Ertugliflozin, a sodium glucose cotransporter‐2 inhibitor, is approved in the United States for treatment of type 2 diabetes mellitus. A novel two‐period study design with 14C microtracer dosing in each period was used to determine absolute oral bioavailability (F) and fraction absorbed (Fa) of ertugliflozin. Eight healthy adult men received 100‐μg i.v. 14C‐ertugliflozin (400 nCi) dose 1 h after a 15‐mg oral unlabeled ertugliflozin dose (period 1), followed by 100 μg 14C‐ertugliflozin orally along with 15 mg oral unlabeled ertugliflozin (period 2). Unlabeled ertugliflozin plasma concentrations were determined using high‐performance liquid‐chromatography tandem mass spectrometry (HPLC‐MS/MS). 14C‐ertugliflozin plasma concentrations were determined using HPLC‐accelerator mass spectrometry (AMS) and 14C urine concentrations were determined using AMS. F ((area under the curve (AUC)p.o./14C‐AUCi.v.)*(14C‐Dosei.v./Dosep.o.)) and Fa ((14C_Total_Urinep.o./14C_Total_Urinei.v.)* (14C‐Dosei.v./14C‐Dosep.o.)) were estimated. Estimates of F and Fa were 105% and 111%, respectively. Oral absorption of ertugliflozin was complete under fasted conditions and F was ∼100%. Ertugliflozin was well tolerated.

Ertugliflozin, an inhibitor of sodium‐glucose cotransporter 2, is approved in the United States and European Union for the treatment of type 2 diabetes in adults, both as monotherapy and as part of fixed‐dose combination (FDC) therapies with either sitagliptin or immediate‐release metformin. The effect of a standard, high‐fat breakfast on the pharmacokinetics of the highest strengths of ertugliflozin monotherapy (15 mg), ertugliflozin/sitagliptin FDC (15‐/100‐mg), and ertugliflozin/metformin FDC (7.5‐/1000‐mg) tablets was evaluated. In 3 separate open‐label, 2‐period, 2‐sequence, single‐dose, crossover studies, 14 healthy subjects per study were randomized to receive either ertugliflozin monotherapy or FDC tablets comprising ertugliflozin and sitagliptin or ertugliflozin and metformin under fasted and fed (or vice versa) conditions. Food did not meaningfully affect the pharmacokinetics of ertugliflozin, sitagliptin, or metformin. For FDCs, the effect of food was consistent with that described for individual components. All treatments were well tolerated. Ertugliflozin and ertugliflozin/sitagliptin FDC tablets can be administered without regard to meals. As metformin is administered with meals because of its gastrointestinal side effects, the ertugliflozin/metformin FDC should also be administered with meals.

Moxidectin is a macrocyclic lactone drug derived from the actinomycete Streptomyces cyanogriseus and is currently being used as a veterinary product for the prevention of canine heartworm disease and for the treatment of internal and external parasites in cattle, sheep, goats, and horses. It is being developed by the World Health Organization (WHO) as a potential macrofilaricidal agent for mass drug administration for the elimination of onchocerciasis (river blindness) in humans caused by the parasitic worm Onchocerca volvulus. Ivermectin (Stromectol; Merck & Co., Inc.) is currently used in mass drug administration programs, but an alternative agent would potentially offer a choice in treatment. Mass drug administration is a process that would call for administration of single doses of medicine, under the supervision of a community health worker, to an entire community at one time.Knowing the extent of excretion of moxidectin into breast milk and the pharmacokinetics of the drug in lactating women will help the community health worker make appropriate decisions about dosing, hence the need for this study. Preclinical studies have shown that the absolute bioavailability of moxidectin is variable, ranging from 19% in rats to 90% in dogs (9). After oral administration, moxidectin is quickly absorbed, with the time to peak plasma concentration (t max ) being 3.7 Ϯ 1.5 h in 27 fasting healthy volunteers receiving an 8-mg dose. Administration of moxidectin with food has been shown to increase the mean peak plasma concentration (C max ) and total area under the concentration-time curve (AUC) by 34% and 39%, respectively (8).The apparent volume of distribution (V z /F) of moxidectin is large (2,000 to 3,500 liters), and moxidectin has a low clearance (CL) (2.37 to 3.50 liters/h) and undergoes very slow elimination, with the terminal-phase elimination half-life (t 1/2 ) being 485 to 842 h (4).A study in lactating dairy sheep showed that after administration of a single oral dose of 200 g/kg of body weight of moxidectin, 2.1% Ϯ 0.33% of the administered dose was excreted in milk for more than 35 days after dosing (7). The ratio of the total AUC curve for moxidectin in breast milk (AUC milk ) to the AUC was 14.3 Ϯ 1.88, indicating that although the total amount of drug that entered the breast milk was small, moxidectin preferentially entered breast milk compared to results for plasma. Similar results were seen in a study in goats (1), where 5.7% Ϯ 1.0% of an orally administered dose of 0.2

The antiparasitic agent moxidectin is under development for the treatment of onchocerciasis. As the first-in-human study of moxidectin used a liquid formulation but other trials used tablets, a study was performed to determine the relative bioavailability of the 2 formulations and to gain more information about the pharmacokinetics of moxidectin. Fifty-eight healthy male participants were randomized to receive open-label moxidectin (10 mg) as a tablet (n = 29) or liquid (n = 29) formulation. The mean ± SD pharmacokinetic parameters observed following administration of the tablet were peak concentration (Cmax) 67.1 ± 27.4 ng/mL, time to peak concentration (tmax) 3.2 ± 1.4 hours, area under the concentration time curve (AUC) 4403 ± 2360 ng·h/mL, apparent volume of distribution 3635 ± 1720 L, oral clearance 2.83 ± 1.25 L/h, and elimination half-life 1032 ± 502 hours. The Cmax and AUC observed following administration of the liquid formulation were 28.6% and 28.8% higher, respectively, and tmax 0.9 hours shorter compared with tablets. No serious adverse events (AEs) were observed. The most commonly reported AEs were headache, infection, diarrhea, asthenia, myalgia, and dizziness during the inpatient phase and flu syndrome, headache, and infection during the 6-month outpatient phase. There was no difference in reporting of these AEs between formulations.

Eighteen adult subjects with mild to moderate hepatic impairment and 18 healthy control subjects were given a single 15-mg dose of sirolimus by oral solution. Mean whole-blood sirolimus weight-normalized oral-dose clearances (CL/F) were significantly decreased (P = .02) in subjects with mild to moderate hepatic impairment by -31.8% and -36.0%, respectively, compared with controls. There were no significant differences in mean sirolimus C(max) and t(max) values among groups. The observed decreases in CL/F may be relevant in renal transplant patients with mild to moderate hepatic impairment, based on the close similarity of sirolimus CL/F in controls and previously studied stable renal transplant patients receiving multiple-dose administration of sirolimus and cyclosporine. There was considerable overlap in the CL/F values of hepatic-impaired subjects and controls, suggesting that whole-blood sirolimus trough concentrations in renal transplant patients exhibiting mild to moderate hepatic impairment be initially monitored to assess the need for dose adjustments.