Clinical Pharmacokinetics, Mass Balance and Metabolism of Fezolinetant in Postmenopausal Women.

Background: Tivantinib (ARQ 197), a selective, oral, non-ATP-competitive, small-molecule inhibitor of c-MET receptor tyrosine kinase, is being evaluated in combination with other agents in non-small cell lung cancer, colorectal cancer, and hepatocellular carcinoma (HCC), and as a single-agent in HCC. This study assessed the absorption, distribution, metabolism, and excretion of tivantinib in healthy subjects. Methods: A phase 1, open-label study was conducted in healthy, male, nonsmoking subjects (age, 18 to 45 years; body mass index, 19 to 29 kg/m2). A single 360-mg oral dose of 14C-tivantinib (∼250 αCi) was administered ∼5 min after consumption of a standard high-fat meal. Blood, feces, and urine samples were collected for tivantinib and radioactivity analysis for a maximum of 16 days postdose. Study endpoints included pharmacokinetic parameters associated with total radioactivity in blood and plasma and tivantinib in plasma, mass balance (rate and extent of excretion) of total 14C radioactivity in urine and feces, and adverse events (AEs). Plasma, urine, and fecal samples were also analyzed for metabolite identification. Results: Six subjects (all CYP2C19 extensive metabolizers) participated in this study. Median time to maximal concentration (tmax) for tivantinib in plasma and total radioactivity in plasma and whole blood were 4, 6, and 6 hours, respectively. Mean terminal half-life (t1/2) for tivantinib in plasma and total radioactivity in plasma and whole blood were 11.7, 20.7, and 13.6 hours, respectively. Based on area under the curve (AUC), tivantinib constituted ∼12% of total radioactivity in plasma, indicating the existence of substantial amounts of circulating tivantinib metabolite(s). Eight tivantinib metabolites were identified in plasma, and 4 were considered major metabolites based on their relative plasma exposure. The mean whole blood to plasma AUCinf ratio (AUCb:AUCp) was 0.609, indicating that most of the total radioactivity resided in plasma and was not highly associated with red blood cells. Mean ± SD recovery of radioactivity in feces and urine was 87.2% (feces = 68.2% ± 3.80%; urine = 19.0% ± 2.42%). Parent tivantinib was not detected in urine and trace amounts were detected in feces. Urinary and fecal metabolites were oxidative and subsequently conjugated molecules. Three subjects (50%) experienced 12 treatment-emergent adverse events; were mild in severity and none resulted in treatment discontinuation. Conclusions: Tivantinib was rapidly absorbed and metabolized after oral administration, and 87% of total radioactivity was recovered in urine and feces. Parent tivantinib was not detected in urine and only trace amounts were detected in feces. The fact that all the urinary and fecal metabolites are oxidative and subsequent conjugated molecules suggests near complete absorption of tivantinib when administered under fed conditions. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 747. doi:1538-7445.AM2012-747

Objective: Ocedurenone is a novel nonsteroidal mineralocorticoid receptor antagonist under development for the treatment of uncontrolled/resistant hypertension in patients with advanced chronic kidney disease. A phase 1, open-label study was conducted to determine absorption, metabolism, and excretion of 14 C labeled Ocedurenone following a single oral dose in healthy male subjects. Methods: A total of seven healthy subjects between 18 and 55 years of age with a body mass index between 18.0 and 32.0 kg/m 2 were selected and received a single oral dose ocedurenone (5 mg, 100 μCi of [ 14 C]-ocedurenone). Blood, urine and feces samples were collected for determination of ocedurenone in plasma, total radioactivity in whole blood and plasma, and metabolite profiling and identification. Results: Fecal excretion was the predominant route and mean cumulative percent of total radioactivity eliminated via feces was 84.2% (4.23 of 5). Urine excretion was the minor route, only 6.91% (0.347 of 5) of total radioactivity was collected. Ocedurenone geometric mean Cmax, AUC0-tlast and AUC0-∞ were 92.7 ng/mL, 6510 h*ng/mL and 6560 h*ng/mL, respectively. The geometric mean Cmax of total radioactivity in plasma and whole blood was 123 and 71.5 ngEq/g, respectively. The geometric mean AUC0-tlast and AUC0-∞ of total radioactivity in plasma and whole blood were 9660 and 9910 h*ngEq/g and 5240 and 5570 h*ngEq/g, respectively. Mean whole blood/plasma ratio for total radioactivity was 0.562 for AUC0-∞, indicating little association of radioactivity with red blood cells. In addition to parent drug, 12 metabolites were detected in various matrices. Unchanged ocedurenone was major circulating entities, oxidation and dehydrogenation were the major metabolic pathways. One subject experienced 1 mild adverse event. No serious adverse event and all events resolved without intervention. Conclusion: Ocedurenone appears to be safe and well-tolerated after single oral 0.5 mg dose in humans. The primary route of elimination was fecal after steadily absorbed and extensively metabolized primarily through oxidation and dehydrogenation.

