title: Single- and multiple-dose pharmacokinetics of long-acting injectable naltrexone.
abstract: BACKGROUND
  Oral naltrexone is effective in the treatment of alcohol dependence; however, a major limitation of its clinical utility is poor patient adherence to the daily dosing schedule. A biodegradable, long-acting naltrexone microsphere formulation was developed to achieve continuous naltrexone exposure for 1 month in the treatment of alcohol dependence.
  
  
  METHODS
  The single- and multiple-dose safety and pharmacokinetics of a long-acting naltrexone microsphere preparation were evaluated in healthy subjects. One group of subjects (n = 28) received a single dose of oral naltrexone 50 mg followed by a single gluteal intramuscular (IM) injection of long-acting naltrexone 190 or 380 mg or placebo. A different group of subjects (n = 14) received oral naltrexone 50 mg daily for 5 days, followed by IM long-acting naltrexone 380 mg or placebo every 28 days for a total of 4 doses. A 7-day washout period separated oral and IM administrations. Blood samples were collected to determine plasma concentrations of naltrexone and the primary metabolite, 6beta-naltrexol.
  
  
  RESULTS
  After a single IM injection of long-acting naltrexone 380 mg, naltrexone plasma concentrations were measurable in all subjects for at least 31 days postdose. The pharmacokinetics were proportional to the dose and multiple dose observations were consistent with single dose observations. Mean apparent elimination half-lives for naltrexone and 6beta-naltrexol ranged from 5 to 7 days. Exposure to 6beta-naltrexol was reduced with IM injection compared with that oral administration. No serious adverse events occurred.
  
  
  CONCLUSIONS
  This study demonstrated that the long-acting naltrexone formulation was well tolerated, displayed predictable pharmacokinetics, and resulted in no meaningful drug accumulation upon multiple dosing. Intramuscular administration avoids first-pass metabolism and changes the exposure ratio of 6beta-naltrexol to naltrexone compared with oral administration. By providing continuous exposure to naltrexone for several weeks following IM injection, this long-acting naltrexone formulation may offer therapeutic benefit to those patients who experience difficulty adhering to the daily administration schedule necessitated by oral naltrexone therapy.
authors.affiliation: Alkermes Inc, Cambridge, MA 02139, USA. joi.dunbar@alkermes.com
authors.forename: Joi L
authors.initials: JL
authors.lastname: Dunbar
authors.forename: Ryan Z
authors.initials: RZ
authors.lastname: Turncliff
authors.forename: Qunming
authors.initials: Q
authors.lastname: Dong
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Silverman
authors.forename: Elliot W
authors.initials: EW
authors.lastname: Ehrich
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Lasseter
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000427:Alcohol Deterrents; D019540:Area Under Curve; D002851:Chromatography, High Pressure Liquid; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006207:Half-Life; D006801:Humans; D007267:Injections; D019344:Lactic Acid; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives / Q000097:blood / Q000493:pharmacokinetics*; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011108:Polymers; D012727:Sex Characteristics
chemical_list: D000427:Alcohol Deterrents; D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D011108:Polymers; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid; C010410:6 beta-hydroxynaltrexone; D009271:Naltrexone