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Pgp Transporter and CNS Biodistribution of Ondansetron in Healthy Volunteers

Primary Purpose

Neuropathic Pain

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ondansetron 8mg with Saline & Tariquidar
Ondansetron 16mg with Saline & Tariquidar
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Neuropathic Pain

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age 18-50;
  2. Body mass index between 18.5 and 30;
  3. Good general health with no remarkable medical conditions;
  4. Able and willing to provide informed consent.

Exclusion Criteria:

  1. Current pregnancy or lactation;
  2. Known history of hepatic, renal, or cardiac disease, including Long QT Syndrome, cardiac arrhythmias or QTc interval >450msec;
  3. Known hypertension, endocrine disorders (such as diabetes mellitus), chronic pain, hematologic disorders, or psychiatric conditions requiring medications;
  4. Abnormal vital signs at screening visit, including:

    • HR <40 or >100
    • SBP < 90mmHg or >150mmHg
    • DBP > 100mmHg
  5. Abnormal troponin values at screening visit
  6. Abnormal complete blood count (CBC) or comprehensive metabolic panel (CMP) values at screening visit that could affect drug pharmacokinetics, or suggest undiagnosed medical condition which would increase the risk of complications resulting from this study.
  7. Any contraindication for ondansetron administration;
  8. Peri- or post-menopausal women experiencing symptoms such as hot flashes;
  9. Contraindication to intrathecal catheter placement, such as known coagulopathy or history of clotting disorders, history of scoliosis or lumbar fusion, current infection or fever;
  10. Ongoing use of any of the following medications with known effects on Pgp function: carbamazepine, phenytoin, phenobarbital, cyclosporine, clarithromycin, erythromycin, ritonavir, verapamil, rifampicin, St. John's wort;
  11. Current treatment (or treatment within < 5 half-lives) with any medication, including QT-prolonging drugs and drugs known to have a significant interaction with ondansetron or P-gp substrates (see below:)

    • Antiretrovirals of Protease inhibitor (e.g. Ritonavir, Saquinavir) or Non-nucleoside reverse transcriptase inhibitors (e.g. Efavirenz, Zidovudine) family.
    • Phenytoin, Carbamazepine, Oxcarbazepine, Rifampin
    • Amiodarone
    • Azole antifungals (e.g. Itraconazole, Fluconazole)
    • Macrolide antibiotics (Erythromycin, Clarithromycin)
    • Cimetidine
    • Non-DHP calcium channel blockers Verapamil and Diltiazem
    • First generation antipsychotic medications Thioridazine, Haloperidol, Chlorpromazine, and Pimozide
    • Second generation antipsychotic medications Ziprasidone and Quetiapine
    • Antihistamine Terfenadine
    • Antidepressants Trazodone, Bupropion, monoamine oxidase inhibitors, Mirtazapine
    • Antiarrhythmics Propafenone, Flecainide, and Procainamide
    • Fluoroquinolone antibiotics Norfloxacin, Ofloxacin, and Ciprofloxacin
    • Cisapride
    • Fentanyl, Lithium, Tramadol
    • Intravenous Methylene blue
    • Other strong inhibitors or inducers of Cytochromes P450 2D6 or 3A4.
    • Other strong inhibitors or inducers of P-glycoprotein

Sites / Locations

  • Washington University in St. Louis

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Ondansetron with Tariquidar

Ondansetron with Placebo

Arm Description

The participants will receive an IV ondansetron infusion with tariquidar. Participants will receive either 8mg or 16 mg of iv ondansetron, with 4mg/kg tariguidar.

The participants will receive an IV ondansetron infusion with D5W as placebo. Participants will receive either 8mg or 16 mg of iv ondansetron.

