Effect of grapefruit juice on the pharmacokinetics of tolvaptan, a non-peptide arginine vasopressin antagonist, in healthy subjects.

Shoaf, Susan; Mallikaarjun, Suresh; Bricmont, Patricia

Purpose: Tolvaptan is a selective vasopressin V2 receptor antagonist that can be given orally once daily for treatment of clinically significant hypervolemic and euvolemic hyponatremia (US and Europe) or extracellular volume expansion despite taking other diuretics (Japan). In vitro studies indicated that tolvaptan was a CYP3A4 substrate. Methods: A single-center, randomized, crossover trial of 60-mg tolvaptan with 240 mL of water or with 240 mL of reconstituted grapefruit juice (washout period of 72 h between doses) was conducted in 20 healthy subjects. Blood samples for tolvaptan plasma concentrations were obtained for 48 h postdose. Results: All subjects completed the trial. Following co-administration with grapefruit juice, tolvaptan concentrations were elevated compared with tolvaptan alone for only 16 h postdose; consequently, the mean elimination half-life of tolvaptan was unchanged, 5.7 vs 5.1 h respectively. The mean maximal plasma concentration (C) and the area under the curve (AUC) of tolvaptan were increased 1.86- and 1.56-fold respectively when co-administered with grapefruit juice. Conclusions: It appears that grapefruit juice increases the bioavailability of tolvaptan, but does not affect its systemic elimination. The adverse event profile was consistent with the aquaretic effect of tolvaptan as urinary frequency, thirst, and dry mouth were the most frequently reported events.

ANALYSIS of variance; BIOAVAILABILITY; CONFIDENCE intervals; CROSSOVER trials; DRUG-food interactions; FRUIT juices; GRAPEFRUIT; HETEROCYCLIC compounds; HIGH performance liquid chromatography; HYPONATREMIA; MASS spectrometry; RESEARCH funding; STATISTICAL sampling; VASOPRESSIN; RANDOMIZED controlled trials; DATA analysis software; DESCRIPTIVE statistics; CHEMICAL inhibitors

European Journal of Clinical Pharmacology, 2012, Vol 68, Issue 2, p207

0031-6970

Academic Journal

10.1007/s00228-011-1106-4