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Healthy VolunteersPhase 1NCT03100838

Drug Interaction With Proton Pump Inhibitors for Nifedipine ER Tablets

A Phase 1 study testing Nifedipine 60 MG Extended Release Oral Tablet, omeprazole/sodium bicarbonate and SmartPill (TM) in people with Healthy Volunteers, run by Food and Drug Administration (FDA) at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to measure the amount of study drug present in blood after being administered a generic version of nifedipine extended-release tablets, 60 mg (Valeant Pharmaceuticals, LLC) and brand-name version PROCARDIA XL extended-release tablets, 60 mg (Pfizer Inc.) individually and in presence of… Read more about this study

Who is it for?
Ages 18 to 55 yearsHealthy volunteers can take part
Conditions the study is for
Healthy Volunteers
What is being tested?
Nifedipine 60 MG Extended Release Oral Tablet, omeprazole/sodium bicarbonate and SmartPill (TM)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
64 participants
Where
1 siteUnited States
Study dates
20 Mar 2017to 6 Apr 2018
Phase
Phase 1
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 55 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Healthy, males and non-pregnant female volunteers, 18 to 55 years of age, inclusive.
  • Smoking status: Only non-tobacco/nicotine users (for at least 6 months prior to the clinical study) will be eligible to participate in this study.
  • BMI that is within 18.5-35.0 kg/m², inclusive.
  • Healthy, according to the medical history, ECG, vital signs, laboratory results and physical examination as determined by the PI/Sub-Investigator.
  • Ability to comprehend and be informed of the nature of the study, as assessed by BPSI staff. Capable of giving written informed consent prior to receiving any study procedure. Must be able to communicate effectively with clinic staff.
  • Ability to fast for at least 14 hours.
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  • Availability to volunteer for the entire study duration and willing to adhere to all protocol requirements.
  • Female subjects must fulfill at least one of the following:
  • Be surgically sterile for a minimum of 6 months;
  • Post-menopausal for a minimum of 1 year;
  • Agree to avoid pregnancy and use medically acceptable method of contraception from at least 30 days prior to the study until 30 days after the study has ended (last study procedure).
  • Medically acceptable methods of contraception include non-hormonal contraceptives, intrauterine device, or double barrier method (condom with foam or vaginal spermicidal suppository, diaphragm with spermicide). Complete abstinence alone can be used as a method of contraception.

