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This study is aimed to investigate the influence of cenobamate on the activity of CYP3A4/5, CYP2B6, CYP2C19, and CYP2C9 by using drugs recommended by both the FDA and EMA as in vivo probes. In order to avoid a potential pharmacokinetic interaction between the probes, midazolam (CYP3A), warfarin (CYP2C9), and omeprazole (CYP2C19) will be administered together as a validated cocktail and separately from bupropion (CYP2B6) using an adequate washout time period between the 2 assessments.
The starting daily dose of cenobamate will be 12.5 mg, which will be administered for 2 weeks. Then, daily cenobamate doses will be increased every 2 weeks to 25 mg, 50 mg, 100 mg, 150 mg, and 200 mg. The CYP probes will be tested before cenobamate administration, at steady state at 100mg/day of cenobamate for midazolam only and finally at steady state at 200mg/day of cenobamate for all CYP probes.
The results of this DDI study will provide a basis to make appropriate dose recommendation for a safe use of concomitant drugs with cenobamate using these isoenzymes in their metabolic pathway.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single Group | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cenobamate | Drug | 12.5 mg q.d.(Days 13-26), 25 mg q.d. (Days 27-40), 50 mg q.d. (Days 41-54), 100 mg q.d. (Days 55-70), 150 mg q.d. (Days 71-84), 200 mg q.d. (Days 85-110) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pharmacokinetic parameters AUC | Will be determined for S- and R-bupropion, total bupropion, midazolam, S-warfarin and R-warfarin, and omeprazole when administered with and without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters Cmax | Will be determined for S- and R-bupropion, total bupropion, midazolam, S-warfarin and R-warfarin, and omeprazole when administered with and without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Pharmacokinetic parameters AUC | Will be determined for probe drug metabolites (S,S-hydroxybupropion and R,R-hydroxybupropion, threohydrobupropion, 1-hydroxymidazolam, and 5-OH omeprazole) | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters Cmax |
| Measure | Description | Time Frame |
|---|---|---|
| Pharmacokinetic parameters tmax | Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters Ctz |
Inclusion Criteria:
Male or female subjects between 18 to 50 years of age inclusive
Subject is willing and able to provide informed consent
Body mass index (BMI) within 19.0 kg/m2 and 29.9 kg/m2, inclusive, at screening
Subject is a non- or ex-smoker and has not used any nicotine containing products within 6 months prior to screening
Subjects who are considered generally healthy upon completion of medical history, physical examination, vital signs, screening laboratory results and screening ECG in the opinion of the Investigator
Subjects who are willing and able to comply with the dosing/visit schedule, laboratory tests, pharmacokinetic sampling schedule, and other study procedures
A female study subject must meet one of the following criteria:
If of childbearing potential - agrees to use one of the accepted contraceptive regimens from screening, during the study and for at least 30 days after the last dose of the study medication. Hormonal contraceptives alone will not be considered an adequate method of contraception. An acceptable method of contraception includes one of the following:
If a female of non-childbearing potential - should be surgically sterile (i.e. has undergone complete hysterectomy, bilateral oophorectomy, or tubal ligation at least 6 months prior to Screening) or in a menopausal state (at least 1 year without menses), as confirmed by FSH levels (post menopausal must be confirmed by the subject having a serum follicle stimulating hormone greater than 40mIU/ml at screening)
A female study subject must agree not to donate eggs during the study and for at least 30 days after the last dose of the study medication
A male study subject must agree to use one of the accepted contraceptive regimens during the study and for at least 90 days after the last dose of the study medications;
A male study subject must agree not to donate sperm during the study and for at least 90 days after the last dose of the study medication
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Vince and Associates Clinical Research, Inc. | Overland Park | Kansas | 66212 | United States |
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| midazolam | Drug | 2 mg midazolam syrup (Days 7, 69, 105) |
|
| Warfarin Pill | Drug | 5 mg (Days 7 and 105) |
|
| Omeprazole Pill | Drug | 20 mg (Days 7 and 105) |
|
| Bupropion Pill | Drug | 150 mg (Days 1 and 99) |
|
Will be determined for probe drug metabolites (S,S-hydroxybupropion and R,R-hydroxybupropion, threohydrobupropion, 1-hydroxymidazolam, and 5-OH omeprazole) |
| bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters AUC (to infinity) | Will be determined for probe drug metabolites (S,S-hydroxybupropion and R,R-hydroxybupropion, threohydrobupropion, 1-hydroxymidazolam, and 5-OH omeprazole) | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameter RAUC (ratio of metabolite to parent) | Will be determined for 5-OH omeprazole/omeprazole, 1-OH midazolam/midazolam, S,S-OH-bupropion/S-bupropion, R,R-OH-bupropion/R-bupropion, total OH-bupropion/total bupropion, threohydrobupropion/R-bupropion | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state |
| bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters tz | Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters t1/2 | Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters CL/F | Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters Vz/F | Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| Pharmacokinetic parameters Cmin | Will be determined for the probe drugs (and metabolites) when administered with or without cenobamate at steady state | bupropion (6 days), midazolam (24 hrs), omeprazole (24 hrs), warfarin (7 days) |
| ID | Term |
|---|---|
| C000654784 | Cenobamate |
| D008874 | Midazolam |
| D014859 | Warfarin |
| D009853 | Omeprazole |
| D016642 | Bupropion |
| ID | Term |
|---|---|
| D001569 | Benzodiazepines |
| D001552 | Benzazepines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D015110 | 4-Hydroxycoumarins |
| D003374 | Coumarins |
| D001578 | Benzopyrans |
| D011714 | Pyrans |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D053799 | 2-Pyridinylmethylsulfinylbenzimidazoles |
| D013454 | Sulfoxides |
| D013457 | Sulfur Compounds |
| D009930 | Organic Chemicals |
| D011725 | Pyridines |
| D001562 | Benzimidazoles |
| D011427 | Propiophenones |
| D007659 | Ketones |
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