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1.
Sci Rep ; 14(1): 16437, 2024 Jul 16.
Article in English | MEDLINE | ID: mdl-39013991

ABSTRACT

Inhalable microparticle-based anti TB drug delivery systems are being investigated extensively for Tuberculosis [TB] treatment as they offer efficient and deep lung deposition with several advantages over conventional routes. It can reduce the drug dose, treatment duration and toxic effects and optimize the drug bioavailability. Yeast derived ß-glucan is a ß-[1-3/1-6] linked biocompatible polymer and used as carrier for various biomolecules. Due to presence of glucan chains, particulate glucans act as PAMP and thereby gets internalized via receptor mediated phagocytosis by the macrophages. In this study, ß-glucan microparticles were prepared by adding l-leucine as excipient, and exhibited 70% drug [Rifabutin] loading efficiency. Further, the sizing and SEM data of particles revealed a size of 2-4 µm with spherical dimensions. The FTIR and HPLC data confirmed the ß-glucan composition and drug encapsulations efficiency of the particles. The mass median aerodynamic diameter [MMAD] and geometric standard deviation [GSD] data indicated that these particles are inhalable in nature and have better thermal stability as per DSC thermogram. These particles were found to be non-toxic upto a concentration of 80 µg/ml and were found to be readily phagocytosed by human macrophage cells in-vitro as well as in-vivo by lung alveolar macrophage. This study provides a framework for future design of inhalable ß-glucan particle based host-directed drug delivery system against pulmonary TB.


Subject(s)
Drug Delivery Systems , Rifabutin , beta-Glucans , Rifabutin/administration & dosage , Rifabutin/pharmacokinetics , Rifabutin/chemistry , beta-Glucans/chemistry , Humans , Administration, Inhalation , Tuberculosis, Pulmonary/drug therapy , Particle Size , Macrophages/metabolism , Macrophages/drug effects , Drug Carriers/chemistry , Antitubercular Agents/administration & dosage , Antitubercular Agents/pharmacokinetics , Antitubercular Agents/chemistry
3.
Br J Clin Pharmacol ; 89(3): 1216-1221, 2023 03.
Article in English | MEDLINE | ID: mdl-36385424

ABSTRACT

Rifampicin, a potent enzyme inducer, causes marked reduction of dolutegravir exposure. Rifabutin, a less potent enzyme inducer, may offer an alternative to rifampicin. We aimed to characterize the population pharmacokinetics of dolutegravir when co-administered with rifabutin. We extended an existing dolutegravir model to include data from volunteers co-administered with dolutegravir 50 mg and rifabutin 300 mg once daily. We ran simulations of dolutegravir with and without rifabutin co-administration and compare dolutegravir trough concentrations with the IC90 and EC90 of 0.064 and 0.3 mg/L, respectively. Rifabutin decreased dolutegravir's volume of distribution by 33.1% (95% confidence interval 25.1%-42.3%) but did not affect the area under the concentration-time curve. Simulations showed that when 50 mg dolutegravir is co-administered with rifabutin once daily, the probability to attain trough concentrations above the IC90 of 0.064 mg/L is more than 99%. Therefore, there is no need for dolutegravir dose adjustment. Rifabutin may offer an alternative to rifampicin for the treatment of HIV/tuberculosis co-infected individuals.


Subject(s)
HIV Infections , Rifabutin , Humans , Rifabutin/pharmacokinetics , Rifabutin/therapeutic use , Rifampin , HIV Infections/drug therapy , Drug Interactions
4.
Pharmacotherapy ; 42(4): 343-361, 2022 04.
Article in English | MEDLINE | ID: mdl-35152432

