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The primary objective of the study (Main Part 2) was to investigate whether and to which extent a combination of multiple oral doses (steady state conditions) of 75 mg of clopidogrel q.d. (after a loading dose of 300 mg) and multiple doses of 150 mg of dabigatran etexilate b.i.d. at steady state affects pharmacokinetic and pharmacodynamic parameters of dabigatran etexilate and clopidogrel.
The objective of the preceding Pilot Part 1 of the study was to explore the effect of a single dose of 300 mg clopidogrel administered after multiple doses of 75 mg and 150 mg dabigatran had reached steady state, regarding safety as well as pharmacokinetic and pharmacodynamic parameters.
The Main Part 3 of the study moreover was to compare intra-individually the effects of a single dose of 600 mg clopidogrel with the same dose, 600 mg clopidogrel, given additionally to multiple doses of 150 mg dabigatran in steady state condition with respect to safety and pharmacokinetic and pharmacodynamic parameters.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fixed sequence 1 | Experimental | multiple-dose, fixed-sequence with 2 periods of 4 days separated by a washout period of at least 14 days. A single dose of 300 mg clopidogrel will be given on top of 75 mg or 150 mg dabigatran in steady state. |
|
| Crossover | Experimental | clopidogrel + dabigatran / clopidogrel / dabigatran in randomized order |
|
| Fixed sequence 2 | Experimental | intra-individual comparison with the fixed sequence of a single dose of 600mg clopidogrel alone and the combination of dabigatran 150 mg in steady state plus single dose of 600 mg clopidogrel |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clopidogrel | Drug |
| ||
| Dabigatran high dose |
| Measure | Description | Time Frame |
|---|---|---|
| AUCτ,ss (area under the concentration-time curve of the analyte in plasma over one dosing interval at steady state) | for total dabigatran, clopidogrel and the inactive metabolite SR26334 | up to 19 days |
| AUC0-24,1 (area under the concentration-time curve of the analyte in plasma over one dosing interval after the loading dose) | for clopidogrel and the inactive metabolite SR26334 | up to 19 days |
| Cmax,ss (maximum measured concentration of the analyte in plasma at steady state) | for total dabigatran, clopidogrel and the inactive metabolite SR26334 | up to 19 days |
| Cmax,1 (maximum measured concentration of the analyte in plasma after the loading dose) | for total dabigatran, clopidogrel and the inactive metabolite SR26334 | up to 19 days |
| AUECIPA,0-24 (area under the effect curve of inhibition of platelet aggregation after the first dose of clopidogrel) | up to 19 days | |
| Emax,IPA,0-24 (maximum percentage change - compared to baseline - in adenosine diphosphate-induced platelet aggregation after the loading dose of clopidogrel) | baseline, up to 19 days |
| Measure | Description | Time Frame |
|---|---|---|
| tmax (time from dosing to the maximum concentration of the analyte in plasma) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| AUC0-infinity (area under the concentration-time curve of the analyte in plasma over the time interval from 0 extrapolated to infinity) |
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Inclusion Criteria:
Exclusion Criteria:
Any gastrointestinal, hepatic, renal, respiratory, cardiovascular, metabolic, immunological or hormonal disorders
Subjects who in the investigator's judgement are perceived as having an increased risk of bleeding, for example because of:
Relevant surgery of gastrointestinal tract
Diseases of the central nervous system (such as epilepsy) or psychiatric disorders or neurological disorders
History of relevant orthostatic hypotension, fainting spells or blackouts
Chronic or relevant acute infections
History of allergy/hypersensitivity (including drug allergy) which is deemed relevant to the trial as judged by the investigator
Intake of any medication within four weeks of first dosing
Use of drugs which might reasonably influence the results of the trial based on the knowledge at the time of protocol preparation within four weeks prior to administration or during the trial, especially inhibitors or inducers of P-gp, CYP3A4 CYP2C9 or CYP2C19
Intake of medication, which influences the blood clotting, i.e., acetylsalicylic acid, nonsteroidal anti-rheumatic drugs, cumarin etc. within 10 days prior to administration or during the trial
Participation in another trial with an investigational drug within one month prior to administration or during the trial
Alcohol abuse (more than 60 g/day on a regular basis)
Drug abuse
Within 5 days of study medication no intake of grapefruit, grapefruit juice, or products containing grapefruit juice, Seville oranges, garlic supplements, or St. John's Worth
