Comparison of the in vivo pharmacokinetics and in vitro dissolution of raltegravir in HIV patients receiving the drug by swallowing or by chewing

Dario Cattaneo, Sara Baldelli, Matteo Cerea, Simona Landonio, Paola Meraviglia, Emanuela Simioni, Valeria Cozzi, Serena Fucile, Andrea Gazzaniga, Emilio Clementi, Massimo Galli, Giuliano Rizzardini, Cristina Gervasoni

Research output: Contribution to journalArticle

Abstract

The pharmacokinetics of raltegravir (RAL) in HIV patients is characterized by high interpatient/intrapatient variability. We investigated the potential contribution of the drug pharmaceutical formulation to RAL pharmacokinetics. We first compared in vivo the pharmacokinetics of RAL for 67 patients to whom the drug was administered by swallowing the intact tablet with those obtained from 13 HIV-infected patients who chewed the RAL tablet due to swallowing difficulties. Subsequently, we evaluated in vitro the dissolution of RAL tablets under different conditions. In the in vivo study, we found that patients given RAL by chewing the tablets presented pharmacokinetic profiles characterized by significantly higher RAL absorption than did patients receiving the drug by swallowing. The in vitro studies showed that when the whole tablets were exposed to an acidic medium, the release of RAL was very low, whereas when the tablets were crushed, the profiles presented significantly higher concentrations of RAL. Crushed tablets tested in water or in a pH 6.8 buffer exhibited prompt and complete dissolution of RAL. HIV-infected patients receiving RAL by chewing the tablet showed higher drug absorption and reduced pharmacokinetic variability compared with patients swallowing the intact tablet. This is related to problems in tablet disintegration and to erratic drug absorption. The amelioration of the RAL pharmaceutical formulation could improve drug pharmacokinetics.

Original languageEnglish
Pages (from-to)6132-6136
Number of pages5
JournalAntimicrobial Agents and Chemotherapy
Volume56
Issue number12
DOIs
Publication statusPublished - Dec 2012

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ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology
  • Infectious Diseases

Cite this

Cattaneo, D., Baldelli, S., Cerea, M., Landonio, S., Meraviglia, P., Simioni, E., Cozzi, V., Fucile, S., Gazzaniga, A., Clementi, E., Galli, M., Rizzardini, G., & Gervasoni, C. (2012). Comparison of the in vivo pharmacokinetics and in vitro dissolution of raltegravir in HIV patients receiving the drug by swallowing or by chewing. Antimicrobial Agents and Chemotherapy, 56(12), 6132-6136. https://doi.org/10.1128/AAC.00942-12