title: Mechanism of absorption enhancement in humans after rectal administration of ampicillin in suppositories containing sodium caprate.
abstract: OBJECTIVE
  The medium chain fatty acid sodium caprate (C10) is approved as an absorption enhancer but its mechanism of action has not been studied in humans. The aim of this study was to investigate the mechanism of action of C10 in human subjects after rectal administration.
  
  
  METHODS
  Twelve healthy human subjects were randomised to receive ampicillin suppositories with (AM-C10) or without (AM) C10. Serum and urine samples were collected and analysed for ampicillin by HPLC. Rectal biopsies were taken before and 25 min (approximate time of maximum serum concentration, Cmax, for ampicillin) and 185 min (during the final part of the elimination phase) after rectal administration of the suppositories. The osmolality of the rectal fluid was also measured.
  
  
  RESULTS
  AM-C10 administration increased Cmax, area under the serum concentration-time curve (AUC) and urinary recovery of ampicillin 2.6-, 2.3- and 1.8-fold, respectively, compared to AM. Histological examination of the biopsies showed that AM-C10 exposure resulted in reversible mucosal damage that occurred at the same time as the Cmax for ampicillin while AM prolonged mucosal damage. A reversible increase in rectal fluid osmolality was observed with both treatments.
  
  
  CONCLUSIONS
  AM-C10-enhanced absorption of ampicillin coincides with non-specific damage to the rectal mucosa. C10 itself as well as the suppository base and the hyperosmolality of the rectal fluid contributed to this effect. However, the histological damage was reversible with AM-C10, suggesting that C10 also has a protective effect on the rectal mucosa.
authors.affiliation: Dept. of Pharmacy, Uppsala University, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Lindmark
authors.forename: J D
authors.initials: JD
authors.lastname: Söderholm
authors.forename: G
authors.initials: G
authors.lastname: Olaison
authors.forename: G
authors.initials: G
authors.lastname: Alván
authors.forename: G
authors.initials: G
authors.lastname: Ocklind
authors.forename: P
authors.initials: P
authors.lastname: Artursson
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000493:pharmacokinetics*; D019540:Area Under Curve; D003652:Decanoic Acids; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D008297:Male; D008854:Microscopy, Electron; D009994:Osmolar Concentration; D012007:Rectum / Q000166:cytology / Q000378:metabolism* / Q000648:ultrastructure; D013488:Suppositories
chemical_list: D003652:Decanoic Acids; D013488:Suppositories; C031071:decanoic acid; D000667:Ampicillin