ABSTRACT

Rifamycins (rifampin, rifabutin, and rifapentine) play an essential role in the treatment of mycobacterial and some nonmycobacterial infections. They also induce the activity of various drug transporting and metabolizing enzymes, which can impact the concentrations and efficacy of substrates. Many anticoagulant and antiplatelet (AC/AP) agents are substrates of these enzymes and have narrow therapeutic indices, leading to risks of thrombosis or bleeding when coadministered with rifamycins. The objective of this systematic review was to evaluate the effects on AC/AP pharmacokinetics, laboratory markers, and clinical safety and efficacy of combined use with rifamycins. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance was performed. The PubMed, Embase, and Web of Science databases were queried for English-language reports on combination use of rifamycins and AC/AP agents from database inception through August 2021. The 29 studies identified examined warfarin (n = 17), direct oral anticoagulants (DOACs) (n = 8), and antiplatelet agents (n = 4) combined with rifampin (n = 28) or rifabutin (n = 1). Eleven studies were case reports or small case series; 14 reported on pharmacokinetic or laboratory markers in healthy volunteers. Rifampin-warfarin combinations led to reductions in warfarin area under the curve (AUC) of 15%-74%, with variability by warfarin isomer and study. Warfarin dose increases of up to 3-5 times prerifampin doses were required to maintain coagulation parameters in the therapeutic range. DOAC AUCs were decreased by 20%-67%, with variability by individual agent and with rifampin versus rifabutin. The active metabolite of clopidogrel increased substantially with rifampin coadministration, whereas prasugrel was largely unaffected and ticagrelor saw decreases. Our review suggests most combinations of AC/AP agents and rifampin are problematic. Further studies are required to determine whether rifabutin or rifapentine could be safe alternatives for coadministration with AC/AP drugs.


Subject(s)
Platelet Aggregation Inhibitors , Rifamycins , Anticoagulants/adverse effects , Drug Interactions , Humans , Platelet Aggregation Inhibitors/adverse effects , Rifabutin/adverse effects , Rifabutin/pharmacokinetics , Rifampin/adverse effects , Warfarin
5.
Drug Discov Today ; 26(9): 2099-2104, 2021 09.
Article in English | MEDLINE | ID: mdl-34242796

ABSTRACT

Rifamycin antibiotics were discovered during the 1950s, and their main representative, rifampicin, remains a cornerstone treatment for TB. The clinical use of rifamycin is restricted to mycobacteria and Gram-positive infections because of its poor ability to penetrate the Gram-negative outer membrane. Rifabutin, a rifamycin antibiotic approved for the prevention of Mycobacterium avium complex disease, makes an exception to this rule by hijacking the iron uptake system of Acinetobacter baumannii, resulting in potent activity against this important Gram-negative pathogen. Here, we describe recent findings on the specific activity of rifabutin and provide evidence of the need for the development of an intravenous formulation of rifabutin (BV100) for the treatment of difficult-to-treat carbapenem-resistant A.baumannii infections.


Subject(s)
Acinetobacter Infections/drug therapy , Anti-Bacterial Agents/administration & dosage , Rifabutin/administration & dosage , Acinetobacter baumannii/drug effects , Animals , Anti-Bacterial Agents/pharmacokinetics , Carbapenems , Drug Resistance, Bacterial , Humans , Infusions, Intravenous , Rifabutin/pharmacokinetics
6.
PLoS One ; 14(10): e0223969, 2019.
Article in English | MEDLINE | ID: mdl-31647836

ABSTRACT

Effects of steady-state rifabutin on the pharmacokinetics of steady-state maraviroc were investigated in fourteen healthy adult female and male volunteers. Maraviroc 300 mg twice daily (BID) was given orally with food for fifteen days. On day six, rifabutin 300 mg once daily (QD, P.O.) was added to the regimen. Formal pharmacokinetic (PK) sampling was performed on days five and fifteen. Individual plasma drug concentration-time data for maraviroc, and rifabutin on day fifteen, were obtained using validated High Performance Liquid Chromatography (HPLC) tandem Mass Spectrometry (MS/MS). Rifabutin steady state exposure was comparable to data in the literature. Maraviroc area under the curve (AUC) and minimum plasma concentration (Clast or Cmin) were reduced by 17% and 30% respectively when co-administered with rifabutin. No unexpected or serious adverse eventsoccurred. Based on the reduced exposure of maraviroc observed in this study, increasing the dose of maraviroc may be studied to normalize its moderately reduced exposure following rifabutin co-administration, a moderate inducer of CYP3A4.


Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Drug Interactions , HIV Fusion Inhibitors/pharmacokinetics , Maraviroc/pharmacokinetics , Rifabutin/pharmacokinetics , Adolescent , Adult , Aged , Female , Healthy Volunteers , Humans , Male , Middle Aged , Tissue Distribution , Young Adult
7.
J Pharm Biomed Anal ; 176: 112775, 2019 Nov 30.
Article in English | MEDLINE | ID: mdl-31446299

ABSTRACT

This article describes the simultaneous determination of bedaquiline fumarate (TMC-207) and rifabutin in human plasma by stable isotope dilution tandem mass spectrometry. The methodology was developed for an investigation of potential drug-drug interactions of the two anti-tuberculosis drugs when given together to healthy human volunteers. Use of the two drugs in combination to treat disease caused by Mycobacterium tuberculosis is contemplated as the bacterium becomes resistant to many currently available drugs.


