Pharmacokinetics of budesonide and formoterol administered via 1 pressurized metered-dose inhaler in patients with asthma and COPD.

In 3 open-label studies, the systemic bioavailability of budesonide and formoterol administered via pressurized metered-dose inhaler (pMDI) or dry powder inhaler (DPI) formulations was evaluated in asthma (24 children, 55 adults) or chronic obstructive pulmonary disease (COPD; n = 26) patients. Treatments were administered at doses high enough to estimate pharmacokinetic parameters reliably. Two of the studies included an experimental budesonide pMDI formulation. In study 1 (asthma, adults), budesonide area under the curve (AUC) was 32% and 31% lower and maximal budesonide concentration (C(max)) 45% and 56% lower after budesonide/formoterol pMDI and budesonide pMDI versus budesonide DPI. Formoterol AUC and C(max) were 13% and 39% lower after budesonide/formoterol pMDI versus formoterol DPI. In study 2 (asthma, children), budesonide AUC and C(max) were 27% and 41% lower after budesonide/formoterol pMDI versus budesonide DPI + formoterol DPI. In study 3 (COPD/asthma, adults), budesonide AUC and C(max) were similar and formoterol AUC and C(max) 18% and 22% greater after budesonide/formoterol pMDI versus budesonide pMDI + formoterol DPI (COPD). Budesonide and formoterol AUC were 12% and 15% higher in COPD versus asthma patients. In conclusion, systemic exposure generally is similar or lower with budesonide/formoterol pMDI versus combination therapy via separate DPIs or monotherapy and comparable between asthma and COPD patients.

Pharmacokinetics of budesonide and formoterol administered via a series of single-drug and combination inhalers: four open-label, randomized, crossover studies in healthy adults.

OBJECTIVE: To investigate the pharmacokinetics of budesonide and formoterol administered concomitantly in healthy adults. METHODS: Three single-dose, open-label crossover studies (n=28 each) were conducted (Study I: budesonide pMDI, formoterol DPI, budesonide pMDI+formoterol DPI; Study II: budesonide/formoterol pMDI, budesonide pMDI+formoterol DPI; Study III: budesonide/formoterol pMDI [three budesonide formulation strengths; constant formoterol]). Study IV (n=28) assessed steady state pharmacokinetics (budesonide/formoterol pMDI [two/four inhalations twice daily, 5-day treatment; four inhalations, single-dose]). RESULTS: Study I: no pharmacokinetic interactions were observed between budesonide and formoterol. Study II: AUC ratios were 97.9% (budesonide) and 82.2% (formoterol) (budesonide/formoterol pMDI versus budesonide pMDI+formoterol DPI). Study III: formoterol AUC was comparable across budesonide/formoterol pMDI formulation strengths; budesonide AUC increased with formulation strength in proportion to fine particle dose. Study IV: dose proportionality was demonstrated for budesonide (AUC ratio, 104.3%) and suggested for formoterol (AUC ratio, 117.6%) with budesonide/formoterol pMDI (steady state); budesonide and formoterol AUC was higher with repeated versus single-dose budesonide/formoterol pMDI (four inhalations). CONCLUSIONS: No pharmacokinetic interactions were observed between budesonide and formoterol. Budesonide dose variation in budesonide/formoterol pMDI did not affect formoterol exposure. Steady state budesonide/formoterol pMDI dose-doubling yielded proportional increases in budesonide and formoterol exposure.

Drug permeability in 16HBE14o- airway cell layers correlates with absorption from the isolated perfused rat lung.

The permeability of the lung is critical in determining the disposition of inhaled drugs and the respiratory epithelium provides the main physical barrier to drug absorption. The 16HBE14o- human bronchial epithelial cell line has been developed recently as a model of the airway epithelium. In this study, the transport of 10 low molecular weight compounds was measured in the 16HBE14o- cell layers, with apical to basolateral (absorptive) apparent permeability coefficients (P(app)) ranging from 0.4 x 10(-6)cms(-1) for Tyr-D-Arg-Phe-Phe-NH(2) to 25.2x10(-6)cms(-1) for metoprolol. Permeability in 16HBE14o- cells was found to correlate with previously reported P(app) in Caco-2 cells and absorption rates in the isolated perfused rat lung (k(a,lung)) and the rat lung in vivo (k(a,in vivo)). Log linear relationships were established between P(app) in 16HBE14o- cells and P(app) in Caco-2 cells (r(2)=0.82), k(a,lung) (r(2)=0.78) and k(a,in vivo) (r(2)=0.68). The findings suggest that permeability in 16HBE14o- cells may be useful to predict the permeability of compounds in the lung, although no advantage of using the organ-specific cell line 16HBE14o- compared to Caco-2 cells was found in this study.

