Absence of a significant pharmacokinetic interaction between atorvastatin and fenofibrate: a randomized, crossover, study of a fixed-dose formulation in healthy Mexican subjects

Omar Patiño-Rodríguez, Rosa María Martínez-Medina, Irma Torres-Roque, Maricela Martínez-Delgado, América Susana Mares-García, Abraham Escobedo-Moratilla, Amador Covarrubias-Pinedo, Angélica Arzola-Paniagua, José Luis Herrera-Torres, José Pérez-Urizar, Omar Patiño-Rodríguez, Rosa María Martínez-Medina, Irma Torres-Roque, Maricela Martínez-Delgado, América Susana Mares-García, Abraham Escobedo-Moratilla, Amador Covarrubias-Pinedo, Angélica Arzola-Paniagua, José Luis Herrera-Torres, José Pérez-Urizar

Abstract

Several clinical trials have substantiated the efficacy of the co-administration of statins like atorvastatin (ATO) and fibrates. Without information currently available about the interaction between the two drugs, a pharmacokinetic study was conducted to investigate the effect when both drugs were co-administered. The purpose of this study was to investigate the pharmacokinetic profile of tablets containing ATO 20 mg, or the combination of ATO 20 mg with fenofibrate (FNO) 160 mg administered to healthy Mexican volunteers. This was a randomized, two-period, two-sequence, crossover study; 36 eligible subjects aged between 20-50 years were included. Blood samples were collected up to 96 h after dosing, and pharmacokinetic parameters were obtained by non-compartmental analysis. Adverse events were evaluated based on subject interviews and physical examinations. Area under the concentration-time curve (AUC) and maximum plasma drug concentration (Cmax) were measured for ATO as the reference and ATO and FNO as the test product for bioequivalence design. The estimation computed (90% confidence intervals) for ATO and FNO combination versus ATO for Cmax, AUC0-t and AUC0-∞, were 102,09, 125,95, and 120,97%, respectively. These results suggest that ATO and FNO have no relevant clinical-pharmacokinetic drug interaction.

Keywords: LC-MS-MS; atorvastatin; combination; fenofibrate; pharmacokinetic interaction.

Figures

FIGURE 1
FIGURE 1
Time-course profile of atorvastatin (ATO) in human plasma of the evaluated formulations.