Subject(s)
Antitubercular Agents/blood , Diarylquinolines/blood , Drug Monitoring/methods , Rifabutin/blood , Antitubercular Agents/administration & dosage , Antitubercular Agents/pharmacokinetics , Chromatography, High Pressure Liquid/methods , Diarylquinolines/administration & dosage , Diarylquinolines/pharmacokinetics , Drug Interactions , Drug Therapy, Combination , Humans , Rifabutin/administration & dosage , Rifabutin/pharmacokinetics , Tandem Mass Spectrometry/methods , Tuberculosis/drug therapy
8.
Indian J Tuberc ; 66(1): 129-133, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30797270

ABSTRACT

BACKGROUND & OBJECTIVE: Rifabutin (RBT) is the rifamycin that is recommended to treat tuberculosis (TB) in HIV-infected individuals during combination antiretroviral therapy (ART) containing HIV protease inhibitors (PIs). We studied the pharmacokinetics of rifabutin at doses of 300 mg thrice weekly and 150 mg daily during concomitant atazanavir/ritonavir (ATZ/r) administration in adult HIV-infected TB patients treated in the Revised National TB Control Programme (RNTCP) in India. METHODS: This was a multi-centric study conducted in 45 adult HIV-infected TB patients, who were being treated for TB with a RBT-containing regimen and an antiretroviral treatment regimen with ATZ/r, at doses of 300 mg thrice-weekly (n = 36) or 150 mg daily (n = 9). Serial blood draws at pre-dosing and at 1, 2, 4, 6, 8, 12 and 24 hours after drug administration were done. Plasma RBT was estimated by high pressure liquid chromatography (HPLC). RESULTS: The peak concentration (Cmax) of both doses were within the therapeutic range (0.45-0.90 µg/ml) of RBT. Proportion of patients having Cmax above or below the therapeutic range and trough concentration (Cmin) below the minimum inhibitory concentration of RBT did not significantly differ between the two doses. TB treatment outcomes were also similar at both doses. CONCLUSIONS: This is the first and only study from India reporting on the pharmacokinetics of RBT at 300 mg thrice weekly and 150 mg daily doses. Both doses yielded similar plasma RBT concentrations, outcomes and were well tolerated. RBT can be administered at either doses during ATZ/r co-administration in HIV-infected patients with TB.


Subject(s)
Antibiotics, Antitubercular/pharmacokinetics , Atazanavir Sulfate/therapeutic use , HIV Infections/drug therapy , HIV Protease Inhibitors/therapeutic use , Rifabutin/pharmacokinetics , Ritonavir/therapeutic use , Tuberculosis/drug therapy , Adult , Antibiotics, Antitubercular/administration & dosage , Drug Interactions , Female , HIV Infections/complications , Humans , Male , Middle Aged , Rifabutin/administration & dosage , Tuberculosis/complications
9.
Clin Pharmacol Drug Dev ; 8(4): 436-442, 2019 05.
Article in English | MEDLINE | ID: mdl-30500116

ABSTRACT

There is an urgent need to identify safe and effective combination treatments for multidrug-resistant (MDR) Mycobacterium tuberculosis infection (TB). Bedaquiline, a new diarylquinoline, is approved for the treatment of MDR pulmonary TB in combination with other drugs, which could include rifabutin, which is also used to treat drug-resistant TB. Both rifabutin and bedaquiline are metabolized via cytochrome P450 3A4, and rifabutin is an inducer of this enzyme. Bedaquiline is metabolized into its primary N-monodesmethyl metabolite, M2, and further desmethylated into an N-didesmethyl metabolite, M3. Both metabolites are cytotoxic and induce phospholipidosis. The effect of rifabutin on the generation and disposition of the 2 metabolites was investigated in healthy adult volunteers coadministered bedaquiline and either rifabutin or rifampin. Subjects received single oral doses (400 mg) of bedaquiline on days 1 and 29. Oral rifabutin (300 mg) or rifampin (600 mg) were given daily on days 20-41. In the rifabutin group maximum M2 concentrations (Cmax ) increased significantly (P < .001) from 47.59 to 79.53 ng/mL, and clearance slowed slightly (P = .01). This resulted in significantly (P < .001) increased overall exposure (area under the concentration-time curve [AUC0-τ ]). Peak concentrations of M3 increased approximately 3-fold with little decline thereafter. In rifampin recipients M2 Cmax doubled (48.44 to 101.52 ng/mL), but M2 clearance and time to Cmax significantly (P < .001) increased, and AUC0-∞ and mean residence time significantly decreased (P < .001). Peak M3 concentrations increased 4-fold and rapidly declined. Although both rifamycins accelerate desmethylation of bedaquiline and M2, differences in clearance resulted in sustained elevations of both metabolites during rifabutin, but not rifampin, treatment.