Who cannot join

  • Known history or presence of any clinically significant hepatic, renal/genitourinary, gastrointestinal (e.g., gastrointestinal obstruction, gastrointestinal ulcers), cardiovascular (e.g., severe obstructive coronary artery disease, myocardial infarction, angina, heart failure), cerebrovascular, pulmonary, endocrine, immunological, musculoskeletal, neurological, psychiatric, dermatological or hematological disease or condition unless determined as not clinically significant by the PI/Sub-Investigator.
  • Clinically significant history or presence of any clinically significant gastrointestinal pathology (e.g. chronic diarrhea, inflammatory bowel disease), unresolved gastrointestinal symptoms (e.g. diarrhea, vomiting, swallowing disorder), or other conditions known to interfere with the absorption, distribution, metabolism or excretion of the drug experienced within 7 days prior to first dosing, as determined by the PI/Sub-Investigator.
  • QTc interval > 430 milliseconds for males and > 450 milliseconds for females, unless deemed otherwise by the PI/Sub-Investigator.
  • Abnormal clinical laboratory values, unless values are deemed by the PI/Sub-Investigator as "Not Clinically Significant".
  • Hemoglobin values less than 11.5 g/dl.
  • Abnormal vital signs (blood pressure [BP], heart rate [HR], respiratory rate [RR] and temperature) measurements, unless deemed otherwise by the PI/Sub-Investigator.
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  • Presence of any clinically significant illness within 30 days prior to first dosing, as determined by the PI/Sub-Investigator.
  • Presence of any significant physical or organ abnormality as determined by the PI/Sub-Investigator.
  • Individuals who have implanted or portable electro-mechanical medical device such as a cardiac pacemaker, defibrillator or infusion pump.
  • A positive test result for any of the following: HIV, Hepatitis B surface antigen, Hepatitis C, drugs of abuse (marijuana, amphetamines, barbiturates, cocaine, opiates, phencyclidine and benzodiazepines), alcohol test and cotinine. Positive pregnancy test for female subjects.
  • Known history or presence of:
  • Alcohol abuse or dependence within one year prior to first study period;
  • Drug abuse or dependence;
  • Hypersensitivity or idiosyncratic reaction to nifedipine, omeprazole/sodium bicarbonate, its excipients, and/or related substances;
  • Hypotension;
  • Bartter's syndrome;
  • Gastric bezoar;
  • Crohn's disease or diverticulitis;
  • severe dysphagia to food or pills;
  • Food allergies and/or presence of any dietary restrictions;
  • Severe allergic reactions (e.g. anaphylactic reactions, angioedema).
  • History of intolerance to and/or difficulty with blood sampling through venipuncture.
  • Abnormal diet patterns (for any reason) during the four weeks preceding the study, including fasting, high protein diets, vegan, etc.
  • Individuals who have donated, in the days prior to first study period:
  • 50-499 mL of blood in the previous 30 days;
  • 500 mL or more in the previous 56 days.
  • Donation of plasma by plasmapheresis within 7 days prior to first study period.
  • Individuals who have participated in another clinical trial or who received an investigational drug within 30 days prior to first study period.
  • Use of any enzyme-modifying drugs and/or other products, including strong inhibitors of cytochrome P450 (CYP) enzymes (e.g. cimetidine, fluoxetine, quinidine, fluconazole, ketoconazole, voriconazole, itraconazole, clarithromycin, erythromycin, nefazodone, atazanavir, saquinavir, indinavir, and nelfinavir) and strong inducers of CYP enzymes (e.g. barbiturates, carbamazepine, glucocorticoids, phenytoin, St. John´s Wort and rifampin) in the previous 30 days before first study period.
  • Use of drugs such as, proton pump inhibitors, clopidogrel, tacrolimus, digoxin, cyclosporine, disulfiram, benzodiazepines, diazepam, warfarin, methotrexate, iron salts, erlotinib, and mycophenolate mofetil (MMF) in the previous 30 days before first study period, or individuals with vitamin B-12 deficiency (as long-term dosing (more than 3 years) of omeprazole/sodium bicarbonateZegerid may lead to vitamin B-12 deficiency)
  • Individuals having undergone gastrointestinal (GI) surgery within 3 months prior to first study period, unless deemed otherwise by PI/Sub-Investigator.
  • Use of any prescription medication within 14 days prior to first study period (except for contraceptives).
  • Use of any over-the-counter medications (including oral multivitamins, herbal and/or dietary supplements and/or teas) within 14 days prior to first study period (except for spermicidal/barrier contraceptive products).
  • Consumption of food or beverages containing grapefruit and grapefruit juice and/or pomelo within 10 days prior to first study period.
  • Consumption of food or beverages containing caffeine/methylxanthines, poppy seeds and/or alcohol within 48 hours before dosing.
  • Use of diuretics (drugs or food, see Appendix D) within 24 hours before dosing of SmartPillTM.
  • Individuals having undergone any major surgery within 6 months prior to the start of the study, unless deemed otherwise by PI/Sub-Investigator.
  • Difficulty with swallowing whole tablets or large capsules.
  • Have had a tattoo or body piercing within 30 days prior to first study period and during the study.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • BioPharma Services Inc.

    Columbia, Missouri, 65201

Other trials in United States

About this study

Official title: A Single-Dose, Open-label, Randomized, Crossover, Drug-Drug Interaction Study of Nifedipine Extended-release Tablets With or Without Multiple-dose Administration of Proton-Pump Inhibitor Omeprazole/Sodium Bicarbonate in Healthy Volunteers

The purpose of this study is to measure the amount of study drug present in blood after being administered a generic version of nifedipine extended-release tablets, 60 mg (Valeant Pharmaceuticals, LLC) and brand-name version PROCARDIA XL extended-release tablets, 60 mg (Pfizer Inc.) individually and in presence of stomach acid reducing drug (antacid), omeprazole/sodium bicarbonate capsules, 40 mg/1100 mg (generic) on separate occasions, on an empty stomach. This study also involves administrations of an FDA-cleared capsule, SmartPill™, which will measure stomach acid, prior to each study arm.

Read the detailed description

A question that arises with generic oral extended-release (ER) products is related to pH-dependent dissolution kinetics in comparison with that of their reference listed drug (RLD). For example, poorly water-soluble drugs with the presence of pKa in the gastrointestinal (GI) pH range have pH-dependent solubility and dissolution behaviors during in vivo drug release. In this case, the generic product which utilizes a different release mechanism could amplify or reduce such a pH dependence (e.g. osmotic pump RLD vs. matrix generic counterparts). This may render these generic ER products more or less dependent on gastric pH modification, commonly occurred in patients taking concomitant over-the-counter (OTC) proton pump inhibitors (PPIs) for the treatment of gastric acid-related disorders. It has been noted that PPIs (e.g. lansoprazole, omeprazole, esomeprazole) and PPIs with antacids (e.g. omeprazole/sodium bicarbonate) can drastically elevate the gastric pH, thus potentially changing the equilibrium solubility of co-administered drug substances or altering their release profiles.

For instance, nifedipine is a calcium channel blocker, indicated for the long-term treatment of hypertension and angina. The drug substance is a weak acid (pKa 3.9) and practically insoluble in water. Currently, there is one RLD of oral ER nifedipine tablets based on an osmotic pump design (Procardia XL) and a generic counterpart of ER nifedipine tablets employing a matrix formulation design which is different from this RLD product. Due to complicated release mechanisms, quality attribute profiles, and in vivo pharmacokinetics (PK) behaviors of ER products, FDA is assessing the need of a drug-drug interaction study between PPIs/antacids (e.g. omeprazole/sodium bicarbonate) and generic nifedipine ER products based on a formulation design which is different from that of its RLD.

