Nalmefene: Safety and Kinetics After Single and Multiple Oral Doses of a New Opioid Antagonist

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Abstract
The aim of these two studies was to evaluate the safety and pharmacokinetics of oral nalmefene, a new orally effective opioid antagonist. In the first study, single ascending doses of 50, 100, 200, and 300 mg of nalmefene HCl were administered in double‐blind fashion to four groups of healthy men. There were six subjects in each group; four received nalmefene and two received placebo. The drug was well tolerated at all dose levels with only mild and transient side effects, such as lightheadedness, at the higher doses. Model‐independent pharmacokinetic analysis of the plasma concentration‐time dathowed that nalmefene was rapidly absorbed and had an elimination half‐life that ranged from seven to 15 hours (mean, 10.7 hr). There was a good linear relationship (r = .97) between administered dose and total area under the curve at each dose level. Only about 4% of the dose was excreted in the urine as unchanged nalmefene, whereas up to 60% was excreted as a β‐glucuronidase/sulfatase hydrolysable conjugate(s) of nalmefene. In the second study, six healthy men were initially administered a single 50‐mg dose of drug, and plasma samples were obtained at selected time intervals for 48 hours. A dosing schedule of 20 mg q12h was then started and continued for seven days. Plasma samples were collected immediately before each dose and at selected times for up to 48 hours after the last dose. The drug was well tolerated by all subjects, and no clinically significant adverse effects were observed during the seven‐day administration period. In most instances, the steady‐state plasma concentrations could be reasonably predicated from the single dose data and had a moderate accumulation factor (about 1.6). There was no significant difference in the mean half‐life following the first and last dose. Both studies indicate that orally administered nalmefene has a wide margin of safety in healthy men and exhibits a linear pharmacokinetic profile at the doses tested.