Subject(s)
Diarylquinolines/administration & dosage , Rifabutin/administration & dosage , Rifampin/administration & dosage , Administration, Oral , Area Under Curve , Diarylquinolines/pharmacokinetics , Drug Administration Schedule , Drug Interactions , Female , Healthy Volunteers , Humans , Male , Prospective Studies , Rifabutin/pharmacokinetics , Rifampin/pharmacokinetics , Young Adult
10.
J Microencapsul ; 35(4): 392-405, 2018 Jun.
Article in English | MEDLINE | ID: mdl-30112917

ABSTRACT

Pulmonary tuberculosis accounts for 80% of cases and the delivery of antitubercular drugs into the lungs allows targeting the infected organ and, possibly, reducing systemic drug toxicity. This work aimed at using fucoidan as matrix of inhalable microparticles that associate two first-line antitubercular drugs, for an application in pulmonary tuberculosis therapy. Fucoidan is composed of fucose and sulphated sugar residues, moieties described as being recognised by surface receptors of alveolar macrophages, which host mycobacteria. Inhalable fucoidan microparticles loaded with antitubercular drugs were successfully produced with high association efficiencies of either isoniazid (95%) or rifabutin (81%). The microparticles evidenced no cytotoxicity on lung epithelial cells (A549). However, rifabutin-loaded microparticles showed a certain degree of toxicity on macrophage-like cells (THP-1) at the highest tested concentration (1 mg/mL). Furthermore, microparticles showed favourable aerodynamic properties for deep lung delivery (MMAD 2.0-3.8 µm) and, thus, show potential for an application as inhalable tuberculosis therapy.


Subject(s)
Antitubercular Agents/administration & dosage , Drug Carriers/chemistry , Isoniazid/administration & dosage , Polysaccharides/chemistry , Rifabutin/administration & dosage , A549 Cells , Administration, Inhalation , Antitubercular Agents/pharmacokinetics , Cell Line , Drug Liberation , Humans , Isoniazid/pharmacokinetics , Rifabutin/pharmacokinetics
11.
BJOG ; 125(7): 804-811, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29130574

ABSTRACT

BACKGROUND: Rifamycin antibiotics are commonly used for treatment of tuberculosis, but may reduce the effectiveness of hormonal contraception (HC). OBJECTIVES: To determine whether interactions between rifamycins and HC result in decreased effectiveness or increased toxicity of either therapy. SEARCH STRATEGY: We searched MEDLINE, Embase, Cochrane and clinicaltrials.gov through May 2017. SELECTION CRITERIA: We included trials, cohort, and case-control studies addressing pregnancy rates, pharmacodynamics or pharmacokinetic (PK) outcomes when HC and rifamycins were administered together versus apart. Of 7291 original records identified, 11 met inclusion criteria after independent review by two authors. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted study details and assessed study quality using the United States Preventive Services Task Force grading system. Findings are reported descriptively. MAIN RESULTS: Studies only addressed combined oral contraceptives (COCs) and none reported pregnancy rates. Quality ranged from good to poor. Rifampin increased the frequency of ovulation in two of four studies, and reduced estrogen and/or progestin exposure in five studies. Rifabutin led to smaller PK changes than rifampin in two studies. In one study each, rifaximin and rifalazil did not alter hormone PK. CONCLUSIONS: No studies evaluated pregnancy risk or non-oral HCs. PK and ovulation outcomes support a clinically concerning drug interaction between COCs and rifampin, and to a lesser extent rifabutin. Data are limited for other rifamycins. TWEETABLE ABSTRACT: Rifampin and rifabutin reduce systemic exposure of oral contraceptives, but no studies have evaluated pregnancy risk.


Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Contraceptives, Oral, Combined/pharmacokinetics , Rifabutin/pharmacokinetics , Rifamycins/pharmacokinetics , Adult , Drug Interactions , Drug Therapy, Combination , Female , Humans , Middle Aged , Ovulation/drug effects , Pregnancy , Treatment Outcome
12.
Infect Disord Drug Targets ; 17(3): 185-191, 2017.
Article in English | MEDLINE | ID: mdl-28595542

ABSTRACT

BACKGROUND: Rifabutin (RFN) is bactericidal antibiotic with a very broad spectrum of activity against gram positive & gram negative organisms including Pseudomonas aeruginosa and specifically Mycobacterium tuberculosis. RFN inhibits DNA dependent RNA polymerase activity in susceptible cells. In the instant work, the therapeutic characteristics of RFN were intended for diagnostic rationale by labeling it with 99mTc (Technetium-99m). OBJECTIVE: The 99mTc labeled RFN (99mTc-RFN) was investigated for labeling capacity, steadiness in saline & serum, in vitro Mycobacterium tuberculosis (MBT) uptake & distribution in MBT stained animal model rats. METHOD: It was found that 99mTc-RFN prepared by mixing 2 mg of RFN, 2.5 mCi sodium pertechnetate, 150 µg stannous chloride at pH 5.4 gave highest yield after 30 minutes and was intact above 90 % after 240 min at room temperature in saline. RESULT: The 99mTc-RFN showed a stable profile in serum at 37 °C and impurities appeared up 16 h was 15.20 %. The maximum in vitro MBT uptake observed in live strain was 71.75 ± 0.75 %. The premier uptake observed in the MBT infected site (target site) was 14.15 ± 0.00 %, in animal model rat. CONCLUSION: Higher labeling capacity, steadiness in saline & serum, higher MBT uptake, maximum uptake in the MBT infected sites and precise imaging posed 99mTc- RFN as an alternate radio-drug for tuberculosis scintigraphy.


Subject(s)
Radiopharmaceuticals , Rifabutin , Technetium , Tuberculosis/diagnostic imaging , Animals , Humans , Male , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/metabolism , Radionuclide Imaging , Rats , Rifabutin/blood , Rifabutin/chemistry , Rifabutin/pharmacokinetics , Technetium/blood , Technetium/chemistry , Technetium/pharmacokinetics , Tissue Distribution
13.
J Chromatogr Sci ; 55(6): 617-624, 2017 Jul 01.
Article in English | MEDLINE | ID: mdl-28334925

ABSTRACT

Tuberculosis (TB) with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome represents the most common infectious diseases worldwide. Anti-TB drugs are used concurrently with antiretroviral drug for treatment of TB-HIV co-morbidities. Due to lower risk of interaction with protease inhibitors, rifabutin is preferred over rifampicin in treatment of HIV and TB co-morbidity. A simple and specific liquid chromatography tandem mass spectrometry method was developed for quantification of rifabutin (RBT) and lopinavir (LPV) simultaneously in human plasma. Following extraction using 60% n-hexane in ethyl acetate, the processed samples were chromatographed on a Discovery HS C18 column (5 µm, 50 × 4.6 mm, id) using mobile phase [85% acetonitrile in ammonium acetate buffer (10 mM, pH 4.5)] at a flow rate of 0.7 mL/min. Mass spectrometric detection was performed in positive electrospray ionization mode using multiple reaction monitoring (RBT, m/z 847.7 → 815.4; LPV, m/z 629.6 → 447.4). Raloxifene and phenacetin were used as internal standards for RBT and LPV, respectively. Linearity was established in the range of 1-1,000 ng/mL and 0.5-10 µg/mL (R2 ≥ 0.99) for RBT and LPV, respectively. The recovery of LPV and RBT were always >90 and >50%, respectively. The precisions and accuracies were well within the acceptable limits of variation.


Subject(s)
Chromatography, Liquid/methods , Lopinavir/blood , Rifabutin/blood , Tandem Mass Spectrometry/methods , Drug Stability , Humans , Linear Models , Lopinavir/chemistry , Lopinavir/pharmacokinetics , Reproducibility of Results , Rifabutin/chemistry , Rifabutin/pharmacokinetics , Sensitivity and Specificity
14.
AAPS PharmSciTech ; 18(3): 829-837, 2017 Apr.
Article in English | MEDLINE | ID: mdl-27350276