References

    1. Athyros V. G., Papageorgiou A. A., Athyrou V. V., Demitriadis D. S., Kontopoulos A. G. (2002). Atorvastatin and micronized fenofibrate alone and in combination in type 2 diabetes with combined hyperlipidemia. Diabetes Care 25 1198–202 10.2337/diacare.25.7.1198
    1. Bahrami G., Mohammadi B., Mirzaeei S., Kiani A. (2005). Determination of atorvastatin in human serum by reversed-phase high-performance liquid chromatography with UV detection. J. Chromatogr. B Analyt. Technol. Biomed. Life Sci. 826 41–45 10.1016/j.jchromb.2005.08.008
    1. Bergman A. J., Murphy G., Burke J., Zhao J. J., Valesky R., Liu L., et al. (2004). Simvastatin does not have a clinically significant pharmacokinetic interaction with fenofibrate in humans. J. Clin. Pharmacol. 44 1054–1062 10.1177/0091270004268044
    1. Corsini A., Bellosta S., Davidson M. H. (2005). Pharmacokinetic interactions between statins and fibrates. Am. J. Cardiol. 96 44K–49K 10.1016/j.amjcard.2005.08.007
    1. Davidson M. H., Rooney M. W., Drucker J., Eugene Griffin H., Oosman S., Beckert M; LCP-AtorFen Investigators. (2009). Efficacy and tolerability of atorvastatin/fenofibrate fixed-dose combination tablet compared with atorvastatin and fenofibrate monotherapies in patients with dyslipidemia: a 12-week, multicenter, double-blind, randomized, parallel-group study. Clin. Ther. 31 2824–2838 10.1016/j.clinthera.2009.12.007
    1. Goosen T. C., Bauman J. N., Davis J. A., Yu C., Hurst S. I., Williams J. A., et al. (2007). Atorvastatin glucuronidation is minimally and nonselectively inhibited by the fibrates gemfibrozil, fenofibrate, and fenofibric acid. Drug Metab. Dispos. 35 1315–1324 10.1124/dmd.107.015230
    1. Hanafy A., Spahn-Langguth H., Vergnault G., Grenier P., Tubic Grozdanis M., Lenhardt T., et al. (2007). Pharmacokinetic evaluation of oral fenofibrate nanosuspensions and SLN in comparison to conventional suspensions of micronized drug. Adv. Drug Deliv. Rev. 59 419–426 10.1016/j.addr.2007.04.005
    1. Jacobson T. A. (2004). Comparative pharmacokinetic interaction profiles of pravastatin, simvastatin, and atorvastatin when coadministered with cytochrome P450 inhibitors. Am. J. Cardiol. 94 1140–1146 10.1016/j.amjcard.2004.07.080
    1. Keating G. M., Croom K. F. (2007). Fenofibrate: a review of its use in primary dyslipidaemia, the metabolic syndrome and type 2 diabetes mellitus. Drugs 67 121–153 10.2165/00003495-200767010-00013
    1. Kiortisis D. N., Millionis H., Bairaktari E., Elisaf M. S. (2000). Efficacy of combination of atorvastatin and micronised fenofibrate in the treatment of severe mixed hyperlipidemia. Eur. J. Clin. Pharmacol. 56 631–635 10.1007/s002280000213
    1. Koh K. K., Quon M. J., Han S. H., Chung W. J., Ahn J. Y., Seo Y. H., et al. (2005). Additive beneficial effects of fenofibrate combined with atorvastatin in the treatment of combined hyperlipidemia. J. Am. Coll. Cardiol. 45 1649–1653 10.1016/j.jacc.2005.02.052
    1. Koytchev R., Ozalp Y., Erenmemisoglu A., van der Meer M. J., Alpan R. S. (2004). Bioequivalence study of atorvastatin tablets. Arzneimittelforschung 54 573–537 10.1055/s-0031-1297051
    1. Lau Y. Y., Huang Y., Frassetto L., Benet L. Z. (2007). Effect of OATP1B transporter inhibition on the pharmacokinetics of atorvastatin in healthy volunteers. Clin. Pharmacol. Ther 81 194–204 10.1038/sj.clpt.6100038
    1. Lennernäs H. (2003). Clinical pharmacokinetics of atorvastatin. Clin. Pharmacokinet. 42 1141–1160 10.2165/00003088-200342130-00005
    1. Liu Y. M., Pu H. H., Liu G. Y., Jia J. Y., Weng L. P., Xu R. J., et al. (2010). Pharmacokinetics and bioequivalence evaluation of two different atorvastatin calcium 10-mg tablets: a single-dose, randomized-sequence, open-label, two-period crossover study in healthy fasted Chinese adult males. Clin. Ther. 32 1396–1407 10.1016/j.clinthera.2010.07.004
    1. NOM-177-SSA1-1998 (2013). Tests and Procedures to Demonstrate Interchangeabil ity Between Pharmaceutical Formulations (InSpanish). Mexican Health Ministry. Mexico (1998). Available at: or [accessed January 30 2013].
    1. Patiño-Rodríguez O., Torres-Roque I., Martínez-Delgado M., Escobedo-Moratilla A., Pérez-Urizar J. (2014). Pharmacokinetic non-interaction analysis in a fixed-dose formulation in combination of atorvastatin and ezetimibe. Front. Pharmacol. 5:261 10.3389/fphar.2014.00261
    1. Pfizer Inc. Lipitor®. (2009). (Atorvastatin Calcicum) Full Prescribing Information. Available at: [accessed July 17 2014].
    1. Posvar E. L., Radulovic L. L., Cilla D. D., Jr., Whitfield L. R., Sedman A. J. (1996). Tolerance and pharmacokinetics of single-dose atorvastatin, a potent inhibitor of HMG-CoA reductase, in healthy subjects. J. Clin. Pharmacol. 36 728–731 10.1002/j.1552-4604.1996.tb04242.x
    1. Vanegas A. L., Jaramillo N. (2008). Intolerancia a las estatinas, un reto en la práctica clínica. Rev. Colom. Cardiol. 15 75–83.
    1. Whitfield L. R., Porcari A. R., Alvey C., Abel R., Bullen W., Hartman D. (2011). Effect of gemfibrozil and fenofibrate on the pharmacokinetics of atorvastatin. J. Clin. Pharmacol. 51 378–388 10.1177/0091270010366446

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