ORAL VERSUS RECTAL IBUPROFEN IN HEALTHY VOLUNTEERS

Main Article Content

Rolanda Vilenchik
Matitiahu Berkovitch
Azaria Jossifoff
Zvi Ben-Zvi
Eran Kozer

Keywords

Ibuprofen, pharmacokinetics, rectal, oral, adults

Abstract

Objective


Ibuprofen is a safe and effective non steroidal anti-inflammatory drug (NSAID). Ibuprofen suppositories are marketed in Europe; but data regarding pharmacokinetics of rectal vs. oral ibuprofen in humans is scarce. The objective of this study is to compare the pharmacokinetics of single-dose rectal vs. oral ibuprofen in healthy adult volunteers.


 


Methods


Ten healthy adult male volunteers, aged 20-37 years, received in a non-blind, cross-over setting, two formulations of ibuprofen. First, a 400 mg (about 5 mg/kg) of racemic ibuprofen suppository; second (after a three week washout period) the same dosage of ibuprofen syrup. Blood samples were collected before dosing and for 12 hours after administration. Pharmacokinetics analysis was preformed.


 


Results


Mean peak plasma concentration (Cmax) of rectal ibuprofen was considerably lower, and the mean time to peak (Tmax) considerably longer, compared to oral ibuprofen. Absorption of rectal ibuprofen was considerably lower than oral ibuprofen, with a relative bioequivalence of 63%. Rectal ibuprofen reached therapeutic plasma concentration (>10 ?g/ml) 45 minutes after dosing and remained in that range for four hours. The values of Vd/F and CL/F also differ significantly after rectal and oral administration, while no difference was found in the elimination rate constant (Kel) or half-life elimination (t1/2).


 


Conclusions


Racemic ibuprofen suppository has lower bioavailability compared with ibuprofen syrup. Therapeutic plasma concentrations of ibuprofen were reached 45 minutes after dosing and remained in that range for 4 hours. Ibuprofen suppositories can contribute to the management of fever and pain when the oral route is not available.