ABSTRACT

Rifabutin (RFB) is prescribed for the treatment of tuberculosis infections as well as Mycobacterium avium complex (MAC) infection in immunocompromised individuals and HIV patients. With a view to develop a sustained release oral solid lipid nanoformulation (SLN), RFB was encapsulated in glyceryl monostearate (GMS) nanoparticles. The rifabutin solid lipid nanoparticles (RFB-SLNs), prepared by the solvent diffusion evaporation method, had a size of 345 ± 17.96 nm and PDI of 0.321 ± 0.09. The stability of RFB-SLNs was investigated in simulated gastric fluid (SGF) pH 2.0, simulated intestinal fluid (SIF) pH 6.8 and physiological buffer (PBS) pH 7.4. The gastric medium did not affect the SLNs and were found to be stable, while a sustained release was observed in SIF up to 48 h and in PBS up to 7 days. The pharmacokinetic profile of a single oral administration of RFB-SLNs in mice showed maintenance of therapeutic drug concentrations in plasma for 4 days and in the tissues (lungs, liver and spleen) for 7 days. Oral administration of free RFB showed clearance from plasma within 24 h. The relative bioavailability of RFB from SLNs was five fold higher as compared to administration with free RFB. The intent of using lipid nanocarriers is primarily to enhance the oral bioavailability of rifabutin and eventually decrease the dose and dosing frequency for successful management of MAC infection.


Subject(s)
Drug Carriers/chemistry , Lipids/chemistry , Nanoparticles/chemistry , Rifabutin/chemistry , Rifabutin/pharmacokinetics , Administration, Oral , Animals , Biological Availability , Drug Delivery Systems/methods , Male , Mice , Particle Size
15.
J Antimicrob Chemother ; 71(7): 1759-71, 2016 07.
Article in English | MEDLINE | ID: mdl-27009031

ABSTRACT

Rifabutin is a spiro-piperidyl-rifamycin structurally closely related to rifampicin that shares many of its properties. We attempted to address the reasons why this drug, which was recently recognized as a WHO Essential Medicine, still had a far narrower range of indications than rifampicin, 24 years after its launch. In this comprehensive review of the classic and more recent rifabutin experimental and clinical studies, the current state of knowledge about rifabutin is depicted, relying on specific pharmacokinetics, pharmacodynamics, antimicrobial properties, resistance data and side effects compared with rifampicin. There are consistent in vitro data and clinical studies showing that rifabutin has at least equivalent activity/efficacy and acceptable tolerance compared with rifampicin in TB and non-tuberculous mycobacterial diseases. Clinical studies have emphasized the clinical benefits of low rifabutin liver induction in patients with AIDS under PIs, in solid organ transplant patients under immunosuppressive drugs or in patients presenting intolerable side effects related to rifampicin. The contribution of rifabutin for rifampicin-resistant, but rifabutin-susceptible, Mycobacterium tuberculosis isolates according to the present breakpoints has been challenged and is now controversial. Compared with rifampicin, rifabutin's lower AUC is balanced by higher intracellular penetration and lower MIC for most pathogens. Clinical studies are lacking in non-mycobacterial infections.


Subject(s)
Antibiotics, Antitubercular , Rifabutin , Antibiotics, Antitubercular/adverse effects , Antibiotics, Antitubercular/pharmacokinetics , Antibiotics, Antitubercular/therapeutic use , Clinical Trials as Topic , Humans , Microbial Sensitivity Tests , Mycobacterium Infections/drug therapy , Mycobacterium tuberculosis/drug effects , Rifabutin/adverse effects , Rifabutin/pharmacokinetics , Rifabutin/pharmacology , Rifabutin/therapeutic use , Rifampin/adverse effects , Rifampin/pharmacokinetics , Rifampin/therapeutic use
16.
J Acquir Immune Defic Syndr ; 72(2): 138-52, 2016 Jun 01.
Article in English | MEDLINE | ID: mdl-26855245

ABSTRACT

Since the advent of combination antiretroviral therapy to successfully treat HIV infection, drug-drug interactions (DDIs) have become a significant problem as many antiretrovirals (ARVs) are metabolized in the liver. Antituberculous therapy traditionally includes rifamycins, particularly rifampicin. Rifabutin (RBT) has shown similar efficacy as rifampicin but induces CYP3A4 to a lesser degree and is less likely to have DDIs with ARVs. We identified 14 DDI pharmacokinetic studies on HIV monoinfected and HIV-tuberculosis coinfected individuals, and the remaining studies were healthy volunteer studies. Although RBT may be coadministered with most nonnucleoside reverse transcriptase inhibitors, identifying the optimal dose with ritonavir-boosted or cobicistat-boosted protease inhibitors is challenging because of concern about adverse effects with increased RBT exposure. Limited healthy volunteer studies on other ARV drug classes and RBT suggest that dose modification may be unnecessary. The paucity of data assessing clinical tuberculosis endpoints concurrently with RBT and ARV pharmacokinetics limits evidence-based recommendations on the optimal dose of RBT within available ARV drug classes.


