Premium
Acute passive cigarette smoke exposure and inhaled human insulin (Exubera ® ) pharmacokinetics
Author(s) -
Fountaine Robert,
Milton Ashley,
Checchio Tina,
Wei Greg,
Stolar Marilyn,
Teeter John,
Jaeger Rudolph,
Fryburg David
Publication year - 2008
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2008.03122.x
Subject(s) - pharmacokinetics , cigarette smoke , medicine , pharmacology , smoke , insulin , human insulin , chemistry , environmental health , organic chemistry
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Active cigarette smoking is associated with increased permeability of the pulmonary alveolar epithelium, resulting in faster absorption of inhaled drugs such as Exubera® (EXU). Absorption of EXU is increased approximately twice to four times as much in chronic smokers compared with nonsmokers. • The rate of clearance of radioaerosols such as technetium‐labelled diethylenetriamine penta‐acetic acid is decreased in response to passive smoke exposure. WHAT THIS STUDY ADDS • Passive smoke exposure causes a decrease in lung permeability, an effect opposite to that of active smoking. • Acute passive smoke exposure results in a decrease in EXU bioavailability and does not create a risk of hypoglycaemia. • These results are consistent with previous studies of radioaerosol lung clearance. AIMS Relative to nonsmokers, the bioavailability of inhaled human insulin (Exubera®; EXU) is markedly increased in chronic smokers. The pharmacokinetics of EXU following passive cigarette smoke exposure is unknown. METHODS In an open‐label, crossover study, healthy nonsmoking volunteers received two treatments in randomized sequence separated by a 2‐week wash‐out: (i) EXU 3 mg with no passive smoke exposure and (ii) EXU 3 mg after passive smoke exposure (atmospheric nicotine levels 75–125 μg m −3 ) for 2 h. Blood samples were obtained at prespecified times up to 6 h after EXU administration. RESULTS Twenty‐seven subjects completed both study periods. Mean plasma insulin AUC 0−360 decreased by 17% [ratio 83%, 95% confidence interval (CI) 68.8, 99.5] and mean C max by 29% (ratio 71%, 95% CI 59.8, 83.1) after passive cigarette smoke exposure. The median (range) t max was 60 min (20–120 min) and 75 min (20–360 min) in the EXU with no exposure and EXU passive exposure groups, respectively. EXU was well tolerated. CONCLUSIONS Unlike active chronic smoking, acute passive cigarette smoke exposure modestly decreases EXU bioavailability and thus should not increase hypoglycaemia risk. These results are consistent with those from published literature involving technetium‐labelled diethylenetriamine penta‐acetic acid and suggest that passive cigarette smoke exposure causes an acute decrease in lung permeability vs. active smoking, which causes an increase in permeability.