Lack of bioequivalence of gatifloxacin when coadministered with calcium-fortified orange juice in healthy volunteers

J Clin Pharmacol. 2003 Jan;43(1):92-6. doi: 10.1177/0091270002239711.

Abstract

Previous work has demonstrated that the chelation interaction seen with ciprofloxacin when it is coadministered with antacids also happens when it is coadministered with calcium-fortified foods. This study was conducted to study whether this was a drug-specific finding or whether the interaction occurs with other members of the fluoroquinolone class of drugs. Sixteen healthy volunteers received single 400-mg oral doses of gatifloxacin with 12 ounces each of water, nonfortified orange juice, and calcium-fortified orange juice and had plasma samples drawn for assay over the subsequent 48 hours. Results demonstrated significant increases in total oral clearance (15%) and volume of distribution (13%) along with a matching significant decrease (12%) in exposure (AUC) when gatifloxacin was taken with the fortified juice. Although not statistically significant, peak concentrations decreased by 15% and were reached (tmax) approximately 38% later when gatifloxacin was coadministered with the calcium-fortified juice. Bioavailability testing indicated that although the 90% confidence intervals (CIs) for the ratio of the geometric means of the calcium-fortified juice and water arms' AUC stayed within the range of 80% to 125%, those for Cmax did not. This study demonstrated a chelation or adsorption interaction between the fortified juice and gatifloxacin that reached regulatory significance. As a result, clinicians may wish to instruct patients to take gatifloxacin either with nonfortified foods or on an empty stomach.

Publication types

  • Clinical Conference
  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Infective Agents / pharmacokinetics*
  • Beverages*
  • Calcium*
  • Citrus sinensis*
  • Female
  • Fluoroquinolones*
  • Food, Fortified*
  • Food-Drug Interactions*
  • Gatifloxacin
  • Humans
  • Male
  • Therapeutic Equivalency

Substances

  • Anti-Infective Agents
  • Fluoroquinolones
  • Gatifloxacin
  • Calcium