Subject(s)
Anti-HIV Agents/administration & dosage , Antitubercular Agents/administration & dosage , HIV Infections/complications , HIV Infections/drug therapy , Rifabutin/administration & dosage , Tuberculosis/complications , Tuberculosis/drug therapy , Anti-HIV Agents/pharmacokinetics , Antitubercular Agents/pharmacokinetics , Coinfection , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Interactions , HIV Protease Inhibitors/administration & dosage , HIV Protease Inhibitors/pharmacokinetics , Humans , Practice Guidelines as Topic , Rifabutin/pharmacokinetics , Rifampin/administration & dosage , Rifampin/pharmacokinetics , Ritonavir/administration & dosage , Ritonavir/pharmacokinetics
17.
J Antimicrob Chemother ; 71(5): 1330-40, 2016 May.
Article in English | MEDLINE | ID: mdl-26832753

ABSTRACT

OBJECTIVES: Extensive but fragmented data from existing studies were used to describe the drug-drug interaction between rifabutin and HIV PIs and predict doses achieving recommended therapeutic exposure for rifabutin in patients with HIV-associated TB, with concurrently administered PIs. METHODS: Individual-level data from 13 published studies were pooled and a population analysis approach was used to develop a pharmacokinetic model for rifabutin, its main active metabolite 25-O-desacetyl rifabutin (des-rifabutin) and drug-drug interaction with PIs in healthy volunteers and patients who had HIV and TB (TB/HIV). RESULTS: Key parameters of rifabutin affected by drug-drug interaction in TB/HIV were clearance to routes other than des-rifabutin (reduced by 76%-100%), formation of the metabolite (increased by 224% in patients), volume of distribution (increased by 606%) and distribution to the peripheral compartment (reduced by 47%). For des-rifabutin, clearance was reduced by 35%-76% and volume of distribution increased by 67%-240% in TB/HIV. These changes resulted in overall increased exposure to rifabutin in TB/HIV patients by 210% because of the effects of PIs and 280% with ritonavir-boosted PIs. CONCLUSIONS: Given together with non-boosted or ritonavir-boosted PIs, rifabutin at 150 mg once daily results in similar or higher exposure compared with rifabutin at 300 mg once daily without concomitant PIs and may achieve peak concentrations within an acceptable therapeutic range. Although 300 mg of rifabutin every 3 days with boosted PI achieves an average equivalent exposure, intermittent doses of rifamycins are not supported by current guidelines.


Subject(s)
Anti-HIV Agents/therapeutic use , Antitubercular Agents/therapeutic use , Drug Interactions , HIV Infections/drug therapy , HIV Protease Inhibitors/therapeutic use , Rifabutin/therapeutic use , Tuberculosis/drug therapy , Adolescent , Adult , Aged , Anti-HIV Agents/pharmacokinetics , Antitubercular Agents/pharmacokinetics , Female , HIV Infections/complications , HIV Protease Inhibitors/pharmacokinetics , Healthy Volunteers , Humans , Male , Middle Aged , Rifabutin/pharmacokinetics , Tuberculosis/complications , Young Adult
18.
Clin Pharmacokinet ; 55(4): 475-83, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26369776

ABSTRACT

BACKGROUND AND OBJECTIVE: We recently published analyses regarding the predictive performance of physiologically based pharmacokinetic (PBPK) models, submitted to the US Food and Drug Administration (FDA), for the effect of cytochrome P450 (CYP) inhibitors on the pharmacokinetics of substrate drugs. We now analyze and summarize the predictive performance of PBPK models for the effect of CYP3A inducers on a substrate's pharmacokinetics. METHODS: This analysis was based on 11 substrate PBPK models, developed by six sponsors, using a commercial PBPK software, with 13 clinical interaction studies. Four CYP3A inducers were used: rifampicin, rifabutin, carbamazepine, and efavirenz. Sponsors either directly used the software-provided inducer models or verified these models' induction magnitude prior to use. The metric for assessing predictive performance was the R predicted/observed value [R predicted/observed = (predicted mean exposure ratio)/(observed mean exposure ratio)], with the exposure ratio defined as maximum plasma concentration (C max) or area under the plasma concentration-time curve (AUC) with and without an inducer. RESULTS: In 77% (10/13; AUCR) and 83% (10/12; C max R) of the cases, the R predicted/observed values were within 1.25-fold of the observed data. Cases with R predicted/observed values >1.25-fold (>twofold for all three AUCR) were under-predictions as a result of using the PBPK software's default rifampicin model. Improved predictions were observed when the rifampicin model was modified by increasing the induction potency. CONCLUSION: Based on submissions to the FDA, and similar to our previous findings for CYP inhibition, we observed good agreement between PBPK-predicted and observed effect of CYP3A inducers on substrate pharmacokinetics. Verification of the inducer model appears to be crucial for improved predictive performance.