To this end, the objective of this proposal is to investigate the dependence of in vivo PK on the formulation design of generic oral extended-release products in comparison with that of their RLD when co-administered with PPIs/antacids. The outcome of this study will help the Agency advance further understanding about product PK performance in potential patient population with abnormal gastric pH and improve review standards for equivalence of this category of oral ER products if necessary. The study results will help the Agency gain a better understanding of drug-drug interaction between oral modified-release products and PPIs/antacids and establish regulatory standards of bioequivalence approaches for this category of generic oral ER products.

Being tested
Nifedipine 60 MG Extended Release Oral Tablet, omeprazole/sodium bicarbonate, SmartPill (TM)
Keywords
Proton Pump Inhibitor, Bioequivalence, Drug-Drug Interaction, Modified Release, Nifedipine

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Nifedipine 60 MG Extended Release Oral TabletDrug

    Also called Procardia XL

    Reference Drug (Brand)

  • Nifedipine 60 MG Extended Release Oral TabletDrug

    Test Drug (Generic)

  • omeprazole/sodium bicarbonateDrug

    Proton Pump Inhibitor/Antacid for drug-drug interaction

  • SmartPill (TM)Device

    Gastric pH measurement using SmartPill (TM) Technology

Study groups in NCT03100838
Study groupRoleWhat they receive
Nifedipine (Generic)Experimental1 x 60 mg Nifedipine extended-release tablet
Receives: Drug: Nifedipine 60 MG Extended Release Oral Tablet; Device: SmartPill (TM)
Nifedipine (Brand)Active comparator1 x 60 mg PROCARDIA XL (nifedipine) extended-release tablet
Receives: Drug: Nifedipine 60 MG Extended Release Oral Tablet; Device: SmartPill (TM)
Nifedipine (Generic) + PPIActive comparator1 x 40 mg/1100 mg omeprazole/sodium bicarbonate capsule daily over a period of 7 days + 1 x 60 mg Nifedipine extended-release tablet on day 7
Receives: Drug: Nifedipine 60 MG Extended Release Oral Tablet; Drug: omeprazole/sodium bicarbonate; Device: SmartPill (TM)
Nifedipine (brand) + PPIActive comparator1 x 40 mg/1100 mg omeprazole/sodium bicarbonate capsule daily over a period of 7 days + 1 x 60 mg PROCARDIA XL (nifedipine) extended-release tablet on day 7
Receives: Drug: Nifedipine 60 MG Extended Release Oral Tablet; Drug: omeprazole/sodium bicarbonate; Device: SmartPill (TM)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Maximum Plasma Concentration (Cmax)

    Measurement of plasma nifedipine prior to dosing and at times 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 16, 20, 24, 36 and 48 hr after nifedipine administration.

    Measured: 48 hours

  2. Time at Maximum Plasma Concentration (Tmax)

    Measurement of plasma nifedipine prior to dosing and at times 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 16, 20, 24, 36 and 48 hr after nifedipine administration.

    Measured: 48 hours

  3. Area Under the Concentration (AUC 0-t)

    Time curve from time zero to last measurable concentration. Measurement of plasma nifedipine prior to dosing and at times 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 16, 20, 24, 36 and 48 hr after nifedipine administration.

    Measured: 48 hours

  4. Half-life

    The apparent terminal exponential half-life. Measurement of plasma nifedipine prior to dosing and at times 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 16, 20, 24, 36 and 48 hr after nifedipine administration.

    Measured: 48 hours

Secondary outcomes (1)
  1. Adverse Events

    Reported from the start of the first session to the follow-up visit.

    Measured: 66 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Apr 2017
  2. Study start20 Mar 2017
  3. Primary completion23 Dec 2017
  4. Study completion6 Apr 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Other
Allocation
Randomised
Intervention model
Crossover
Model description
A single-dose, randomized, open-label, drug-drug interaction (DDI), 4-way crossover, four-treatment, four-sequence, bioequivalence study
Masking
None (open label)
Enrolment
64 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03100838
Sponsor's protocol ID
RIHSC 16-070D
Status last verified
Aug 2019
First submitted
29 Mar 2017
Last updated
16 Aug 2019
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Undecided: We do not have the plans to share the de-identified IPD at this time.

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Nifedipine 60 MG Extended Release Oral Tablet, omeprazole/sodium bicarbonate and SmartPill (TM) in people with Healthy Volunteers, run by Food and Drug Administration (FDA) at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 39 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Aug 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Jul 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Maximum Plasma Concentration (Cmax) (time frame: 48 hours). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Aug 2019.

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