Excipient Impact on Drug Absorption

Overseen by Katherine Yang, PharmD, MPH

Age: 18 - 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase < 1

Recruiting

Sponsor: University of California, San Francisco

Must not be taking: OATP2B1 substrates

Disqualifiers: Extreme obesity, Pregnancy, Liver disease, others

No Placebo Group

Approved in 6 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing if adding sodium lauryl sulfate (SLS) to fexofenadine changes how well the drug works. It looks at people taking fexofenadine and checks drug levels in the blood and stool to see if SLS makes a difference. SLS has been shown to help various substances get into the body better.

Will I have to stop taking my current medications?

Yes, you will need to stop taking any drugs, especially those known as OATP2B1 substrates, except for birth control hormonal medications.

What data supports the effectiveness of the drug Sodium Lauryl Sulfate on drug absorption?

Research shows that Sodium Lauryl Sulfate can enhance the absorption of certain drugs, like cefadroxil, by increasing their passive absorption in the intestines. However, it can also reduce the absorption of other drugs, like ritonavir, in acidic environments due to the formation of poorly soluble salts. ^{1 2 3 4 5}

Is sodium lauryl sulfate (SLS) safe for human use in drug formulations?

Sodium lauryl sulfate (SLS) is commonly used in drug formulations, but it can reduce cell viability and alter the barrier integrity of the gut lining in lab and animal studies. Some research suggests it may be linked to conditions like ulcerative colitis and metabolic disorders, so its safety in humans should be carefully considered. ^{3 5 6 7 8}

How does the drug sodium lauryl sulfate affect drug absorption?

Sodium lauryl sulfate (SLS) is unique because it can enhance the passive absorption of drugs by altering the intestinal membrane's permeability, making it easier for drugs to pass through. This effect is particularly notable when the drug's carrier-mediated transport is saturated, leading to increased absorption rates. ^{2 5 9 10 11}

Research Team

Katherine Yang, PharmD, MPH

Principal Investigator

University of California, San Francisco

Eligibility Criteria

Healthy adults aged 18-64, willing to avoid certain fruit juices and supplements, can join this trial. They must not be extremely obese, allergic to the drug or its components, have low hemoglobin levels, be pregnant/breastfeeding without birth control use, or have liver/kidney/heart diseases.

Inclusion Criteria

Subjects who are willing to avoid ingestion of fruit juices and citrus bioflavonoids, such as grapefruit extract, hesperidin supplement and naringin supplement, for a period extending from one week prior to the initiation of the study until its completion

I am between 18 and 64 years old.

Written informed consent obtained from the subject and ability for subject to comply with the requirements of the study

Exclusion Criteria

I have had gastrointestinal issues or surgery.

Subjects with a condition, disease, or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data

Participating in another research study while participating in this research study

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive fexofenadine with or without sodium lauryl sulfate in a 3-period crossover design

6 weeks

3 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 weeks

Treatment Details

Interventions

• Excipient Effect on Drug Absorption (Other)
• Sodium Lauryl Sulfate ()

Trial Overview The study is testing how a common non-drug ingredient called sodium lauryl sulfate (SLS) affects the absorption of Fexofenadine Hydrochloride. Participants will take the drug with varying amounts of SLS to see if there's any difference in how well their body absorbs it.

Participant Groups

Group I: Fexofenadine without SLS Experimental Treatment 1 Intervention

Participants will be administered by mouth with a capsule containing 120 mg fexofenadine hydrochloride and 101 mg microcrystalline cellulose

Group II: Fexofenadine and 30 mg SLS Experimental Treatment 1 Intervention

Participants will be administered by mouth with a capsule containing 120 mg fexofenadine hydrochloride, 30 mg SLS and 101 mg microcrystalline cellulose

Group III: Fexofenadine and 3 mg SLS Experimental Treatment 1 Intervention

Participants will be administered by mouth with a capsule containing 120 mg fexofenadine hydrochloride, 3 mg SLS and 101 mg microcrystalline cellulose

Excipient Effect on Drug Absorption is already approved in Canada, Japan, China, Switzerland for the following indications:

Approved in Canada as Sodium lauryl sulfate for:

• Approved as a non-medicinal ingredient in various drug products

Approved in Japan as Sodium lauryl sulfate for:

• Approved as an excipient in various medicinal products

Approved in China as Sodium lauryl sulfate for:

• Approved as an excipient in various medicinal products

Approved in Switzerland as Sodium lauryl sulfate for:

• Approved as an excipient in various medicinal products

Who Is Running the Clinical Trial?

