Tolerability, Safety and Pharmacokinetics of Four Formulations of Ketorolac Tromethamine in Healthy Volunteers

• Maximum Observed Plasma Concentration (Cmax) [ Time Frame: Anytime at pre-dose, 15 minutes, 30 minutes, 45 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 15 hours (ketorolac tromethamine only), and 24 hours (ketorolac tromethamine only) post-dose ] [ Designated as safety issue: No ]
• Area Under the Plasma Concentration-time Profile From Time Zero to the Last Quantifiable Post-dose (AUC 0-t) [ Time Frame: Anytime at pre-dose, 15 minutes, 30 minutes, 45 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 15 hours (ketorolac tromethamine only), and 24 hours (ketorolac tromethamine only) post-dose ] [ Designated as safety issue: No ]
• Area Under the Plasma Concentration-time Profile From Time Zero to Infinity (AUC 0-∞) [ Time Frame: Anytime at pre-dose, 15 minutes, 30 minutes, 45 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 15 hours (ketorolac tromethamine only), and 24 hours (ketorolac tromethamine only) post-dose ] [ Designated as safety issue: No ]

• Maximum observed plasma concentration (Cmax) [ Time Frame: Pre-dose, 15 minutes, 30 minutes, 45 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 15 hours (ketorolac tromethamine only), and 24 hours (ketorolac tromethamine only) post-dose ] [ Designated as safety issue: No ]
• Area under the plasma concentration-time profile from time zero to the last quantifiable post-dose (AUC 0-t) [ Time Frame: Pre-dose, 15 minutes, 30 minutes, 45 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 15 hours (ketorolac tromethamine only), and 24 hours (ketorolac tromethamine only) post-dose ] [ Designated as safety issue: No ]
• Area under the plasma concentration-time profile from time zero to infinity (AUC 0-∞) [ Time Frame: Pre-dose, 15 minutes, 30 minutes, 45 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 15 hours (ketorolac tromethamine only), and 24 hours (ketorolac tromethamine only) post-dose ] [ Designated as safety issue: No ]

This was a phase 1, double-blind, 4-way crossover study in healthy male and female volunteers. Subjects received 4 formulations of intranasal ketorolac tromethamine 30 mg. There was a wash-out period of 3-7 days between each dose. On Day 1 of each period subjects were randomised to receive either a single intranasal dose of 30 mg ketorolac tromethamine alone or single intranasal dose of 30 mg ketorolac tromethamine with 4%, 5% or 6% lidocaine hydrochloride. At the end of the study each subject had received all 4 treatments.

The primary objective of this study in healthy volunteers was to compare the safety, tolerability, and pharmacokinetics of 4 formulations of ketorolac tromethamine. A secondary objective was to monitor lidocaine hydrochloride plasma levels.

• Drug: Ketorolac Tromethamine
  30 mg Ketorolac Tromethamine intranasal (IN)
• Drug: Ketorolac Tromethamine with 4% Lidocaine hydrochloride (HCl)
  30 mg Ketorolac Tromethamine with 4% Lidocaine HCl IN
• Drug: Ketorolac Tromethamine with 5% Lidocaine HCl
  30 mg Ketorolac Tromethamine with 5% Lidocaine HCl IN
• Drug: 30 mg Ketorolac Tromethamine with 6% Lidocaine HCl
  30 mg Ketorolac Tromethamine with 6% Lidocaine HCl IN

• Experimental: Ketorolac Tromethamine
  Intervention: Drug: Ketorolac Tromethamine
• Experimental: Ketorolac Tromethamine with 4% Lidocaine hydrochloride (HCl)
  Intervention: Drug: Ketorolac Tromethamine with 4% Lidocaine hydrochloride (HCl)
• Experimental: Ketorolac Tromethamine with 5% Lidocaine HCl
  Intervention: Drug: Ketorolac Tromethamine with 5% Lidocaine HCl
• Experimental: Ketorolac Tromethamine with 6% Lidocaine HCl
  Intervention: Drug: 30 mg Ketorolac Tromethamine with 6% Lidocaine HCl

Inclusion Criteria:

• Male or female volunteers, aged 18 to 60 years inclusive
• Female subjects of child bearing potential must have had a negative urine pregnancy test prior to entry into the study and must not have been breast feeding
• All female subjects of child bearing potential and all male subjects with female partners of child bearing potential must have consented to use a medically acceptable method of contraception (oral or implanted contraceptive hormones, condom or diaphragm with spermicidal agent, intrauterine device or surgical sterilisation) throughout the study period
• Subject had given signed informed consent
• Subject was within 20% of normal weight for his/her height and body build according to the table of "Desirable Weights for Men and Women" (Metropolitan Life Insurance Co. 1999)
• Subject's medical history was considered normal, with no clinically significant abnormalities
• Subject was considered to be in good health in the opinion of the Investigator as determined by a pre-study physical examination with no clinically significant abnormalities, vital signs within normal range and an ECG with no clinically significant abnormalities
• Subject's pre-study clinical laboratory findings were within normal range or, if outside of the normal range, not deemed clinically significant in the opinion of the Investigator
• Subject had bilateral patent nasal airways at screening as assessed by the Investigator
• Body weight was at least 70 kg

Exclusion Criteria:

• Subject had a clinically significant illness in the 4 weeks before screening
• Use of prescribed medications in the 3 weeks prior to dosing or over-the-counter preparations for 7 days prior to dosing, except paracetamol which was allowed up to 48 hours prior to dosing. However, use of multivitamins and oral contraceptives were permitted
• Subject had a significant history of drug/solvent abuse, or a positive drugs of abuse test at screening
• Subject had history of alcohol abuse or drank in excess of 28 units per week (males) or 21 units per week (females)
• Current tobacco use or a history of smoking within the past 5 years
• Subject was, in the opinion of the Investigator, not suitable to participate in the study
• Subjects who had participated in any clinical study with an investigational drug/device within 3 months prior to the first day of dosing
• Subjects who had a positive result of HIV screen, Hepatitis B screen or Hepatitis C screen
• Subjects with a serious adverse reaction or significant hypersensitivity to any drug
• Subjects who has donated 500 mL or more of blood within the 3 months prior to screening
• Any history of co-existing nasal polyps, NSAID sensitivity and asthma
• Allergic reaction to aspirin or other NSAIDs
• Current upper respiratory tract infection or other respiratory tract condition that could have interfered with the absorption of the nasal spray or with the assessment of AEs
• Any suspicion of rhinitis medicamentosa (chronic daily use of topical decongestants)
• Use of a monoamine oxidase inhibitor in the 14 days prior to study entry
• Active peptic ulcer disease, gastrointestinal bleeding or perforation, or a history of peptic ulcer disease or gastrointestinal bleeding
• Anemia due to unexplained or known gastrointestinal bleeding
• History of asthma or any other chronic pulmonary disorder
• Renal impairment or a risk of renal failure due to volume depletion
• Known sensitivity to lidocaine hydrochloride