A miniaturized nebulization catheter for improved gene delivery to the mouse lung.

BACKGROUND: The available methods for administration of gene delivery systems to the lungs of small animals via nebulization have several drawbacks. These include lack of control over the delivered dose and a negative impact on the stability of the formulation. This paper describes a new nebulization catheter device for the administration of plasmid-based gene delivery systems (polyplexes) as aerosols to the mouse lung in vivo. METHODS: The physical stability of naked pDNA and polyplexes formulated with chitosan oligomers and PEI was examined following nebulization with the catheter device. We also examined the in vitro transfection efficiency of the polyplexes recovered after nebulization. Lung distribution and gene expression after administration of the selected gene delivery systems to the mouse lung were also investigated. RESULTS: In contrast to previously described nebulization methods, the structural integrity of the unprotected naked pDNA was maintained following nebulization by the catheter device, which indicates relatively mild nebulization conditions. In addition, the nebulization procedure did not affect the physical stability of the formulated polyplexes. Small volumes of the pDNA aerosol (10-20 microl) were delivered in a highly controlled and reproducible manner. The aerosol droplet size varied with the molecular weight of the polycations. Aerosol delivery via this method resulted in improved lung distribution of pDNA polyplexes and a six-fold increase in the efficiency of gene delivery in vivo over that seen with the commonly used intratracheal instillation method. CONCLUSION: The use of the nebulization catheter device provides a promising alternative for aerosol gene delivery to the mouse lung.

Drug absorption from the isolated perfused rat lung--correlations with drug physicochemical properties and epithelial permeability.

The pulmonary absorption of nine low-molecular-weight (225-430 Da) drugs (atenolol, budesonide, enalaprilat, enalapril, formoterol, losartan, metoprolol, propranolol and terbutaline) and one high-molecular-weight membrane permeability marker compound (FITC-dextran 10000 Da) was investigated using the isolated, perfused and ventilated rat lung (IPL). The relationships between pulmonary transport characteristics, epithelial permeability of Caco-2 cell monolayers and drug physicochemical properties were evaluated using multivariate data analysis. Finally, an in vitro-in vivo correlation was made using in vivo rat lung absorption data. The absorption half-life of the investigated drugs ranged from 2 to 59 min, and the extent of absorption from 21 to 94% in 2 h in the isolated perfused rat lung model. The apparent first-order absorption rate constant in IPL (ka(lung)) was found to correlate to the apparent permeability (P(app)) of Caco-2 cell monolayers (r = 0.87), cLog D(7.4) (r = 0.70), cLog P, and to the molecular polar surface area (%PSA) (r = -0.79) of the drugs. A Partial Least Squares (PLS)-model for prediction of the absorption rate (log ka(lung)) from the descriptors log P(app), %PSA and cLogD(7.4) was found (Q2 = 0.74, R2 = 0.78). Furthermore, a strong in vitro-in vivo correlation (r = 0.98) was found for the in vitro (IPL) drug absorption half-life and the pulmonary absorption half-life obtained in rats in vivo, based on a sub-set of five compounds.

Pulmonary absorption rate and bioavailability of drugs in vivo in rats: structure-absorption relationships and physicochemical profiling of inhaled drugs.

The aim of this investigation was to analyze the structure-absorption relationships for pulmonary delivered drugs. First, the inhaled drugs on the market during 2001 were identified and a profile of the calculated physicochemical properties was made. Second, an in vivo pharmacokinetic investigation was performed in anesthetized rats. Eight selected drugs were administered by intratracheal nebulization and intravenous bolus administration and the plasma concentrations of the drugs were determined by LC-MS-MS. Third, an evaluation of the relationships between the absorption/bioavailability data and the drugs' physicochemical characteristics and the epithelial permeability in Caco-2 cells, respectively, was performed. The drug absorption rate was found to correlate to the molecular polar surface area and the hydrogen bonding potential, as well as to the apparent permeability in Caco-2 cell monolayers, which indicated that passive diffusion was the predominating mechanism of absorption in the rat lung. In contrast to the intestinal mucosa and the blood-brain barrier, the pulmonary epithelium was shown to be highly permeable to compounds with high molecular polar surface area (e.g., PSA 479 A(2)). Furthermore, a high bioavailability was found for the efflux transporter substrates talinolol (81%) and losartan (92%), which provides functional evidence for a quantitatively less important role for efflux transporters, such as P-glycoprotein, in limiting the absorption of these drugs from the rat lung. In conclusion, the pulmonary route should be regarded as a potential alternative for the delivery of drugs that are inadequately absorbed after oral administration.

Miniaturized nebulization catheters: a new approach for delivery of defined aerosol doses to the rat lung.