ABSTRACTEcopipam is a dopamine‐1 (D1) receptor antagonist in development for Tourette syndrome. In vitro data showed that ecopipam is metabolized to ecopipam glucuronide through uridine diphosphate‐glucuronosyltransferase 1A9 and to EBS‐101‐40853 (previously called N‐desmethylecopipam or SCH 40853) through cytochrome P450 3A4. This open‐label, non‐randomized, mass balance study investigated metabolism and elimination pathways of ecopipam. A single oral dose of ecopipam 179.2 mg containing 88.5 μCi (3.27 MBq) of [14C]‐labeled ecopipam was administered to 8 healthy males. Total radioactivity, ecopipam, and ecopipam metabolite concentrations were measured in blood, plasma, urine, and feces periodically until discharge (between Days 8 and 15 postdose). Pooled plasma was used to identify and quantify unknown metabolites. Overall, 83.3% of radioactivity was recovered in urine as metabolites (< 1% as ecopipam), and 8.27% was excreted in feces (6.43% as ecopipam). Ecopipam glucuronide accounted for 80.0% of radioactivity in plasma and 66.9% of radioactivity in urine. EBS‐101‐40853 accounted for 10.5% of the plasma AUC∞ for ecopipam. Geometric mean half‐lives of ecopipam, EBS‐101‐40853, and total radioactivity in plasma were 17.3, 25.6, and 94.1 h, respectively. Uncharacterized metabolites P3 and P5, ‘corrected’ for extraction efficiency, had plasma half‐lives (97.4 and 122 h, respectively) similar to total radioactivity. Unknown P3, P4, and P5 metabolites accounted for 4.62%, 0.243%, and 6.03%, respectively, of plasma radioactivity. Ecopipam is primarily metabolized to ecopipam glucuronide, with only 10.5% metabolized to EBS‐101‐40853. The long half‐life of plasma radioactivity was attributed to previously uncharacterized metabolites that each accounted for < 10% of radioactivity and were considered not clinically relevant.

The objectives of this study were to characterize the concentration‐time profiles of total radioactivity equivalent and unchanged cefiderocol, the route(s) of elimination and mass balance, and safety of cefiderocol after intravenous administration of a single 1000‐mg (100 μCi) dose of [14C]‐cefiderocol as a 1‐hour infusion in healthy adult male subjects. Unchanged cefiderocol accounted for the majority of total radioactivity in plasma, and the partitioning of total radioactivity into red blood cells was negligible. The recovery of total radioactivity was complete in all subjects within 120 hours after initiation of the infusion (101.5% of the administered dose). Cefiderocol‐related material was primarily excreted into urine, with 98.7% of the administered dose of [14C]‐cefiderocol excreted as total radioactivity into urine and negligible excretion into feces. Based on the results of metabolite profiling, cefiderocol accounted for 92.3% of area under the concentration‐time curve of total radioactivity in plasma and accounted for 90.6% of the administered dose excreted into urine. Metabolism was a minor route of elimination for cefiderocol. Cefiderocol was generally safe and well tolerated in healthy adult male subjects. In conclusion, unchanged cefiderocol represents the majority of total radioactivity in plasma. Cefiderocol is primarily excreted as unchanged drug into urine. This study indicates that cefiderocol and drug‐related material did not remain in the body.

