Drug Res (Stuttg) 2020; 70(10): 472-477
DOI: 10.1055/a-1180-4357
Original Article

Single Ascending Dose Study to Assess Pharmacokinetic Linearity, Safety, and Tolerability of Trimetazidine - Modified Release in Healthy Human Subjects

Thomas Körnicke
1   Parexel International GmbH, Berlin, Germany
,
Deepa Arora
2   Drug Safety and Risk Management, Lupin Limited (India), Mumbai, India
,
Abdus Samad
2   Drug Safety and Risk Management, Lupin Limited (India), Mumbai, India
,
Sigal Kaplan
3   Teva Pharmaceutical Industries LTD, Petach Tikva, Israel
,
Mónika Domahidy
4   Department of Clinical Research, Gedeon Richter Plc. Budapest, Hungary
,
Hanka de Voogd
5   Clinical Development Mylan EPD, Amstelveen, the Netherlands
,
Stella Böhmert
6   Sandoz International GmbH, Holzkirchen, Germany
,
Rita Silveira Ramos
7   Generis® Farmacêutica, Amadora, Portugal
,
Shashank Jain
2   Drug Safety and Risk Management, Lupin Limited (India), Mumbai, India
› Author Affiliations

Abstract

Aim This study assessed the linearity of pharmacokinetics (PK) of trimetazidine (TMZ) modified-release tablets (indicated in adults as an add-on therapy for stable angina pectoris) and measured its renal elimination, safety, and tolerability in healthy subjects.

Methods This was a randomized, open-label, single-ascending dose study in healthy subjects. Subjects were administered with a single dose of 35, 70, or 105 mg TMZ-modified release tablets (six subjects each). Pharmacokinetic evaluations and safety analysis were performed before the first dose and till 48 h post-first dose.

Results Following administration of 35, 70, and 105 mg TMZ-modified release; the Cmax (mean±SD) was 79.32 (±23.08), 153.17 (±23.08), and 199.67 (±23.08) ng/mL, the Tmax was 5.42 (±0.49), 4.51 (±1.27), and 4.57 (±0.96) h, t1/2 was 7.75 (±1.62), 6.40 (±1.23), and 6.50 (±1.18) h, AUC(0-inf) was 1116.89 (±378.35), 1838.39 (±284.50), and 2504.84 (±348.35) ng.h/mL, CLR was 13.70 (±2.24), 14.80 (±5.91), and 19.58 (±6.24) L·h−1 and CL/F was 33.69 (±8.51), 38.85 (±6.15), and 42.74 (±7.10) L·h−1, respectively. Slope estimates for AUC(0-inf), AUC(0-t), and Cmax were less than 1. Corresponding 95% CI of the slope for the AUC parameters excluded 1, indicating that the deviation from dose-proportionality was statistically significant. Corresponding 95% CI of the slope for Cmax included 1, indicating that the less than dose-proportional increase in Cmax was not statistically significant. No significant adverse events were observed.

Conclusion Substantial deviation from a dose-proportional increase in AUC(0-inf) and AUC(0-t) suggested a non-linear PK for TMZ-modified release. Single dose of TMZ-modified release was well tolerated and safe.



Publication History

Received: 25 February 2020

Accepted: 27 March 2020

Article published online:
04 September 2020

© 2020. Thieme. All rights reserved.

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Les Laboratoiros Servier France. VASTAREL 35 mg, modified-release film-coated tablet. 2012
  • 2 Jackson PJ, Brownsill RD, Taylor AR. et al. Identification of trimetazidine metabolites in human urine and plasma. Xenobiotica 1996; 26: 221-228 DOI: 10.3109/00498259609046702.
  • 3 Barré J, Ledudal P, Oosterhuis B. et al. Pharmacokinetic profile of a modified release formulation of trimetazidine (TMZ MR 35 mg) in the elderly and patients with renal failure. Biopharm Drug Dispos 2003; 24: 159-164 DOI: 10.1002/bdd.350.
  • 4 Thadani U. Modified-release formulation of trimetazidine for exceptional control of angina pectoris: Fact or fiction. Am J Cardiovasc Drugs 2005; 5: 331-334 doi:10.2165/00129784-200505050-00006
  • 5 European Medicines Agency (EMA). Assessment Report for trimetazidine containing medicinal products 2012; 44, https://www.ema.europa.eu/en/documents/referral/trimetazidine-article-31-referral-assessment-report_en.pdf
  • 6 Nenchev N, Skopek J, Arora D. et al. Effect of age and renal impairment on the pharmacokinetics and safety of trimetazidine: An open-label multiple-dose study. Drug Dev Res 2020; ddr. 21654. DOI: doi:10.1002/ddr.21654.
  • 7 Levey AS, Bosch JP, Lewis JB. et al A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Ann Intern Med 1999; 130: 461-470. DOI: 10.7326/0003-4819-130-6-199903160-00002.
  • 8 Ozbay L, Unal DO, Erol D. Food effect on bioavailability of modified-release trimetazidine tablets. J Clin Pharmacol 2012; 52: 1535-1539 doi:10.1177/0091270011422813
  • 9 Dézsi CA. Trimetazidine in Practice. Am J Ther 2016; 23: e871-e879 doi:10.1097/MJT.0000000000000180
  • 10 Vasiuk IA, Shal’nova SA, Shkol’nik EL, Kulikov KG. The (PRIMA) Study. Comparison of clinical effect of trimetazidine MR in men and women. Kardiologiia 2011; 51: 11-15
  • 11 Meibohm B, Beierle I, Derendorf H. How Important Are Gender Differences in Pharmacokinetics?. Clin Pharmacokinet 2002; 41: 329-342. doi:10.2165/00003088-200241050-00002