Pharmacokinetic interaction of chloroquine and methylene blue combination against malaria.
OBJECTIVE
The combination of chloroquine and methylene blue is potentially effective for the treatment of chloroquine-resistant malaria caused by Plasmodium falciparum. The aim of this study was to investigate whether methylene blue influences the pharmacokinetics of chloroquine.


METHODS
In a randomized, placebo-controlled, parallel group design, a 3-day course of therapeutic oral doses of chloroquine (total 2.5 g in male, 1.875 g in female participants) with oral co-administration of placebo or 130 mg methylene blue twice daily for 3 days was administered to 24 healthy individuals. Chloroquine, desethylchloroquine, and methylene blue concentrations were determined by means of HPLC/UV or LC/MS/MS assays in whole blood, plasma, and urine for 28 days after the last dose.


RESULTS
During methylene blue exposure, the area under the chloroquine whole blood concentration-time curve normalized to body weight (AUC(0-24 h)/BW) yielded a trend of reduction (249+/-98.2 h mug l(-1) kg(-1) versus 315+/-65.0 h mug l(-1) kg(-1), P=0.06). The AUC(0-24 h)/BW of desethylchloroquine was reduced by 35% (104+/-40.3 h mug l(-1) kg(-1) versus 159+/-66.6 h mug l(-1) kg(-1), P=0.03), whereas the metabolic ratio between chloroquine and desethylchloroquine remained unchanged (2.25+/-0.49 versus 1.95+/-0.42, P=0.17). The renal clearance of chloroquine and the ratio between chloroquine in whole blood and plasma remained unchanged (P>0.1).


CONCLUSIONS
Oral co-administration of methylene blue appears to result in a small reduction of chloroquine exposure which is not expected to be clinically relevant and thus represents no concern for further development as an anti-malarial combination.
Rengelshausen
Jens
J
Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Burhenne
Jürgen
J
Fröhlich
Margit
M
Tayrouz
Yorki
Y
Singh
Shio Kumar
SK
Riedel
Klaus-Dieter
KD
Müller
Olaf
O
Hoppe-Tichy
Torsten
T
Haefeli
Walter E
WE
Mikus
Gerd
G
Walter-Sack
Ingeborg
I
D000284:Administration, Oral; D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000097:blood / Q000494:pharmacology*; D000962:Antimalarials / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D019540:Area Under Curve; D002738:Chloroquine / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D004347:Drug Interactions; D005260:Female; D006207:Half-Life; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy; D008297:Male; D008751:Methylene Blue / Q000494:pharmacology*
D000892:Anti-Infective Agents, Urinary; D000962:Antimalarials; D002738:Chloroquine; D008751:Methylene Blue; C007278:desethylchloroquine