Safety, Tolerability, and PK Parameters of Sodium Nitrite Inhalation Solution in Healthy Subjects

This is an interventional treatment trial for Pulmonary Hypertension focused on measuring vasodilator, nitric oxide, sodium nitrite, sildenafil, PDE-5, pulmonary hypertension, pulmonary arterial hypertension Read More

Inclusion Criteria:

• Be informed of the nature of the study and is able to understand and has provided written informed voluntary consent
• Be healthy males or females, of any race, at least 18 years of age or the legal age of consent (whichever is greater) and less than 56 years of age at the time of the first dose of study drug (or sildenafil)
• Have a body mass index (BMI) >=18.0 and <32.0 kg/m2 and weigh at least 50 kg
• Be in good general health with no clinically relevant abnormalities based on the medical history, physical examination, clinical laboratory evaluations (hematology, clinical chemistry, urinalysis, methemoglobin), and 12-lead ECG that, in the opinion of the Investigator, would affect subject safety
• Agree to comply with the study procedures and restrictions

Exclusion Criteria:

• Any disease or condition that might affect drug absorption, metabolism, or excretion, or clinically significant cardiovascular, ocular, hematological, renal, hepatic, pulmonary, endocrine, gastrointestinal, immunological, dermatological, neurological, or psychiatric disease
• Clinically significant illness (including lower respiratory tract infection) or clinically significant surgery within 4 weeks before the administration of study drug (or sildenafil)
• Use of any commercially marketed mouthwash or oral rinse with agents other than tap water as well as tongue brushing or scraping from screening onwards through completion of study
• Currently a smoker or has a past history of smoking (of >10 pack years)
• History of bronchial asthma or sleep apnea
• Evidence of restrictive or obstructive lung disease (Forced Expiratory Volume in 1 second (FEV1)/Forced Vital Capacity (FVC) <70%, FEV1 <70% predicted, and/or FVC <70% predicted)
• Family history of primary PH
• History of pulmonary embolism
• Evidence of supine hypertension or hypotension (systolic BP >180 mmHg or <90 mmHg and/or diastolic BP> 100 mmHg or <50 mmHg) pre-dose [NOTE: BP measurements may be repeated twice, at least 10 minutes apart]
• Orthostatic hypotension defined as a drop in systolic BP by >=20 mmHg or diastolic BP of >=10 mmHg at screening or predose or the development of significant postural symptoms (dizziness, lightheadedness, vertigo) when going from the supine to the standing position
• Personal or family history of congenital or acquired methemoglobinemia
• Personal or family history of RBC CYP B5 reductase deficiency
• Personal or family history or any evidence of hemoglobinopathy
• Known or suspected hypersensitivity or allergic reaction to sodium nitrite, sodium nitrate, or saccharin
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency or any contraindication to receiving methylene blue
• History of hypersensitivity or idiosyncratic reaction to drugs from multiple drug classes
• If female, is pregnant or breast feeding, or has a positive pregnancy test result pre-dose

• If a sexually active female, is not surgically sterile (defined as having had a hysterectomy, bilateral oophorectomy, or tubal ligation at least 6 months prior to screening) or post-menopausal (defined as amenorrhea for the past 2 years if <50 years of age or for the past 1 year if <=50 years or, if on hormone replacement therapy [HRT], documented follicle stimulating hormone [FSH] >30 IU/L before starting HRT), or does not agree to utilize two effective methods of contraception consistently and as intended from screening until at least 4 weeks after the last dose of study drug. Subjects must use a barrier method (diaphragm with intravaginal spermicide, cervical cap with intravaginal spermicide, or partner using condoms plus use of intravaginal spermicide) in combination with at least one of the following methods of contraception:

  1. systemic hormonal contraceptive (oral, implant, injection, or patch)
  2. intrauterine device
  3. or male partner who has undergone a vasectomy at least 6 months prior to screening.
• Unless approved by the Sponsor, chronic use of any systemic medications (with the exception of systemic hormonal contraceptives and vitamins taken at standard supplement doses); use of a drug therapy (including herbal preparations, e.g., St. John's wort) known to induce or inhibit hepatic drug metabolism within 30 days before the first dose of study drug (or sildenafil); use of prescription medication within 14 days before administration of study drug (or sildenafil) or over-the-counter [OTC] products (including natural products, vitamins) within 7 days before administration of study drug (or sildenafil). By exception, topical products without systemic absorption will be allowed. (NOTE: in particular, use of any PDE-5 inhibitor [e.g., sildenafil, tadalafil, vardenafil] is prohibited)
• Current history or evidence of drug abuse, history of regular alcohol consumption exceeding 21 drinks/week for men and 14 drinks/week for women (1 drink = 5 ounces [150 mL] of wine or 12 ounces [360 mL] of beer or 1.5 ounces [45 mL] of hard liquor) within 6 months of screening or a positive screen for substances of abuse or alcohol at screening or pre-dose
• Positive screen for hepatitis B surface antigen (HBsAg), hepatitis C antibody, or HIV antibody
• Receipt of an investigational product or device, or participation in a drug research study within a period of 30 days (or 5 half-lives of the drug, whichever is longer) before the first dose of study drug (sildenafil)
• Blood loss or blood donation of >550 mL within 90 days or plasma donation >500 mL within 14 days before administration of study drug (or sildenafil)
• Any food allergy, intolerance, restriction, or special diet that, in the opinion of the Investigator, should preclude the subject's participation in this study

Part B Only:

• Known or suspected hypersensitivity or allergic reaction to sildenafil or other therapeutics of similar chemical structure or any of the components of Revatio® tablets
• Any medical condition that constitutes a contraindication or risk to taking sildenafil, including a history of hereditary degenerative retinal disorders such as retinitis pigmentosa
• Ingestion of grapefruit or grapefruit juice within 72 hours before sildenafil administration