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"This study is a single-center, randomized, open-label, 3-period, 5-treatment, 6-sequence design. A total of 54 eligible subjects will receive three total treatments; one with intravenous (IV) infusion and two with the Study System. Each subject will be randomly assigned to receive a treatment sequence consisting of Treatment A (IV fentanyl citrate), Study System Treatment B (170 mcAmp), and one of three additional Study System treatments (140 mcAmp or 200 mcAmp or 230 mcAmp) "
"The Study System is a single-use system that consists of two parts: a Drug Unit containing 10.8 mg fentanyl hydrochloride, and a Controller that supplies the dosing current. The two parts are packaged separately and assembled immediately prior to use. The Study System will be applied to the upper, outer arm of each subject. Fentanyl will be delivered from the Study System via transdermal iontophoresis using a current of 170 mcAmp (Treatment B), 140 mcAmp (Treatment C), 200 mcAmp (Treatment D), or 230 mcAmp (Treatment E). Each subject will be randomly assigned to a treatment sequence consisting of Treatment A (IV fentanyl citrate), Study System Treatment B (170 mcAmp), and one of three additional Study System treatments consisting of Treatment C (140 mcAmp), Treatment D (200 mcAmp), or Treatment E (230 mcAmp). Each subject will therefore receive a total of three treatments (A and B and either C, D, or E).
The specific treatments are outlined in detail below:
Naltrexone (50 mg) will be administered orally (PO) every 12 hours, beginning 14 hours before the start of each fentanyl treatment and ending approximately 11 hours after completion of each treatment "
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fentanyl citrate IV infusion & Naltrexone | Active Comparator | Fentanyl citrate (equivalent to 80 mcg fentanyl)administered over 20 minutes by IV infusion every hour through 23.33 hours. Naltrexone (50 mg) will be administered orally (PO) every 12 hours, beginning 14 hours before the start of fentanyl treatment and ending approximately 11 hours after completion of treatment regimen to antagonize the clinical opioid effects of fentanyl. |
|
| Fentanyl Study System (170 mcAmps) & Naltrexone | Experimental | Two consecutive 40 mcg fentanyl doses each delivered over 10 minutes by the Study System (170 mcAmps) every hour through 23.33 hours. Naltrexone (50 mg) will be administered orally (PO) every 12 hours, beginning 14 hours before the start of fentanyl treatment and ending approximately 11 hours after completion of treatment regimen to antagonize the clinical opioid effects of fentanyl. |
|
| Fentanyl, Study System (140 mcAmp) & Naltrexone | Experimental | Two consecutive 35 mcg fentanyl doses, each delivered over 10 minutes by the Study System (140 mcAmp) every hour through 23.33 hours. Naltrexone (50 mg) will be administered orally (PO) every 12 hours, beginning 14 hours before the start of fentanyl treatment and ending approximately 11 hours after completion of treatment regimen to antagonize the clinical opioid effects of fentanyl. |
|
| Fentanyl, Study System (200 mcAmp) & Naltrexone | Experimental |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fentanyl | Drug |
|
| Measure | Description | Time Frame |
|---|---|---|
| Measure area under the fentanyl concentration-time curve (AUC) | Measure area under the fentanyl concentration-time curve (AUC), one of the five key pharmacokinetic (PK) parameters for the Active, Separated System with PK Controller in the study population. | The two-hour period for hours 23-24 for all treatment groups. |
| Measure maximum fentanyl concentration (Cmax) | Measure maximum fentanyl concentration (Cmax), one of the five key pharmacokinetic (PK) parameters for the Active, Separated System with PK Controller in the study population. | The two-hour period for hours 23-24 for all treatment groups. |
| Measure time to Cmax (tmax) | Measure time to Cmax (tmax), one of the five key pharmacokinetic (PK) parameters for the Active, Separated System with PK Controller in the study population. | The two-hour period for hours 23-24 for all treatment groups. |
| Measure terminal half-life (t½) | Measure terminal half-life (t½), one of the five key pharmacokinetic (PK) parameters for the Active, Separated System with PK Controller in the study population. | The two-hour period for hours 23-24 for all treatment groups. |
| Measure the amount of fentanyl absorbed | Measure the amount of fentanyl absorbed, one of the five key pharmacokinetic (PK) parameters for the Active, Separated System with PK Controller in the study population. | The two-hour period for hours 23-24 for all treatment groups. |
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Inclusion Criteria:
Exclusion Criteria:
Subjects who are pregnant or plan to become pregnant during the time of their participation in this study
Subjects with clinically significant medical problems that, in the opinion of the supervising principal investigator, place the subject at undue risk of AEs. These conditions can include, but are not limited to, dermatologic, psychiatric, respiratory, cardiovascular, hepatic, renal, gastrointestinal, hematological, genitourinary, gynecologic, neurologic, or endocrine or other organ abnormality or pathology.
