Effect of Fluconazole, Clarithromycin, and Rifabutin on the Pharmacokinetics of Sulfamethoxazole-Trimethoprim and Dapsone and Their Hydroxylamine Metabolites

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT00000826
First received: November 2, 1999
Last updated: May 1, 2012
Last verified: May 2012
  Purpose

To determine the effects of fluconazole and either rifabutin or clarithromycin, alone and in combination, on the pharmacokinetics of first sulfamethoxazole-trimethoprim and then dapsone in HIV-infected patients.

Although prophylaxis for more than one opportunistic infection is emerging as a common clinical practice in patients with advanced HIV disease, little is known about possible adverse drug interactions. The need exists to define pharmacokinetics and pharmacodynamic adverse interactions of the many combination prophylactic regimens that may be prescribed.


Condition Intervention Phase
Bacterial Infections
Mycoses
HIV Infections
Drug: Clarithromycin
Drug: Rifabutin
Drug: Sulfamethoxazole-Trimethoprim
Drug: Dapsone
Drug: Fluconazole
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Pharmacokinetics Study
Masking: Open Label
Primary Purpose: Treatment
Official Title: Effect of Fluconazole, Clarithromycin, and Rifabutin on the Pharmacokinetics of Sulfamethoxazole and Dapsone and Their Hydroxylamine Metabolites

Resource links provided by NLM:


Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Estimated Enrollment: 48
Study Completion Date: May 1999
Detailed Description:

Although prophylaxis for more than one opportunistic infection is emerging as a common clinical practice in patients with advanced HIV disease, little is known about possible adverse drug interactions. The need exists to define pharmacokinetics and pharmacodynamic adverse interactions of the many combination prophylactic regimens that may be prescribed.

In Part A, patients receive sulfamethoxazole-trimethoprim (SMX/TMP) alone for 2 weeks, then in combination with fluconazole, rifabutin, or both drugs, each over 2-week periods in a randomly assigned order. Patients in Part B receive the same regimens except with clarithromycin substituted for rifabutin. In Part C, patients receive dapsone alone for 2 weeks, then in combination with fluconazole, rifabutin, or both drugs in the same manner as in Part A. Part D patients receive the same regimen as those in Part C, except with clarithromycin substituted for rifabutin. Patients are followed every 2 weeks.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

Concurrent Medication:

Allowed:

  • Antiretroviral therapy provided patient has been on a stable dose for at least 4 weeks prior to study entry.
  • Methadone for drug abuse programs provided patient has been on a stable dose for at least 4 weeks prior to the study.

Patients must have:

  • HIV infection.
  • CD4 count >= 200 cells/mm3.
  • No active opportunistic infection.

Prior Medication:

Allowed:

  • Antiretroviral therapy.
  • Methadone for drug abuse therapy.

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

  • Suspicion of gastrointestinal malabsorption problems (at discretion of investigator).
  • Known hypersensitivity to dapsone, SMX, or other sulfonamides, trimethoprim, clarithromycin, rifabutin or other rifamycins, fluconazole, or other azoles.
  • G-6-PD deficiency or methemoglobinemia (in Part C and D patients only).

Concurrent Medication:

Excluded:

  • Cytolytic agents.
  • Amiodarone.
  • Anesthetics, general.
  • Astemizole.
  • Azithromycin.
  • Barbiturates.
  • Carbamazepine.
  • Cimetidine.
  • Ciprofloxacin.
  • Cisapride.
  • Clarithromycin (except as required on study).
  • Clotrimazole.
  • Dexamethasone.
  • Disulfiram.
  • Erythromycin.
  • Fluoroquinolones.
  • Fluoxetine.
  • Gestodene.
  • Hydrochlorothiazide.
  • Hypoglycemics, oral.
  • Isoniazid.
  • Itraconazole.
  • Ketoconazole.
  • Levomepromazine.
  • Loratadine.
  • MAO inhibitors.
  • Methoxsalen.
  • Miconazole.
  • Nafcillin.
  • Narcotic analgesics.
  • Naringenin.
  • Nifedipine.
  • Norethindrone.
  • Pentazocine.
  • Phenothiazines.
  • Phenytoin.
  • Protease inhibitors.
  • Quinidine.
  • Ranitidine.
  • Rifabutin (except as required on study).
  • Rifampin.
  • Sedative hypnotics.
  • Sulfaphenazole.
  • Terfenadine.
  • Tranquilizers (unless allowed by investigator).
  • Tricyclic and tetracyclic antidepressants.
  • Troleandomycin.
  • Warfarin.

