title: A new esomeprazole packet (sachet) formulation for suspension: in vitro characteristics and comparative pharmacokinetics versus intact capsules/tablets in healthy volunteers.
abstract: BACKGROUND
  A packet (sachet) formulation of esomeprazole for suspension has been developed for use in patients who have difficulty swallowing.
  
  
  OBJECTIVE
  This article reports the in vitro characteristics of the new esomeprazole formulation, including stability in suspension and suitability for administration orally or via enteral tubes. It also describes the pharmacokinetic profile of the esomeprazole 40-mg packet compared with that of existing solid dosage forms (capsules and tablets) in a clinical bioequivalence study.
  
  
  METHODS
  The stability in suspension of the packet formulation was assessed after reconstitution at various strengths (2.5, 10, and 40 mg) and a different pH (3.4-5.0) in strength-appropriate volumes of water held at temperatures ranging from 5 degrees C to 37 degrees C for up to 60 minutes. Suitability for oral administration was examined in terms of reconstitution time and the actual dose delivered after simulated oral administration, as well as in terms of the actual dose delivered by enteral tubes ranging in diameter from 6 to 20 Fr. Chemical stability and suspension characteristics were also analyzed using alternative reconstitution vehicles (applesauce, apple juice, and orange juice). The comparative pharmacokinetics of the packet, capsule, and tablet formulations of esomeprazole were evaluated in a randomized, open-label, 3-way crossover study in healthy volunteers, who received single 40-mg doses of each formulation. Bioequivalence was assumed if the 90% CIs for the ratios of the geometric mean AUC and CmaX were between 0.80 and 1.25. Reversephase liquid chromatography with ultraviolet detection was used to assess the esomeprazole content and/or degradation products of esomeprazole in the tests for in-suspension stability, dose delivery, and acid resistance. Normal-phase liquid chromatography was used to assess the esomeprazole content of the plasma samples in the bioequivalence study.
  
  
  RESULTS
  At the pH and temperature ranges investigated, the packet formulation was stable for up to 60 minutes after reconstitution. Chemical degradation was low (<0.1%) for all reconstitution vehicles investigated. Reconstitution time was 2 minutes with water and 9 to 10 minutes with apple or orange juice. Dose delivery was >/=98% after simulated oral administration and was generally >/=96% after administration via enteral tubes. Ninety-six healthy volunteers (56 women, 40 men; mean age, 24.9 years; mean weight, 68.9 kg) participated in the randomized, crossover, comparative pharmacokinetic study of the packet and capsule/tablet formulations. The estimated ratios of the geometric mean AUC and C(max) for the packet:capsule and packet: tablet formulations were 0.98 (90% CI, 0.93-1.03) and 0.99 (90% CI, 0.94-1.04), respectively.
  
  
  CONCLUSIONS
  In these analyses, the packet (sachet) formulation of esomeprazole was chemically stable in suspension and when administered orally and via enteral tubes. The formulation had a short reconstitution time, remaining fully dispersed in water for at least 30 minutes, and was dispersed in applesauce, apple juice, or orange juice without compromising its stability or dispersion characteristics. The packet formulation met the regulatory definition for bioequivalence to the tablet and capsule formulations.
authors.affiliation: Pharmaceutical & Analytical R&D, AstraZeneca R&D, Lund, Sweden. nina.bladh@astrazeneca.com
authors.forename: Nina
authors.initials: N
authors.lastname: Bladh
authors.forename: Eva
authors.initials: E
authors.lastname: Blychert
authors.forename: Karin
authors.initials: K
authors.lastname: Johansson
authors.forename: Anna
authors.initials: A
authors.lastname: Backlund
authors.forename: Christina
authors.initials: C
authors.lastname: Lundin
authors.forename: Mohammad
authors.initials: M
authors.lastname: Niazi
authors.forename: Gunilla
authors.initials: G
authors.lastname: Pettersson
authors.forename: Mia
authors.initials: M
authors.lastname: Fjellman
mesh_terms: D000328:Adult; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D002214:Capsules; D018592:Cross-Over Studies; D004355:Drug Stability; D064098:Esomeprazole / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013535:Suspensions; D013607:Tablets; D013810:Therapeutic Equivalency
chemical_list: D000897:Anti-Ulcer Agents; D002214:Capsules; D013535:Suspensions; D013607:Tablets; D064098:Esomeprazole