Blood donation (more than 100 mL within four weeks prior to administration)
Excessive physical activities (within one week prior to administration or during the trial)
Any laboratory value outside the reference range that is of clinical relevance
Inability to comply with dietary regimen of study centre
Male subjects do not agree to minimise the risk of female partners becoming pregnant from the first dosing day until 3 months after the completion of the study. Acceptable methods of contraception comprises barrier contraception and a medically accepted contraceptive method for the female partner (intra-uterine device with spermicide, hormonal contraceptive since at least two months)
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| Drug |
|
| Dabigatran low dose | Drug |
|
Clopidogrel and SR 26334 after the loading dose |
| up to 8 weeks |
| AUC0-tz (area under the concentration-time curve of the analyte in plasma from the time point 0 to the last quantifiable analyte plasma concentration) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| λz (terminal rate constant in plasma) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| t1/2 (terminal half-life of the analyte in plasma) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| MRTpo (mean residence time of the analyte in the body after oral administration) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| CL/F (apparent clearance of the analyte in the plasma after extravascular administration) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| Vz/F (apparent volume of distribution during the terminal phase λz following an extravascular dose) | Clopidogrel and SR 26334 after the loading dose | up to 8 weeks |
| Cmax, ss | free dabigatran after multiple dosing | up to 8 weeks |
| AUCτ,ss | free dabigatran after multiple dosing | up to 8 weeks |
| AUC0-tz,ss (area under the concentration-time curve of the analyte in plasma from the time point 0 after the last dose at steady state to the last quantifiable analyte plasma concentration within the uniform dosing interval τ) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| tz,ss (time of last measureable concentration of the analyte in plasma within the dosing interval τ at steady state) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| tmax,ss (time from last dosing to the maximum concentration of the analyte in plasma at steady state on day 4) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| CL/F,ss (apparent clearance of the analyte in the plasma at steady state after extravascular multiple dose administration) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| Cmin,ss (minimum measured concentration of the analyte in plasma at steady state over a uniform dosing interval τ) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| tmin,ss (time from last dosing to the minimum concentration of the analyte in plasma at steady state over a uniform dosing interval τ) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| Cpre,ss (predose concentration of the analyte in plasma at steady state immediately before administration of the next dose) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| MRTpo,ss (mean residence time of the analyte in the body at steady state after oral administration) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| Vz/F,ss (apparent volume of distribution during the terminal phase λz at steady state following an extravascular administration) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| PTF (peak trough fluctuation) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| Cavg (average concentration of the analyte in plasma at steady state over a uniform dosing interval) | Clopidogrel and SR 26334; dabigatran (free and total) after multiple dosing | up to 8 weeks |
| AUECt1-t2 (area under the effect curve (baseline corrected by ratio)) | for activated partial thromboplastin time, thrombin time and ecarin clotting time | up to 8 weeks |
| ERmax (maximum effect ratio) | for activated partial thromboplastin time, thrombin time and ecarin clotting time | up to 8 weeks |
| tmax (time to maximum effect) | for activated partial thromboplastin time, thrombin time and ecarin clotting time | up to 8 weeks |
| Occurence of Adverse Events | up to 13 weeks |
| Assessment of Tolerability by investigator | up to 13 weeks |
| ID | Term |
|---|---|
| D000077144 | Clopidogrel |
| D000069604 | Dabigatran |
| ID | Term |
|---|---|
| D013988 | Ticlopidine |
| D058924 | Thienopyridines |
| D013876 | Thiophenes |
| D013457 | Sulfur Compounds |
| D009930 | Organic Chemicals |
| D011725 | Pyridines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D001562 | Benzimidazoles |
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