Abstract 5833 | PDF Downloads 578

References

1. Davies NM. Clinical pharmacokinetics of ibuprofen: the first 30 years. Clin Pharmacokinet 1998;34(2):101-54.
2. Viitanen H, Tuominen N, Vääräniemi H, et al. Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy. Br J Anaest 2003;91(3): 363-7.
3. Maunuksela EL, Ryhanen P, Janhunen L. Efficacy of rectal ibuprofen in controlling postoperative pain in children. Can J Anaesth 1992;39:226-30.
4. Funk CD. Prostaglandins and Leukotrienes: Advances in Eicosanoid Biology. Science 2001;294(5548):1871–5.
5. Lacy CF, Armstrong LL, Goldman MP, et al. Drug Information Handbook. 15th ed. Lexi- Comp 2008:873-6.
6. Rainsford KD. Ibuprofen: A Critical Bibliographic Review. 2nd ed. Loose Leaf, 2009:Chapters 1,3,4,5.
7. Lesko SM, Mitchell AA. An assessment of the safety of pediatric ibuprofen – a practitionerbased randomized clinical trial. JAMA 1995;273(12):929-33.
8. Kokki H, Hendolin H, Maunuksela EL, et al. Ibuprofen in the treatment of postoperative pain in small children. A randomized double-blind placebo controlled group. Acta Anaesthesiol Scand 1994: 38(5):467-72.
9. Brown RD, Wilson JT, Kearns GL, et al. Singledose pharmacokinetics of ibuprofen and acetaminophen in febrile children. J Clin Pharmacol 1992;32:231-41.
10. Owen H, Galvin RJ, Shaw NA. Ibuprofen in the management of postoperative pain. Br J Anaesth 1986;58:1371-5.
11. Perrott DA, Piira T, Goodenough B, et al. Efficacy and safety of acetaminophen vs. ibuprofen for treating children's pain or fever. Arch Pediatr Adolesc Med 2004;158:521-6.
12. Kyllonen M, Olkkola K, Seppala T, et al. Perioperative pharmacokinetics of ibuprofen enantiomers after rectal administration. Pediatric Anest 2005;15:566-73.
13. Anschel J, Lieberman H. Suppositories. In: Lachman and Lieberman. Theory and Practice of Industrial Pharmacy. Lea and Febiger, 1976; Chapter 8.
14. Sharma PK, Garg SK, Narang A. Pharmacokinetics of oral ibuprofen in premature infants. J Clin Pharmacol 2003;43(9):968-73.
15. Lionberger RA. FDA critical path initiatives: opportunities for generic drug development. AAPS J 2008;10(1):103-9.
16. Chen ML, Shah V, Patnaik R, et al. Bioavailability and bioequivalence: an FDA regulatory overview. Pharmaceut Res 2001;18(12):1645-50.
17. Cheng H, Rogers JD, Demetriades JL, et al. Pharmacokinetics and bioinversion of ibuprofen enantiomers in humans. Pharmaceut Res 1994;11(6):824-30.
18. Martin W, Koselowske G, Töberich H, et al. Pharmacokinetics and absolute bioavailability of ibuprofen after oral administration of ibuprofen lysine in man. Biopharm & Drug Disp 1990;11(3):265-78.
19. Brown RD, Wilson JT, Kearns GL, et al. Singledose pharmacokinetics of ibuprofen and acetaminophen in febrile children. J Clin Pharmacol 1992;32:231-41.
20. Nahata MC, Durrell DE, Powell DA, et al. Pharmacokinetics of ibuprofen in febrile children. Eur J Clin Pharmacol 1991;40(4):427- 8.
21. Eller MG, Wright C 3rd, Della-Coletta AA. Absorption kinetics of rectally and orally administered ibuprofen. Biopharm Drug Dispos 1989;10:269-78.
22. American Academy of Pediatrics, Committee on drugs. Alternative Routes of Drug Administration-Advantages and Disadvantages. Pediatrics 1997;100:143-52.
23. Hermann T, Gtowka F, Garrett E. Bioavailability of racemic ibuprofen and its lysinate from suppositories in rabbits. J Pharm Sci 1993;82:1102-11.
24. Kaka J, Asgedom T. Bioavailability of ibuprofen from oral and suppository preparation in rats. Res Comm Chem Pathol Pharmacol 1992;92:172-82.
25. Zhu X, Conklin DR, Eisenach JC. Preoperative inhibition of cyclooxygenase-1 in the spinal cord reduces postoperative pain. Anesth Analg 2005;100(5):1390-3.
26. Bannwarth B, Demotes-Mainard F, Schaeverbeke T, et al. Where are peripheral analgesics acting? Ann Rheum Dis 1993;52(1):1-4.
27. Svensson CI, Yaksh TL. The spinal phospholipase-cyclooxygenase-prostanoid cascade in nociceptive processing. Annu Rev Pharmacol Toxicol 2002;42:553-83.
28. Walson PD, Mortensen ME. Pharmacokinetics of common analgesics, anti-inflammatories and antipyretics in children. Clin Pharmacokinet 17 Suppl 1:1989;116-37.
29. Brown RD, Kearns GL, Wilson JT. Integrated pharmacokinetic-pharmacodynamic model for acetaminophen, ibuprofen, and placebo antipyresis in children. J Pharmacokinet Biopharm 1998;26(5): 559-79.
30. Kelley MT, Walson PD, Edge JH, et al. Pharmacokinetics and pharmacodynamics of ibuprofen isomers and acetaminophen in febrile children. Clin Pharmacol Ther 1992;52(2):181- 9.
31. Kokki H, Kumpulainen E, Lehtonen M et al. Cerebrospinal fluid distribution of ibuprofen after intravenous administration in children. Pediatrics 2007;120(4):1002-8.
32. Laska EM, Sunshine A, Marrero I, et al. The correlation between blood levels of ibuprofen and clinical analgesic response. Clin Pharmacol Ther 1986;40(1):1-7.
33. Goldstein LH, Berlin M, Berkovitch M, et al. Effectiveness of oral vs. rectal acetaminophen: a meta-analysis. Arch Pediatr Adolesc Med 2008;162(11):1042-6.