Outcomes

Primary Outcome Measures

CSF penetration of ondansetron with and without tariquidar - area under the curve (AUC)
CSF penetration of intravenous ondansetron will be determined as AUCCSF0-∞ of ondansetron, and compared between the two sessions, with and without tariquidar

Secondary Outcome Measures

Cmax CSF
Maximum CSF concentration (Cmax CSF) of ondansetron, compared between the sessions
CSF:plasma concentration ratio
CSF:plasma concentration ratio of ondansetron, compared between the two sessions
Plasma Cmax
Maximum plasma concentration (Cmax) of ondansetron, compared between the sessions

Full Information

First Posted
January 14, 2019
Last Updated
March 28, 2022
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT03809234
Brief Title
Pgp Transporter and CNS Biodistribution of Ondansetron in Healthy Volunteers
Official Title
Effects of Pgp Transporter Inhibition on CNS Biodistribution of Ondansetron in Healthy Volunteers
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Terminated
Why Stopped
Adverse effects related to study procedure (not study drug)
Study Start Date
May 20, 2019 (Actual)
Primary Completion Date
November 30, 2020 (Actual)
Study Completion Date
November 30, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To determine the time-course of plasma and CSF concentrations of intravenous (IV) ondansetron in healthy subjects, with and without selective inhibition of Pgp efflux transporter.
Detailed Description
The study hypothesis is that inhibition of Pgp efflux transporters will increase the CNS bio-distribution of the 5-HT3R antagonist ondansetron. Specifically: Intravenous administration of ondansetron is expected to yield low CSF exposure. Co-administration of ondansetron with intravenous tariquidar, an inhibitor of Pgp efflux transporters, will result in increased CSF exposure of ondansetron.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neuropathic Pain