Concurrent Treatment:

Excluded:

  • Radiation therapy.

Prior Medication:

Excluded:

  • Cytolytic agents within 5 years prior to study entry.
  • Rifabutin and/or rifampin within 4 weeks prior to study entry.
  • Fluconazoles or other azoles within 4 weeks prior to study entry.
  • Glutathione, glutathione precursors, or related prodrugs within 2 weeks prior to study entry.

Excluded within 72 hours prior to study entry:

  • Amiodarone.
  • Anesthetics, general.
  • Astemizole.
  • Azithromycin.
  • Cimetidine.
  • Ciprofloxacin.
  • Cisapride.
  • Clarithromycin.
  • Dexamethasone.
  • Disulfiram.
  • Erythromycin.
  • Fluoroquinolones.
  • Fluoxetine.
  • Hydrochlorothiazide.
  • Hypoglycemics, oral.
  • Isoniazid.
  • Levomepromazine.
  • Loratadine.
  • MAO inhibitors.
  • Methoxsalen.
  • Nafcillin.
  • Narcotic analgesics.
  • Naringenin.
  • Nifedipine.
  • Norethindrone.
  • Pentazocine.
  • Phenothiazines.
  • Phenytoin.
  • Protease inhibitors.
  • Quinidine.
  • Ranitidine.
  • Sedative hypnotics.
  • Sulfaphenazole.
  • Terfenadine.
  • Tranquilizers (unless allowed by investigator).
  • Troleandomycin.
  • Warfarin.

Excluded within 4 weeks prior to study entry:

  • Barbiturates.
  • Carbamazepine.
  • Clotrimazole.
  • Gestodene.
  • Itraconazole.
  • Ketoconazole.
  • Miconazole.
  • Omeprazole.
  • Rifabutin.
  • Rifampin.
  • Tricyclic and tetracyclic antidepressants.

Prior Treatment:

Excluded:

  • Blood transfusion within 1 week prior to study entry.
  • Radiation therapy within 5 years prior to study entry.

Active drug or alcohol abuse or dependence that would preclude completion of study.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00000826

Locations
United States, California
Ucsf Aids Crs
San Francisco, California, United States
United States, Washington
University of Washington AIDS CRS
Seattle, Washington, United States, 98122
Sponsors and Collaborators
Investigators
Study Chair: Unadkat J
Study Chair: Trapnell CB
  More Information

Additional Information:
Publications:
Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT00000826     History of Changes
Other Study ID Numbers: ACTG 283, 11259
Study First Received: November 2, 1999
Last Updated: May 1, 2012
Health Authority: United States: Federal Government

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Rifabutin
Trimethoprim-Sulfamethoxazole Combination
AIDS-Related Opportunistic Infections
Dapsone
Drug Interactions
Fluconazole
Acquired Immunodeficiency Syndrome
AIDS-Related Complex
Clarithromycin
Sulfamethoxazole-Trimethoprim

Additional relevant MeSH terms:
Infection
Communicable Diseases
HIV Infections
Acquired Immunodeficiency Syndrome
Bacterial Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Trimethoprim-Sulfamethoxazole Combination
Rifabutin
Trimethoprim
Sulfamethoxazole
Dapsone
Fluconazole
Clarithromycin
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Anti-Infective Agents, Urinary
Renal Agents
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Bacterial Agents

ClinicalTrials.gov processed this record on October 20, 2014