Single-center, open-label, sequential treatment study to investigate the influence of the combined P-glycoprotein and CYP3A4 inducer hypericum perforatum on the pharmacokinetics and pharmacodynamics of rivaroxaban in healthy volunteers.
Each session (one with and one without preceding CYP induction) will start with phenotyping using 25 mg fexofenadine orally for P-gp phenotyping and 2 mg midazolam orally for cytochrome P450 (CYP) 3A4 phenotyping. After a washout period of 5 days, subjects will receive a single oral dose of 20 mg rivaroxaban, a dose currently approved for human use in clinical routine. The same procedure will be repeated after pretreatment with St. John's wort extract (Jarsin®) twice daily 450 mg po (dose usually used in clinical routine) for 2 weeks.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
12
20 mg rivaroxaban after supplementation with St. John's wort extract (Jarsin®) twice daily 450 mg po for 2 weeks.
20 mg rivaroxaban.
Inselspital
Bern, Switzerland
Pharmacokinetic outcome measures: area under the curve (AUC).
Effect of pretreatment with hypericum perforatum on geometric mean AUC.
Time frame: AUC will be calculated from the concentration-time plot (time points included: pre-dose, 0.5, 1, 2, 3, 4, 6, 8, 12, 24, 36, and 48 hours (post-dose) during both sessions)
Pharmacokinetic outcome measures: maximal concentration of rivaroxaban.
Effect of pretreatment with hypericum perforatum on maximal concentration of rivaroxaban.
Time frame: Will be obtained from the individual plasma concentration data (time points included: pre-dose, 0.5, 1, 2, 3, 4, 6, 8, 12, 24, 36, and 48 hours (post-dose) during both sessions)
Pharmacodynamic outcome measures: Factor Xa activity
Displayed as maximal effect (Emax) and parametrized by calculating the area under the time-effect curves (AUEC)).
Time frame: Time points used for analysis: pre-dose, 0.5, 1, 2, 4, 8, 12, 24, 36, and 48 hours (post-dose) during both sessions
Pharmacokinetic parameters: Time to reach maximal concentration
Time to reach maximal concentration of rivaroxaban
Time frame: Time points used for analysis: 0.5, 1, 2, 3, 4, 6, 8, 12, 24, 36, and 48 hours (post-dose) during both sessions
Pharmacokinetic parameters: Plasma elimination half-life
Plasma elimination half-life of rivaroxaban
Time frame: Time points used for analysis: 0.5, 1, 2, 3, 4, 6, 8, 12, 24, 36, and 48 hours (post-dose) during both sessions
Phenotyping metrics: AUC fexofenadine
Estimated AUC of fexofenadine
Time frame: Time points used for analysis: Before dosing and 0.5, 2, 3, 6 h after administration
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Phenotyping metrics: AUC ratios midazolam
AUC ratios of midazolam and 1'-hydroxymidazolam
Time frame: Time points used for analysis: Before dosing and 0.5, 2, 3, 6 h after administration
Phenotyping metrics: Single point metabolic ratios midazolam
Single point metabolic ratios of midazolam and 1'-hydroxymidazolam
Time frame: Time points used for analysis: Before dosing and 0.5, 2, 3, 6 h after administration