KF2022#4-trial: Effects of a Beta Blocker and NSAID on CYP Mediated Drug Metabolism

Helsinki University Central Hospital12 enrolled

Overview

Carvedilol is a non-selective beta-blocker in common clinical use, used to treat hypertension, heart failure, and angina pectoris symptoms associated with coronary artery disease. Diclofenac is a non-selective anti-inflammatory drug in general use, which is used to treat rheumatic diseases, osteoarthritis, musculoskeletal pain conditions, menstrual pains and migraines, among others. In our recent experiments involving liver cell enzymes, both carvedilol and diclofenac were found to inhibit several cytochrome P450 (CYP) enzymes central to drug metabolism, potentially leading to adverse drug interactions with other drugs metabolized by the same enzyme. The purpose of this study is to investigate the effects of the use of carvedilol and diclofenac on the activity of key CYP enzymes in drug metabolism in healthy volunteers using a low-dose model drug combination covering seven CYP enzymes. In an open three-phase, randomized, crossover study with 12 healthy volunteers, the subjects will receive a drug combination of caffeine, bupropion, repaglinide, flurbiprofen, omeprazole, dextromethorphan, midazolam and simvastatin and as a premedication either placebo, carvedilol or diclofenac. Blood samples will be collected and carvedilol, diclofenac, caffeine, bupropion, repaglinide, flurbiprofen, omeprazole, dextromethorphan, midazolam and simvastatin pharmacokinetics will be monitored up to 23 hours post dose.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Conditions

Drug Interaction

Interventions

Caffeine TabletDRUG

0,5 x 100 mg tablet (50 mg caffeine).

Bupropion Hydrochloride CapselsDRUG

1 x 20 mg tablet.

Repaglinide CapselsDRUG

1 x 0,05 mg tablet.

Flurbiprofen CapselsDRUG

1 x 10 mg tablet.

Omeprazole 10 MGDRUG

1 x 10 mg tablet.

Dextromethorphan Oral SolutionDRUG

5,0 ml of 2 mg/ml oral solution (10 mg dextromethorphan).

Midazolam oral solutionDRUG

0,5 ml of 2 mg/ml oral solution (1,0 mg midazolam).

Simvastatin tabletsDRUG

1 x 10 mg tablet.

PlaceboDRUG

2 x placebo tablets in the Placebo Phase/Arm

CarvedilolDRUG

2 x 25 mg tablets

DiclofenacDRUG

1 x 50 mg tablet (three times daily for three days)

Eligibility

Sex: ALLMin age: 18 YearsMax age: 40 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Written informed consent * Age 18-40 * Healthy * Systolic blood pressure ≥110 mmHg * Heart rate ≥ 55/min * Normal ECG * Accepted results from laboratory tests (blood haemoglobin, basic blood count and blood platelets, alanine aminotransferase, alkaline phosphatase, glutamyl transferase, creatine kinase, creatinine, plasma glucose concentration, plasma potassium and sodium). Negative pregnancy test result (serum human chorionic gonadotropin) for women. Exclusion Criteria: * Significant disease * Previous or current gastrointestinal bleeding, ulcer or perforation * Findings of a medical examination and laboratory tests, which require a more detailed examination of the state of health * Smoking * Hormonal birth control or other regular medication * Pregnancy (current or planned) or nursing * Participation in any other studies involving investigational or marketed drug products within three months prior to the entry into this study * Donation of blood within three months prior to the entry into this study * Significant overweight / small or hard-to-find veins * BMI \< 18.5 kg/m2 * Insufficient Finnish language skills * Hypersensitivity or contraindication to study drugs

Outcomes

Primary Outcomes

Area under the plasma concentration - time curve of carvedilol, diclofenac, caffeine, bupropion, repaglinide, flurbiprofen, omeprazole, dextromethorphan, midazolam and simvastatin