title: Levothyroxine soft capsules demonstrate bioequivalent pharmacokinetic exposure with the European reference tablets in healthy volunteers under fasting conditions.
abstract: OBJECTIVE
  To assess the bioequivalence (BE) potential under fasting conditions between levothyroxine soft capsules and the European reference tablet formulation.
  
  
  METHODS
  Two studies were conducted to assess the BE potential as per European regulations. Study 1 was a two-way crossover BE study comparing a high strength of levothyroxine soft capsules versus levothyroxine tablets (200 μg), while study 2 was a three-way crossover dosage form proportionality study between low, medium, and high strengths of soft capsules. 70 healthy adult subjects participated in the two studies. Each treatment consisted of a 600-μg dose of levothyroxine sodium, administered under fasting conditions. Blood samples were collected for levothyroxine (T4) assay prior to dosing and up to 72 hours post dose. A washout of 35 days separated treatments in each study. Pharmacokinetics was assessed using noncompartmental methods.
  
  
  RESULTS
  A total of 61 subjects completed the studies. Baseline-adjusted total T4 ratios (test/reference) and 90% confidence intervals (CIs) between soft capsules and tablets were within 80.00 - 125.00%. Comparison of the three strengths of soft capsules indicated pharmacokinetic equivalence between them (ratios and 90% CIs were contained within 80.00 - 125.00%). Overall, levothyroxine sodium was well tolerated with all products when given as single oral doses of 600 μg, except for 1 serious adverse event of secondary bacteremia reported in study 2, deemed not to be related to treatment.
  
  
  CONCLUSIONS
  Levothyroxine soft capsules meet BE criteria in terms of systemic exposure when compared to a European reference tablet under fasting conditions in healthy volunteers.
authors.forename: Dina
authors.initials: D
authors.lastname: Al-Numani
authors.forename: Claudia
authors.initials: C
authors.lastname: Scarsi
authors.forename: Murray P
authors.initials: MP
authors.lastname: Ducharme
mesh_terms: D000328:Adult; D002214:Capsules; D018592:Cross-Over Studies; D005215:Fasting / Q000378:metabolism*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D013607:Tablets; D013810:Therapeutic Equivalency; D013974:Thyroxine / Q000009:adverse effects / Q000493:pharmacokinetics*
chemical_list: D002214:Capsules; D013607:Tablets; D013974:Thyroxine