title: Bioavailability and tolerability of combination treatment with revaprazan 200 mg + itopride 150 mg: a randomized crossover study in healthy male Korean volunteers.
abstract: BACKGROUND
  To date, no definitive treatment of functional dyspepsia (FD) has been proven to be effective and reasonably well-tolerated. Proton pump inhibitors (PPIs) combined with prokinetic agents are considered an effective option. Revaprazan is a selective potassium-competitive acid blocker that reversibly inhibits gastric H(+)/K(+)-ATPase and shows effective acid suppression comparable to PPIs. Itopride is a prokinetic agent that has anticholinesterase activity as well as dopamine D(2) receptor antagonistic activity. For this reason, revaprazan and itopride have been prescribed for FD; however, no available studies have reported the pharmacokinetic interactions of these 2 drugs.
  
  
  OBJECTIVE
  The objective of this study was to compare the bioavailability and tolerability of revaprazan and itopride combination therapy to those of equally dosed monotherapies to acquire basic drug-drug interaction information about revaprazan.
  
  
  METHODS
  This multiple-dose, randomized crossover study was conducted in healthy male Korean subjects. Subjects received, in randomized sequence, a 7-day oral dose of revaprazan 200 mg once daily, itopride 50 mg TID, or both. Each treatment period was separated by a 7-day washout period. Blood samples were collected for up to 24 hours following the last dose at steady state, and drug concentrations were determined using validated LC/MS-MS. Pharmacokinetic properties were obtained using noncompartmental analysis. Drug tolerability was assessed throughout the study, using measurements of vital signs, clinical chemistry testing, and interviews.
  
  
  RESULTS
  A total of 30 subjects were enrolled in the study. Among them, 28 subjects completed revaprazan treatment, and 27 completed the study (3 subjects were withdrawn). The geometric mean ratios (GMRs) (90% CI) of C(max,ss), and AUC(τ,ss) with revaprazan were 0.92 (0.84-1.00) and 0.96 (0.89-1.03), respectively. The GMRs of C(max,ss) and AUC(τ,ss) with itopride were 1.07 (0.96-1.20) and 1.12 (1.06-1.18), respectively. A total of 15 adverse events (AEs) were reported in 8 subjects. All AEs were considered to be mild, and there were no clinically significant differences between treatment groups.
  
  
  CONCLUSIONS
  The findings from this study suggest bioequivalence between revaprazan given as monotherapy and in combination with itopride in these healthy Korean male volunteers, with no clinical significant drug-drug interaction. All treatments in this study was generally well tolerated. ClinicalTrials.gov identifier: NCT0133289.
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, Songpa-gu, Seoul, Korea.
authors.forename: Hee Youn
authors.initials: HY
authors.lastname: Choi
authors.forename: Yook-Hwan
authors.initials: YH
authors.lastname: Noh
authors.forename: Seok-Joon
authors.initials: SJ
authors.lastname: Jin
authors.forename: Yo Han
authors.initials: YH
authors.lastname: Kim
authors.forename: Mi-Jo
authors.initials: MJ
authors.lastname: Kim
authors.forename: Hyeryoung
authors.initials: H
authors.lastname: Sung
authors.forename: Seong Bok
authors.initials: SB
authors.lastname: Jang
authors.forename: Sung Jae
authors.initials: SJ
authors.lastname: Lee
authors.forename: Kyun-Seop
authors.initials: KS
authors.lastname: Bae
authors.forename: Hyeong-Seok
authors.initials: HS
authors.lastname: Lim
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001549:Benzamides / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D001593:Benzyl Compounds / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D001682:Biological Availability; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D002853:Chromatography, Liquid; D018592:Cross-Over Studies; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D011744:Pyrimidinones / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D056910:Republic of Korea; D053719:Tandem Mass Spectrometry; D044005:Tetrahydroisoquinolines / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D055815:Young Adult
chemical_list: D001549:Benzamides; D001593:Benzyl Compounds; D002800:Cholinesterase Inhibitors; D054328:Proton Pump Inhibitors; D011744:Pyrimidinones; D044005:Tetrahydroisoquinolines; C108798:YH 1885; C102254:itopride