This pilot trial aims to study 10 selected commonly prescribed medicines with different grade of phototoxic potential. As there is no currently established way to assess phototoxic potential in a systematic and quantitative way, we want to test a novel radiation and measurement protocol to provide more granular information for patients and providers.
The purpose of this clinical study is to test ten commonly prescribed drugs with known photosensitizing properties in order to gain more detailed knowledge about the effects, which can help to make recommendations for patients who need these drugs for their therapy. Phototoxic and photoallergic drug-induced reactions are relatively common side effects of multiple drugs. However, the incidence and threshold doses are underreported, misdiagnosed or not adequately investigated. In this open, randomized, monocentric, parallel group study, 12 healthy subjects are randomized into 2 groups of 6 healthy subjects each after fulfilling inclusion and exclusion criteria and a screening visit (demographics, medical history, laboratory parameters, vital parameters, ECG, physical examination including skin examination and baseline measurement of skin properties). In the study, one drug from a fixed block of 5 drugs allocated during randomization is administered orally as a single dose weekly (on days 1, 8, 15, 22, 29). 6 hours after drug administration, when the drugs have reached their peak plasma concentrations, the skin is irradiated with UVA, UVB and visible light at previously determined locations on the upper and lower arms and back. The irradiation is carried out using equipment that is also used in clinical routine, namely a UVA lamp from Sellamed (Germany), UVB lamps from Waldmann Medizintechnik and a slide projector for visible light radiation. In the next step, skin reactions that occur immediately after irradiation and after 24 hours are analyzed using Mexameter®, Aquaflux® and a confocal Raman microscope. In addition to the safety blood parameters, regular reserve blood samples are taken at the screening and final visits for the purpose of possible later analysis of drug levels. The subjects are asked to avoid direct sunlight for the entire duration of the study or, if this cannot be avoided, to use a high sun protection factor. The final visit (visit 12) is planned for day 36.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
12
amiodarone (Amiodaron Arcana) 200mg, diclofenac (Diclobene) 100mg, hydrochlorothiazide (HCT G.L) 25mg, pantoprazole (Pantoloc) 40mg, voriconazole (Voriconazol Aristo®) 200mg
The skin of the inner arm will be exposed to five fixed incremental doses of UVA and UVB. Each dose will be applied to a circular area on the inner forearm of 1 cm diameter for both UVA and UVB.
acetylsalicylic acid (ASS Genericon) 500mg, doxycycline (Doxybene) 200mg, enalapril (Enalapril "ratiopharm") 10mg, furosemide (Lasix) 40mg, verapamil (Verapabene) 80mg
Medical University of Vienna, Department of Clinical Pharmacology
Vienna, State of Vienna, Austria
Minimal erythema dose
To assess the Minimal Erythema Dose (MED) of 10 selected human medicines with known photosensitizing properties for UVA and UVB and the reaction to visible spectrum light 24 hours after exposure to radiation
Time frame: after 24 hours once weekly respectively, for 5 weeks in total
Transepidermal water loss
To assess the transepidermal water loss (TEWL) as a marker of skin barrier function of 10 selected medicines with known photosensitizing properties 24 hours after exposure to UVA, UVB and visible spectrum light radiation.
Time frame: after 24 hours once weekly respectively, for 5 weeks in total
Change in molecular skin properties
To assess changes in skin properties on a molecular level of 10 selected medicines with known photosensitizing properties 24 hours after exposure to UVA, UVB and visible specrum light radiation
Time frame: after 24 hours once weekly respectively, for 5 weeks in total
Immediate photosensitivity and phototoxicity reactions
To assess other immediate photosensitivity and phototoxicity reactions of 10 selected medicines with known photosensitizing properties after exposure to UVA, UVB and visible spectrum light radiation, including * presence of exanthema * presence of hyperpigmentation * presence of erythema * presence of urticaria * presence of pruritus * presence of combustion
Time frame: Immediately after UV exposure once weekly, respectively, for 5 weeks in total
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