume H, Donath F, Warnke A, Schug BS. Pharmacokinetic drug interaction profiles of proton pump inhibitors. Drug Saf. 2006; 36 (9) 769-84