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A study comparing the clinical pharmacokinetics, pharmacodynamics, and tolerability of triamcinolone acetonide HFA-134a metered-dose inhaler and budesonide dry-powder inhaler following inhalation administration.

Abstract
The impending phaseout of chlorofluorocarbons as propellants in pressurized metered-dose inhalers used in the treatment of asthma has resulted in the development of alternative devices to deliver drug to the pulmonary airways. These alternative devices include metered-dose inhalers using environmentally friendly hydroflurocarbon propellants and breath-actuated dry-powder inhalers. The purpose of this study was to compare the single- and multiple-dose pharmacokinetics, pharmacodynamics, and tolerability of a newly developed hydroflurocarbon formulation of triamcinolone acetonide (Azmacort HFA 225 mcg Inhalation Aerosol) to that of the dry-powder formulation of budesonide (Pulmicort Turbuhaler 200 mcg). This three-way crossover study used 18 normal healthy subjects each receiving a 675 mcg dose of triamcinolone acetonide, 600 mcg dose of budesonide, or placebo twice a day for 5 days. Serial plasma samples were collected after the first and last dose of test medication for pharmacokinetic analysis. Pharmacodynamics were assessed by changes in hypothalamic-pituitary-adrenal axis function as measured by 8 a.m. serum cortisol, 24-hour overnight serum cortisol AUC(0-24), and 24-hour urinary-free cortisol after the last evening dose of test drug. Tolerability was assessed through physical examinations, vital signs, 12-lead ECG, routine clinical labs, and adverse events recording. Both compounds were systemically absorbed. However, no significant drug accumulation was noted with chronic dosing. Chronic dosing did result in a statistically significant 20% reduction in basal 24-hour serum cortisol AUC(0-24) for both compounds. There were no clinically significant abnormalities in physical examination, vital signs, 12-lead ECG, or routine clinical labs noted during the study. Overall, the study drugs were well tolerated, with adverse events characterized as mild to moderate in severity.
AuthorsD Argenti, B Shah, D Heald
JournalJournal of clinical pharmacology (J Clin Pharmacol) Vol. 40 Issue 5 Pg. 516-26 (May 2000) ISSN: 0091-2700 [Print] England
PMID10806605 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)
Chemical References
  • Aerosol Propellants
  • Anti-Inflammatory Agents
  • Hydrocarbons, Fluorinated
  • Budesonide
  • Triamcinolone Acetonide
  • apaflurane
  • Hydrocortisone
Topics
  • Administration, Inhalation
  • Adolescent
  • Adult
  • Aerosol Propellants (administration & dosage)
  • Analysis of Variance
  • Anti-Inflammatory Agents (adverse effects, blood, pharmacokinetics)
  • Area Under Curve
  • Blood Pressure (drug effects)
  • Budesonide (adverse effects, blood, pharmacokinetics)
  • Cross-Over Studies
  • Diarrhea (chemically induced)
  • Dizziness (chemically induced)
  • Dose-Response Relationship, Drug
  • Electrocardiography
  • Headache (chemically induced)
  • Humans
  • Hydrocarbons, Fluorinated (administration & dosage)
  • Hydrocortisone (blood, urine)
  • Male
  • Nebulizers and Vaporizers
  • Pulse
  • Triamcinolone Acetonide (adverse effects, blood, pharmacokinetics)

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