University of California, San Francisco

Lead Sponsor

Trials

2,636

Recruited

19,080,000+

Food and Drug Administration (FDA)

Collaborator

Trials

184

Recruited

1,553,000+

Findings from Research

Sodium lauryl sulfate (SLS) significantly enhances the penetration of certain compounds like tritiated water and nickel through human cadaver skin, with a clear dose-effect relationship observed at concentrations of 0.25%, 2%, and 10%.

However, SLS does not affect the penetration of hydrocortisone, indicating that its effects are selective based on the physicochemical properties of the compounds tested.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of sodium lauryl sulfate (SLS) on in vitro percutaneous penetration of water, hydrocortisone and nickel. Frankild, S., Andersen, KE., Nielsen, GD.[2019]

Sodium lauryl sulfate (SLS) acts as a nonspecific inhibitor of the carrier-mediated absorption of cefadroxil, leading to a significant reduction in its absorption capacity at lower concentrations of the antibiotic (0.1 mg/ml).

At higher concentrations of cefadroxil (10.0 mg/ml), SLS enhances the passive absorption of the antibiotic, resulting in improved absorption rates, indicating that the effect of SLS on cefadroxil absorption is concentration-dependent.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experimental studies on the influence of surfactants on intestinal absorption of drugs. Cefadroxil as model drug and sodium lauryl sulfate as model surfactant: studies in rat duodenum. Sancho-Chust, V., Bengochea, M., Fabra-Campos, S., et al.[2013]

Sodium lauryl sulfate (SLS), commonly used to enhance drug dissolution, unexpectedly worsened the dissolution of ritonavir (RTV) in acidic conditions due to the formation of a poorly soluble salt, [RTV2+][LS-]2.

The study found that when SLS concentration is low, it can lead to precipitation of this salt, negatively impacting the bioavailability of RTV, highlighting the need for caution when formulating basic drugs with SLS in acidic environments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mechanism for the Reduced Dissolution of Ritonavir Tablets by Sodium Lauryl Sulfate. Guo, Y., Wang, C., Dun, J., et al.[2020]

A successful tablet formulation was developed for a poorly water-soluble immunosuppressive drug using sodium lauryl sulfate (SDS), achieving good mechanical properties and chemical stability despite challenges with the drug's compressibility and stability.

The drug release rate from the tablet was primarily influenced by the particle size of the drug and was governed by surface erosion of the tablet matrix, indicating that formulation strategies can effectively enhance drug solubility and release.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Design and characterization of a surfactant-enriched tablet formulation for oral delivery of a poorly water-soluble immunosuppressive agent. Ruddy, SB., Matuszewska, BK., Grim, YA., et al.[2019]

Sodium lauryl sulfate significantly enhances the absorption of the antibiotic cefadroxil in the colon, with absorption rates increasing up to 7-fold at higher surfactant concentrations, indicating a strong interaction with the intestinal membrane.

The study suggests that the mechanism behind this increased absorption is related to the surfactant's effect on membrane polarity and its adsorption to the intestinal absorbent membrane, rather than micelle solubilization of the drug.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experimental studies on the influence of surfactants on intestinal absorption of drugs. Cefadroxil as model drug and sodium lauryl sulfate as model surfactant: studies in rat colon. Sancho-Chust, V., Fabra-Campos, S., Gómez-Meseguer, V., et al.[2013]

Surfactants used in oral pharmaceutical products can reduce the viability of intestinal epithelial cells and disrupt barrier integrity, raising concerns about their safety based on in vitro and animal studies.

