Single- and Multiple-Dose Pharmacokinetics of Long-acting Injectable Naltrexone

• Published in: Alcoholism, clinical and experimental research Vol. 30; no. 3; pp. 480 - 490
• Main Authors: Dunbar, Joi L., Turncliff, Ryan Z., Dong, Qunming, Silverman, Bernard L., Ehrich, Elliot W., Lasseter, Kenneth C.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.03.2006; Lippincott Williams & Wilkins
• Subjects: Administration, Oral; Adolescent; Adult; Alcohol Deterrents; Alcoholism and acute alcohol poisoning; Area Under Curve; Biological and medical sciences; Chromatography, High Pressure Liquid; Delayed-Action Preparations; Dose-Response Relationship, Drug; Double-Blind Method; Extended-Release Preparation; Female; Half-Life; Humans; Injections; Lactic Acid; Long-acting Injectable; Male; Medical sciences; Microspheres; Middle Aged; Naltrexone; Naltrexone - administration & dosage; Naltrexone - adverse effects; Naltrexone - analogs & derivatives; Naltrexone - blood; Naltrexone - pharmacokinetics; Narcotic Antagonists - administration & dosage; Narcotic Antagonists - adverse effects; Narcotic Antagonists - pharmacokinetics; Pharmacokinetics; Polyglycolic Acid; Polymers; Sex Characteristics; Toxicology; Morphinan derivatives; Multiple dose; Narcotic antagonist; Preparation; Extended-Release Preparation; Long-acting Injectable; Naltrexone; Pharmacokinetics; Release
• ISSN: 0145-6008; 1530-0277
• DOI: 10.1111/j.1530-0277.2006.00052.x

Background: Oral naltrexone is effective in the treatment of alcohol dependence; however, a major limitation of its clinical utility is poor patient adherence to the daily dosing schedule. A biodegradable, long‐acting naltrexone microsphere formulation was developed to achieve continuous naltrexone exposure for 1 month in the treatment of alcohol dependence. Methods: The single‐ and multiple‐dose safety and pharmacokinetics of a long‐acting naltrexone microsphere preparation were evaluated in healthy subjects. One group of subjects (n=28) received a single dose of oral naltrexone 50 mg followed by a single gluteal intramuscular (IM) injection of long‐acting naltrexone 190 or 380 mg or placebo. A different group of subjects (n=14) received oral naltrexone 50 mg daily for 5 days, followed by IM long‐acting naltrexone 380 mg or placebo every 28 days for a total of 4 doses. A 7‐day washout period separated oral and IM administrations. Blood samples were collected to determine plasma concentrations of naltrexone and the primary metabolite, 6β‐naltrexol. Results: After a single IM injection of long‐acting naltrexone 380 mg, naltrexone plasma concentrations were measurable in all subjects for at least 31 days postdose. The pharmacokinetics were proportional to the dose and multiple dose observations were consistent with single dose observations. Mean apparent elimination half‐lives for naltrexone and 6β‐naltrexol ranged from 5 to 7 days. Exposure to 6β‐naltrexol was reduced with IM injection compared with that oral administration. No serious adverse events occurred. Conclusions: This study demonstrated that the long‐acting naltrexone formulation was well tolerated, displayed predictable pharmacokinetics, and resulted in no meaningful drug accumulation upon multiple dosing. Intramuscular administration avoids first‐pass metabolism and changes the exposure ratio of 6β‐naltrexol to naltrexone compared with oral administration. By providing continuous exposure to naltrexone for several weeks following IM injection, this long‐acting naltrexone formulation may offer therapeutic benefit to those patients who experience difficulty adhering to the daily administration schedule necessitated by oral naltrexone therapy.