Subjects with evidence of orthostatic hypotension (e.g., supine-to-standing blood pressure decrease of ≥ 20 mm Hg systolic or ≥ 10 mm Hg diastolic AND ≥ 20 beats per minute (bpm) increase in heart rate after standing for 3 minutes) or with any reported symptoms of lightheadedness, dizziness, or fainting upon standing.
Subjects with resting heart rate < 50 or > 100 beats per minute.
Subjects with a history of chronic obstructive pulmonary disease (COPD) or any other lung disease (e.g., sleep apnea,asthma) that could cause CO2 retention beyond normal.
Subjects with oxygen saturation < 97% on room air.
Subjects with active systemic skin disease or with active local skin disease, such as but not limited to, sunburn, psoriasis, or atopic dermatitis, which would preclude application of the Study System to the upper outer arm.
Subjects with a history of significant dermatologic cancers (e.g., melanoma or squamous cell carcinoma). Basal cell carcinomas that were superficial and do not involve the arms are acceptable.
Subjects with localized skin pigmentation (e.g., tattoos, sunburn, scars, branding, etc.) or open sores, body piercing, active skin lesions on the upper arms that could interfere with the ability to assess skin site reactions.
Subjects with excessive body hair at the intended application site and who refuse hair clipping at the application site
Subjects with a known allergy or hypersensitivity to fentanyl or other opioids, naltrexone, naloxone, cetylpyridinium chloride, skin adhesives, tapes, or other transdermal systems
Subjects who have reported using:
Subjects planning to take prescription, OTC, or herbal medications from Day 0 of the first treatment period to the last study assessment with the exception of sex-hormone replacement, birth control, multivitamins, or acetaminophen (< 2 g/day). NOTE: use of topical medications, including antibiotics and corticosteroids, required to treat skin irritation resulting from application of the Study System is allowed.
Subjects who have received an investigational drug within the longer of: (a) the past 28 days, or (b) a period of five times the drug's half-life.
Subjects with a history or presence of drug or alcohol dependence or abuse.
Subjects who smoke > 10 cigarettes, 2 cigars, or 2 tobacco pipes per day within the last 6 months, as determined by medical history and/or subject's verbal report.
Subjects who are unable to abstain from smoking during the treatment periods.
Subjects who consume alcohol in quantities > 2 alcohol drinks every day, where 1 alcohol drink is defined as 12 ounces of beer, 1 ounce of hard liquor, or 4 ounces of wine.
Subjects who exhibit one or more signs or symptoms of opioid withdrawal due to the naloxone challenge test as determined by the Investigator(s).
Males with hemoglobin < 12.5 g/dL and females with hemoglobin < 11.5 g/dL.
Subjects who have donated blood, experienced a blood loss of > 400 mL within 28 days before dosing, or who plan to donate blood during the study.
Subjects who donated plasma within 7 days prior to dosing, or who plan to donate plasma during the study.
Subjects who are febrile (temperature > 100.3ºF) at check-in for each treatment period.
Subjects who are known to have tested positive for HIV or hepatitis B or hepatitis C.
Employees of the investigator or study center, as well as family members of the employees or the investigator.
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| Name | Affiliation | Role |
|---|---|---|
| Robert I. Cooper, M.D. | PRACS Institute, Ltd. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| PRACS Institute, Ltd. | Fargo | North Dakota | 58104 | United States |
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Two consecutive 50 mcg fentanyl doses, each delivered over 10 minutes by the Study System (200 mcAmp) every hour through 23.33 hours. Naltrexone (50 mg) will be administered orally (PO) every 12 hours, beginning 14 hours before the start of fentanyl treatment and ending approximately 11 hours after completion of treatment regimen to antagonize the clinical opioid effects of fentanyl.
|
| Fentanyl, Study System (230 mcAmp) & Naltrexone | Experimental | Two consecutive 54 mcg fentanyl doses, each delivered over 10 minutes by the Study System (230 mcAmp) every hour through 23.33 hours. Naltrexone (50 mg) will be administered orally (PO) every 12 hours, beginning 14 hours before the start of fentanyl treatment and ending approximately 11 hours after completion of treatment regimen to antagonize the clinical opioid effects of fentanyl. |
|
| Naltrexone | Drug |
|
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D005283 | Fentanyl |
| D009271 | Naltrexone |
| ID | Term |
|---|---|
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D009270 | Naloxone |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |
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