A nebulization catheter technique (AeroProbe) was adapted and evaluated as a new approach for pulmonary delivery of defined aerosol doses to the rat lung. The lung distribution profile was evaluated by dosing Evans blue and Nile blue dye, respectively, to isolated and perfused rat lungs (IPL) and to the lungs of anesthetized and tracheal-intubated rats. The intratracheal aerosol dosing was synchronized with the inspiration of the lungs. Immediately after dosing, the lungs were dissected into upper- and lower trachea, bronchi, and parenchyma. The dye was then extracted from the tissue samples to determine the regional distribution and the recovery of the aerosol dose in the lungs. The droplet-size distribution and the weight of the delivered aerosol dose were analyzed with laser diffraction and gravimetric analysis respectively. The recovery of the delivered dose was high, 99 +/- 12 and 105 +/- 1%, respectively, in the in vivo administrations and IPL-experiments. The lung distribution profile after aerosol dosing to anesthetized rats was mainly tracheobronchial. Only 12 +/- 4% of the dose was recovered in the lung parenchyma. However, after aerosol dosing to the IPL, 38 +/- 11% of the dose was distributed to the lung parenchyma. At the settings used, the nebulization catheter aerosolized 1-2 microL of liquid per puff using 1-1.5 mL of air. The droplet-size distribution of the generated aerosols was broad (2-8% <3 microm; 10% <4-7 microm; 50% <10-15 microm; and 90% <20-40 microm). The nebulization catheter technique provides a complement to existing methodology for pulmonary drug delivery in small animals. With this new technique, defined aerosol doses can be delivered into the lungs of rats with no need for aerosol dosimetry.

Mechanisms for absorption enhancement of inhaled insulin by sodium taurocholate.

The effects of sodium taurocholate (NaTC) on the absorption of inhaled insulin was investigated using both in vivo and in vitro experiments. The absolute bioavailability of insulin when given as a nebulized solution (0.6 mM) to anesthetized intubated beagle dogs was low (2.6+/-0.3%). However, when NaTC at different concentrations (2-32 mM) were included in the formulations the bioavailability increased and at 32 mM it was about nine times higher (23.2+/-4.4%) than for pure insulin. In a similar concentration interval (20-25 mM) NaTC decreased the transepithelial electrical resistance (TEER) across Caco-2 cell monolayers leading to an increased permeability of insulin. At higher concentrations (above 30 mM) the viability of the Caco-2 cells decreased and the insulin permeability increased dramatically. Furthermore, we show that NaTC in the concentration range 2-15 mM gradually decreases the aggregation state of insulin, i.e., produces mono- or dimeric insulin from hexameric insulin. In conclusion, NaTC increases the bioavailability of nebulized insulin, increases the permeability of insulin across Caco-2 cell monolayers, and decreases the aggregation state of insulin at similar concentrations. We suggest that the main mechanisms behind the absorption enhancement of inhaled insulin by NaTC are the production of insulin monomers and an opening of tight junctions between adjacent airway epithelial cells.

High airway-to-blood transport of an opioid tetrapeptide in the isolated rat lung after aerosol delivery.

The airway-to-blood absorption of the mu-selective opioid tetrapeptide agonist Tyr-D-Arg-Phe-Phe-NH(2) (MW 631) was investigated in the isolated, perfused, and ventilated rat lung model. The lung metabolism of the peptide was compared after airway and vascular delivery. The concentrations of the parent tetrapeptide and five of its metabolites in the perfusate and in bronchoalveolar lavage fluid were analyzed by LC-MS. The metabolism of the peptide was higher after delivery to the airways compared to vascular delivery. However, the tetrapeptide was highly transported from the air-to-blood side to an extent of 47.8 +/- 10.7% in 2 h. In conclusion, the results prompt investigations of the pulmonary route as a successful alternative to parenteral delivery for this tetrapeptide.

Regional differences in bioavailability of an opioid tetrapeptide in vivo in rats after administration to the respiratory tract.

TArPP (Tyr-D-Arg-Phe-Phe-NH(2)), 1-10 micromol/kg, was administered to anesthetized rats by nasal microinfusion, intratracheal microinfusion, intratracheal nebulization, aerosol inhalation, and i.v. bolus and infusion. Plasma concentrations of TArPP and its deamidated metabolite were determined by LC-MS-MS. Regional differences in bioavailability (F), first-pass metabolism, and absorption rate were found for TArPP after delivery to the respiratory tract. Absorption was rapid after both pulmonary and nasal administration (t(max) approximately 10-20 min). After nasal microinfusion, F was 52 +/- 9%. For all the pulmonary groups, F was higher (72-114%). First-pass metabolism of TArPP was lower in the lung than in the nasal cavity. It is evident that the pulmonary route is attractive for successful systemic delivery of small, hydrophilic and enzymatic susceptible peptides.