Impact of Paroxetine, a Strong CYP2D6 Inhibitor, on SPN-812 (Viloxazine Extended-Release) Pharmacokinetics in Healthy Adults

Clin Pharmacol Drug Dev. 2021 Nov;10(11):1365-1374. doi: 10.1002/cpdd.948. Epub 2021 May 4.

Abstract

SPN-812 (viloxazine extended-release) is a novel nonstimulant recently approved as a treatment for attention-deficit/hyperactivity disorder in children and adolescents. Given that SPN-812 is metabolized by CYP2D6 and may be coadministered with CYP2D6 inhibitors, this trial investigated the pharmacokinetics and safety of SPN-812 coadministered with the potent CYP2D6 inhibitor paroxetine. In this single-sequence, 3-treatment period study in healthy volunteers, subjects received a single oral dose of 700 mg SPN-812 alone (period 1), 20 mg daily paroxetine (10 days, period 2), followed by concurrent administration of SPN-812 and paroxetine (period 3). Blood samples were collected for 72 hours post-SPN-812 dosing and analyzed for viloxazine and its primary metabolite, 5-HVLX-gluc. Twenty-two healthy adults were enrolled; all completed the trial. The potential for drug interaction between SPN-812 and paroxetine was assessed using analysis of variance on the log-transformed pharmacokinetic parameters Cmax , AUC0-t , and AUCinf . The least-squares geometric mean ratios for viloxazine were (reported as the ratio of combination/SPN-812 alone) Cmax , 116.04%; 90%CI, 109.49%-122.99%; AUC0-t , 134.65%; 90%CI, 127.65-142.03; and AUCinf , 134.80%; 90%CI, 127.94%-142.03%. CYP2D6 inhibition resulted in a modest change (<35%) on viloxazine AUCs with no change in Cmax . All adverse events were mild in severity.

Keywords: CYP2D6; SPN-812; attention-deficit/hyperactivity disorder; paroxetine; pharmacokinetics; viloxazine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic Uptake Inhibitors / adverse effects
  • Adrenergic Uptake Inhibitors / pharmacokinetics*
  • Adult
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Cytochrome P-450 CYP2D6 Inhibitors / pharmacology*
  • Delayed-Action Preparations
  • Female
  • Healthy Volunteers
  • Humans
  • Male
  • Middle Aged
  • Paroxetine / pharmacology*
  • Viloxazine / adverse effects
  • Viloxazine / pharmacokinetics*

Substances

  • Adrenergic Uptake Inhibitors
  • Cytochrome P-450 CYP2D6 Inhibitors
  • Delayed-Action Preparations
  • Paroxetine
  • Viloxazine