Subject(s)
Cytochrome P-450 CYP3A Inducers/pharmacology , Cytochrome P-450 CYP3A Inducers/pharmacokinetics , Models, Biological , Carbamazepine/pharmacokinetics , Carbamazepine/pharmacology , Computer Simulation , Humans , Rifabutin/pharmacokinetics , Rifabutin/pharmacology , Rifampin/pharmacokinetics , Rifampin/pharmacology , Software , Substrate Specificity , United States , United States Food and Drug Administration
19.
Antimicrob Agents Chemother ; 60(1): 617-20, 2016 01.
Article in English | MEDLINE | ID: mdl-26482301

ABSTRACT

Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.).


Subject(s)
Antitubercular Agents/pharmacokinetics , Organic Anion Transporters/genetics , Polymorphism, Single Nucleotide , Rifabutin/pharmacokinetics , Tuberculosis, Pulmonary/drug therapy , Adult , Antitubercular Agents/administration & dosage , Antitubercular Agents/blood , Area Under Curve , CD4 Lymphocyte Count , Coinfection , Ethambutol/administration & dosage , Female , Gene Expression , HIV Infections/pathology , HIV Infections/virology , Humans , Isoniazid/administration & dosage , Liver-Specific Organic Anion Transporter 1 , Male , Monte Carlo Method , Organic Anion Transporters/metabolism , Pyrazinamide/administration & dosage , Rifabutin/administration & dosage , Rifabutin/blood , Rifampin/administration & dosage , Sex Factors , Tuberculosis, Pulmonary/blood , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/pathology
20.
Vestn Ross Akad Med Nauk ; (3): 366-71, 2015.
Article in Russian | MEDLINE | ID: mdl-26495727

ABSTRACT

BACKGROUND: One way to increase drug efficacy is to provide a drug delivery transport system to the target organ. A widely used method is to incorporate the drug in a biodegradable polymer composition with forming nanosized drug's transport forms. Objective: Our aim was to investigate the tissue biodistribution of antibiotic rifabutin transport system based on lactic and glycolic acids copolymer, and to compare it with the pure substance of rifabutin. METHODS: These substances were administered to two groups of rats intragastrically in the doses of 10 mg/kg. After a certain period of time, the animals were sacrificed by cervical dislocation. Samples preparation for analysis was carried out of the liquid-liquid extraction. Active substance's concentrations were measured by high performance liquid chromatography method. RESULTS: The study included 8-week-aged Wistar rats of both sexes weighing 0.22 ± 0.02 kg. Animals were divided into 2 groups. The study group received polymer form of antibiotic, and the comparison group received substance of rifabutin. In intervals of 10 min, 30 min, 1 h, 2 h, 4 h, 7h, 15 h, 24 h after drug administration liver, lung, spleen, kidney, intestines, stomach, heart and brain were resected respectively. Organs were measured by their weight. The drug was not detected in the brain. Rifabutin was determined in other examined tissues within 10 minutes and the maximum drug concentration in organs was fixed in 1.5-3.5 hours after administration. The rifabutin concentrations defined in the lungs were significantly higher in polymerform (p < 0.05). The polymer form's distribution coefficient was higher in the liver and lungs (15.83 and 10.14 µg/g respectively) in comparison with the substance one. The minimum amount of the active ingredient was observed in the heart (0.02 µg/g). CONCLUSION: It is shown that the inclusion of the drug in a polymeric form substantially alters its localization in organs and tissues. Extensive biodistribution nanorifabutin in lung tissue, liver and spleen is established.


Subject(s)
Drug Delivery Systems/methods , Lactic Acid/pharmacology , Liver , Lung , Polyglycolic Acid/pharmacology , Rifabutin , Spleen , Animals , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacokinetics , Biocompatible Materials/pharmacology , Chromatography, High Pressure Liquid , Drug Carriers/pharmacology , Liver/metabolism , Liver/pathology , Lung/metabolism , Lung/pathology , Nanoconjugates , Polylactic Acid-Polyglycolic Acid Copolymer , Rats , Rats, Wistar , Rifabutin/administration & dosage , Rifabutin/pharmacokinetics , Spleen/metabolism , Spleen/pathology , Tissue Distribution
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