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01-11-2018 | Original Research

A Novel Ileocolonic Release Peppermint Oil Capsule for Treatment of Irritable Bowel Syndrome: A Phase I Study in Healthy Volunteers

Authors: Zsa Zsa R. M. Weerts, Daniel Keszthelyi, Lisa Vork, Nic C. P. Aendekerk, Henderik W. Frijlink, Jacobus R. B. J. Brouwers, Cees Neef, Daisy M. A. E. Jonkers, Ad A. M. Masclee

Published in: Advances in Therapy | Issue 11/2018

Abstract

Introduction

Peppermint oil (PO) has been shown to reduce abdominal pain in patients with irritable bowel syndrome (IBS). PO is assumed to induce intestinal smooth muscle relaxation and desensitization of nociceptive nerve afferents. To increase colonic PO concentration, an ileocolonic release peppermint oil (IC-PO) capsule has been developed. The aim of this study was to compare pharmacokinetic parameters of the currently available small intestinal release PO (SI-PO) and the novel IC-PO.

Methods

In this randomized, double-blind, crossover study, subjects received 182 mg of either SI-PO or IC-PO in a crossover design with a washout period of more than 14 days. Blood samples were collected to determine menthol glucuronide concentrations.

Results

Eight healthy volunteers (50% female, median age 22) were included. The time to reach the maximum concentration (T_max) of IC-PO was significantly longer compared to SI-PO with a median (IQR) of 360 (360–405) versus 180 (120–180) min. The lag time (T_lag) was significantly longer with a median (IQR) of 225 (204–284) for IC-PO compared to 37 (6–65) min for SI-PO. The areas under the menthol glucuronide plasma concentration–time curves were significantly smaller with a median (IQR) of 2331 μg h/L (2006–2510) for IC-PO compared to 2623 μg h/L (2471–2920) for SI-PO. No significant differences were found in peak concentrations and elimination half-lives.

Conclusion

IC-PO has a significantly delayed peak menthol glucuronide concentration and T_lag, both pointing to the release of PO in the more distal part of the intestine. This may enhance therapeutic efficacy as it results in increased exposure of colonic mucosal afferents to the PO. A randomized controlled trial investigating the efficacy of SI and IC-PO in IBS is currently ongoing.

Trial registration

ClinicalTrials.gov identifier, NCT02291445, EudraCT database 2014-004195-32.

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Title: A Novel Ileocolonic Release Peppermint Oil Capsule for Treatment of Irritable Bowel Syndrome: A Phase I Study in Healthy Volunteers
Authors: Zsa Zsa R. M. Weerts
Daniel Keszthelyi
Lisa Vork
Nic C. P. Aendekerk
Henderik W. Frijlink
Jacobus R. B. J. Brouwers
Cees Neef
Daisy M. A. E. Jonkers
Ad A. M. Masclee
Publication date: 01-11-2018
Publisher: Springer Healthcare
Published in: Advances in Therapy / Issue 11/2018
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI: https://doi.org/10.1007/s12325-018-0802-1

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