Some commonly used emulsifiers in oral products may be linked to serious health issues like ulcerative colitis and certain metabolic disorders, indicating a need for careful evaluation of their safety in humans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of surfactant excipients in oral drug formulations. Maher, S., Geoghegan, C., Brayden, DJ.[2023]

Pharmaceutical excipients, which are often thought to be inactive, can actually influence the absorption and metabolism of drugs by interacting with metabolic enzymes and transporters in the gastrointestinal tract.

Variations in excipients between drug formulations can lead to bio-inequivalence, potentially affecting clinical outcomes, especially for drugs classified under the Biopharmaceutics Classification System (BCS).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Pharmaceutical Excipients on Gastrointestinal Tract Metabolic Enzymes and Transporters-an Update. Zhang, W., Li, Y., Zou, P., et al.[2018]

Excipients, even in small amounts, can significantly impact the bioavailability of drugs like risperidone and alendronate, challenging existing regulatory guidelines from the US-FDA and WHO regarding their effects.

The study highlights that waivers for in vivo bioequivalence studies should be approached with caution, as variations in excipient composition can lead to substantial differences in drug absorption, even when amounts are considered 'normal' by regulatory standards.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interactions between active pharmaceutical ingredients and excipients affecting bioavailability: impact on bioequivalence. García-Arieta, A.[2014]

Dioctyl sodium sulfosuccinate significantly enhances the gastrointestinal absorption of phenolsulfonphthalein in rats, with maximum effectiveness observed at its ED50 concentration, likely due to increased intestinal membrane permeability.

In contrast, poloxalene does not enhance drug absorption and can actually decrease it at higher concentrations due to micellar entrapment of the drug, demonstrating that not all surfactants have the same effect on drug absorption.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of surfactants on absorption through membranes III: effects of dioctyl sodium sulfosuccinate and poloxalene on absorption of a poorly absorbable drug, phenolsulfonphthalein, in rats. Malik, SN., Canaham, DH., Gouda, MW.[2019]

Excipients can significantly influence drug absorption, and the Biopharmaceutics Classification System (BCS) has specific guidelines on how much these excipients can change for drugs to qualify for a biowaiver, particularly for BCS Class 1 and 3 compounds.

For BCS Class 1 drugs, changes in excipients are unlikely to affect absorption, while for Class 3 drugs, only a few mechanisms are identified that could impact absorption, suggesting that careful selection and understanding of excipients can help ensure drug efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Potential for pharmaceutical excipients to impact absorption: A mechanistic review for BCS Class 1 and 3 drugs. Flanagan, T.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

Effect of sodium lauryl sulfate (SLS) on in vitro percutaneous penetration of water, hydrocortisone and nickel. [2019]

2. Germany pubmed.ncbi.nlm.nih.gov

Experimental studies on the influence of surfactants on intestinal absorption of drugs. Cefadroxil as model drug and sodium lauryl sulfate as model surfactant: studies in rat duodenum. [2013]

3. United States pubmed.ncbi.nlm.nih.gov

Mechanism for the Reduced Dissolution of Ritonavir Tablets by Sodium Lauryl Sulfate. [2020]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Design and characterization of a surfactant-enriched tablet formulation for oral delivery of a poorly water-soluble immunosuppressive agent. [2019]

5. Germany pubmed.ncbi.nlm.nih.gov

Experimental studies on the influence of surfactants on intestinal absorption of drugs. Cefadroxil as model drug and sodium lauryl sulfate as model surfactant: studies in rat colon. [2013]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Safety of surfactant excipients in oral drug formulations. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

The Effects of Pharmaceutical Excipients on Gastrointestinal Tract Metabolic Enzymes and Transporters-an Update. [2018]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Interactions between active pharmaceutical ingredients and excipients affecting bioavailability: impact on bioequivalence. [2014]

9. United States pubmed.ncbi.nlm.nih.gov

Effect of surfactants on absorption through membranes III: effects of dioctyl sodium sulfosuccinate and poloxalene on absorption of a poorly absorbable drug, phenolsulfonphthalein, in rats. [2019]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Potential for pharmaceutical excipients to impact absorption: A mechanistic review for BCS Class 1 and 3 drugs. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

The Effects of Dose Volume and Excipient Dose on Luminal Concentration and Oral Drug Absorption. [2021]