Effect of steady-state enoxacin on single-dose pharmacokinetics of roflumilast and roflumilast N-oxide

J Clin Pharmacol. 2011 Apr;51(4):586-93. doi: 10.1177/0091270010370590. Epub 2010 May 13.

Abstract

Roflumilast is an oral phosphodiesterase 4 (PDE4) inhibitor for the treatment of chronic obstructive pulmonary disease (COPD). It is metabolized by CYP1A2 and CYP3A4 to its primary metabolite, roflumilast N-oxide, through which >90% total PDE4 inhibitory activity (tPDE4i) is mediated. Fluoroquinolones, of which enoxacin is the most potent CYP1A2 inhibitor, are used to treat COPD exacerbations. This phase I, open, nonrandomized, fixed-sequence, 2-period study evaluated the effects of steady-state enoxacin on the single-dose pharmacokinetics of roflumilast and roflumilast N-oxide. Twenty healthy participants received roflumilast, 500 µg once daily, on days 1 and 12, and enoxacin, 400 mg twice daily, on days 7 to 18. Pharmacokinetic profiles were obtained for days 1 to 6 and 12 to 19. The safety and tolerability of all treatments were also assessed. In 19 evaluable participants, coadministration led to 56% higher mean systemic exposure, 20% higher mean peak concentrations, and 36% lower mean apparent oral clearance compared with roflumilast alone. For roflumilast N-oxide, 23% higher mean systemic exposure and 14% lower mean peak concentrations were seen after coadministration. Roflumilast was well tolerated both alone and in combination with enoxacin. A weak interaction was shown between roflumilast and enoxacin, as mean tPDE4i increased by 25%, but is unlikely to have clinical relevance.

Publication types

  • Clinical Trial, Phase I
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aminopyridines / administration & dosage*
  • Aminopyridines / adverse effects
  • Aminopyridines / pharmacokinetics*
  • Benzamides / administration & dosage*
  • Benzamides / adverse effects
  • Benzamides / pharmacokinetics*
  • Cyclopropanes / administration & dosage
  • Cyclopropanes / adverse effects
  • Cyclopropanes / pharmacokinetics
  • Cytochrome P-450 CYP1A2 Inhibitors
  • Cytochrome P-450 CYP3A / metabolism
  • Drug Interactions
  • Enoxacin / administration & dosage*
  • Enoxacin / adverse effects
  • Enoxacin / pharmacokinetics*
  • Female
  • Humans
  • Male
  • Phosphodiesterase 4 Inhibitors / administration & dosage
  • Phosphodiesterase 4 Inhibitors / adverse effects
  • Phosphodiesterase 4 Inhibitors / pharmacokinetics
  • Young Adult

Substances

  • Aminopyridines
  • Benzamides
  • Cyclopropanes
  • Cytochrome P-450 CYP1A2 Inhibitors
  • Phosphodiesterase 4 Inhibitors
  • Roflumilast
  • Enoxacin
  • Cytochrome P-450 CYP3A
  • CYP3A4 protein, human
  • roflumilast N-oxide