7. Study Design

Primary Purpose
Other
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Non-Randomized
Enrollment
14 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ondansetron with Tariquidar
Arm Type
Experimental
Arm Description
The participants will receive an IV ondansetron infusion with tariquidar. Participants will receive either 8mg or 16 mg of iv ondansetron, with 4mg/kg tariguidar.
Arm Title
Ondansetron with Placebo
Arm Type
Placebo Comparator
Arm Description
The participants will receive an IV ondansetron infusion with D5W as placebo. Participants will receive either 8mg or 16 mg of iv ondansetron.
Intervention Type
Drug
Intervention Name(s)
Ondansetron 8mg with Saline & Tariquidar
Intervention Description
Each participant will receive two IV infusions of ondansetron, 24 hours apart. In the first and second sessions, respectively, placebo (D5W) or tariquidar (4mg/kg dose in D5W) 22 will be administered IV over 60 minutes. Ondansetron will be diluted in 50mL 0.9% normal saline, and tariquidar will be diluted in 250mL D5W.
Intervention Type
Drug
Intervention Name(s)
Ondansetron 16mg with Saline & Tariquidar
Intervention Description
Each participant will receive two IV infusions of ondansetron, 24 hours apart. In the first and second sessions, respectively, placebo (D5W) or tariquidar (4mg/kg dose in D5W) 22 will be administered IV over 60 minutes. Ondansetron will be diluted in 50mL 0.9% normal saline, and tariquidar will be diluted in 250mL D5W.
Primary Outcome Measure Information:
Title
CSF penetration of ondansetron with and without tariquidar - area under the curve (AUC)
Description
CSF penetration of intravenous ondansetron will be determined as AUCCSF0-∞ of ondansetron, and compared between the two sessions, with and without tariquidar
Time Frame
48 hours
Secondary Outcome Measure Information:
Title
Cmax CSF
Description
Maximum CSF concentration (Cmax CSF) of ondansetron, compared between the sessions
Time Frame
48 hours
Title
CSF:plasma concentration ratio
Description
CSF:plasma concentration ratio of ondansetron, compared between the two sessions
Time Frame
48 hours
Title
Plasma Cmax
Description
Maximum plasma concentration (Cmax) of ondansetron, compared between the sessions
Time Frame
48 hours
Other Pre-specified Outcome Measures:
Title
Evaluation of analgesic effect of ondansetron in an experimental heat pain model
Description
Comparison of analgesic effect of ondansetron in an experimental heat pain model: HPTT (as Δ°C from baseline) will be compared between the sessions at 30 min and 50 min after ondansetron infusion completion
Time Frame
48 hours
Title
Assessment of analgesic effect of ondansetron in an experimental cold pain model
Description
Comparison of analgesic effect of ondansetron in an experimental cold pain model duration of tolerance and pain rating after 120 second (or maximum tolerable) hand submersion in 3-5°C water will be compared between the sessions at 40 minutes.
Time Frame
48 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age 18-50; Body mass index between 18.5 and 30; Good general health with no remarkable medical conditions; Able and willing to provide informed consent. Exclusion Criteria: Current pregnancy or lactation; Known history of hepatic, renal, or cardiac disease, including Long QT Syndrome, cardiac arrhythmias or QTc interval >450msec; Known hypertension, endocrine disorders (such as diabetes mellitus), chronic pain, hematologic disorders, or psychiatric conditions requiring medications; Abnormal vital signs at screening visit, including: HR <40 or >100 SBP < 90mmHg or >150mmHg DBP > 100mmHg Abnormal troponin values at screening visit Abnormal complete blood count (CBC) or comprehensive metabolic panel (CMP) values at screening visit that could affect drug pharmacokinetics, or suggest undiagnosed medical condition which would increase the risk of complications resulting from this study. Any contraindication for ondansetron administration; Peri- or post-menopausal women experiencing symptoms such as hot flashes; Contraindication to intrathecal catheter placement, such as known coagulopathy or history of clotting disorders, history of scoliosis or lumbar fusion, current infection or fever; Ongoing use of any of the following medications with known effects on Pgp function: carbamazepine, phenytoin, phenobarbital, cyclosporine, clarithromycin, erythromycin, ritonavir, verapamil, rifampicin, St. John's wort; Current treatment (or treatment within < 5 half-lives) with any medication, including QT-prolonging drugs and drugs known to have a significant interaction with ondansetron or P-gp substrates (see below:) Antiretrovirals of Protease inhibitor (e.g. Ritonavir, Saquinavir) or Non-nucleoside reverse transcriptase inhibitors (e.g. Efavirenz, Zidovudine) family. Phenytoin, Carbamazepine, Oxcarbazepine, Rifampin Amiodarone Azole antifungals (e.g. Itraconazole, Fluconazole) Macrolide antibiotics (Erythromycin, Clarithromycin) Cimetidine Non-DHP calcium channel blockers Verapamil and Diltiazem First generation antipsychotic medications Thioridazine, Haloperidol, Chlorpromazine, and Pimozide Second generation antipsychotic medications Ziprasidone and Quetiapine Antihistamine Terfenadine Antidepressants Trazodone, Bupropion, monoamine oxidase inhibitors, Mirtazapine Antiarrhythmics Propafenone, Flecainide, and Procainamide Fluoroquinolone antibiotics Norfloxacin, Ofloxacin, and Ciprofloxacin Cisapride Fentanyl, Lithium, Tramadol Intravenous Methylene blue Other strong inhibitors or inducers of Cytochromes P450 2D6 or 3A4. Other strong inhibitors or inducers of P-glycoprotein
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Simon Haroutounian, PhD
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University in St. Louis
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20849570
Citation
Yawn BP, Wollan PC, Weingarten TN, Watson JC, Hooten WM, Melton LJ 3rd. The prevalence of neuropathic pain: clinical evaluation compared with screening tools in a community population. Pain Med. 2009 Apr;10(3):586-93. doi: 10.1111/j.1526-4637.2009.00588.x. Epub 2009 Mar 17. Erratum In: Pain Med. 2011 Aug;12(8):1294.
Results Reference
background
PubMed Identifier
22395856
Citation
Smith BH, Torrance N. Epidemiology of neuropathic pain and its impact on quality of life. Curr Pain Headache Rep. 2012 Jun;16(3):191-8. doi: 10.1007/s11916-012-0256-0.
Results Reference
background
PubMed Identifier
25575710
Citation
Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpaa M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015 Feb;14(2):162-73. doi: 10.1016/S1474-4422(14)70251-0. Epub 2015 Jan 7.
Results Reference
background
PubMed Identifier
19427839
Citation
Dogrul A, Ossipov MH, Porreca F. Differential mediation of descending pain facilitation and inhibition by spinal 5HT-3 and 5HT-7 receptors. Brain Res. 2009 Jul 14;1280:52-9. doi: 10.1016/j.brainres.2009.05.001. Epub 2009 May 8.
Results Reference
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Pgp Transporter and CNS Biodistribution of Ondansetron in Healthy Volunteers

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