Objectives: To characterize the primary routes of elimination of the second-generation, oral, irreversible, pan-HER tyrosine kinase inhibitor, PF299804; to evaluate the pharmacokinetics (PK) of total radioactivity and of PF299804; and to identify the metabolites of PF299804 in plasma, urine, and feces in healthy volunteers (HVs). Methods: This Phase 1 study evaluated the mass balance and PK of PF299804 in HVs (18-55 yrs), following a single 45-mg oral dose containing ∼100 µCi [14C] PF299804. Serial samples were collected over an 18-day period. Radioactivity measurements of blood, plasma, urine, and feces were conducted by liquid scintillation spectroscopy. Plasma samples were analyzed for PF299804 and the metabolite PF5199265 using high-performance liquid chromatography with atmospheric pressure ionization tandem mass spectrometry. Plasma, urine, and fecal samples were analyzed for metabolic profiling of PF299804; major metabolites of PF299804 were identified where possible. Results: 6 HVs (male; median age 31.5 yrs) received treatment and were evaluated for PK and safety. 78.8% of the radiolabeled material was excreted in feces, and a further 3.2% was recovered in urine. Peak concentrations of PF299804 in plasma generally occurred 12 hrs after oral dosing, and 6 hrs post-dose for PF5199265. Plasma exposure for the metabolite was approximately one-third of that for the parent compound. Terminal plasma half-life (t1/2) averaged about 55 hrs for PF299804 and 73 hrs for PF5199265. Peak concentrations of total radioactivity in plasma occurred at 12 hrs. Geometric mean Cmax was approximately 2-fold higher and total exposure (AUCinf) was almost 6-fold higher for total radioactivity than for PF299804 in plasma. t1/2 for plasma radioactivity was 182 hrs. PF299804 and its O-desmethyl metabolite, PF5199265, were the major drug-related components in plasma. Other trace components were observed in the profile. The most abundant drug-related components identified in excreta were proposed to be PF299804, PF5199265, a cysteine conjugate (M2), and a mono-oxygenated metabolite (M7). There were no serious adverse events (AEs), severe AEs, or deaths during the study. Mild AEs were reported in 2 HVs: dermatitis acneiform, dizziness, insomnia, and photophobia (all considered related to study drug). Conclusions: Following single-dose administration of [14C] PF299804 the radiolabeled material was primarily eliminated in feces (78.8%) and, to a lesser degree, in urine (3.2%). Estimates of exposure for total radioactivity in plasma (Cmax and AUCinf) were 2- and 6-fold higher, respectively, than exposure for plasma PF299804, indicating the presence of circulating metabolic product(s). The metabolic profiles indicated that [14C] PF299804 underwent oxidative and conjugative metabolism in HVs. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1291. doi:10.1158/1538-7445.AM2011-1291

Absorption, distribution, metabolism, excretion and mass balance of ainuovirine, a non-nucleoside reverse transcriptase inhibitor in humans.

Avibactam, a novel non-β-lactam β-lactamase inhibitor with activity against Ambler class A, class C, and some class D enzymes is being evaluated in combination with various β-lactam antibiotics to treat serious bacterial infections. The in vivo mass balance recovery and metabolite profile of [(14)C] avibactam (500 mg/1-h infusion) was assessed in six healthy male subjects, and a series of in vitro experiments evaluated the metabolism and drug-drug interaction potential of avibactam. In the mass balance study, measurement of plasma avibactam (using a validated liquid chromatography-tandem mass spectrometry method) and total radioactivity in plasma, whole blood, urine, and feces (using liquid scintillation counting) indicated that most of the avibactam was excreted unchanged in urine within 12 hours, with recovery complete (>97% of the administered dose) within 96 hours. Geometric mean avibactam renal clearance (158 ml/min) was greater than the product of unbound fraction of drug and glomerular filtration rate (109.5 ml/min), suggesting that active tubular secretion accounted for some renal elimination. There was no evidence of metabolism in plasma and urine, with unchanged avibactam the major component in both matrices. Avibactam demonstrated in vitro substrate potential for organic anion transporters 1 and 3 (OAT1 and OAT3) proteins expressed in human embryonic kidney 293 cells (Km > 1000 μM; >10-fold the Cmax of a therapeutic dose), which could account for the active tubular secretion observed in vivo. Avibactam uptake by OAT1 and OAT3 was inhibited by probenecid, a potent OAT1/OAT3 inhibitor. Avibactam did not interact with various other membrane transport proteins or cytochrome P450 enzymes in vitro, suggesting it has limited propensity for drug-drug interactions involving cytochrome P450 enzymes.

To relate the disposition kinetics of 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] to its function, we injected a physiological dose of radiolabeled 1,25-(OH)2D3 (84.6 pmol) into the wing veins of vitamin D-deficient chicks. The concentration of calcium-binding protein in duodenal mucosal cytosol, the concentration of 1,25-(OH)2D3 in plasma and duodenal mucosa, and the total radioactivity in bone, kidney, liver, muscle, pancreas, spleen, plasma, and duodenal mucosa were determined in individual chicks from 1–72 h later. The uptake of 1,25-(OH)2D3 by the duodenal mucosa occurred quickly, reaching a peak concentration of 6.2 pmol/g wet wt at 3 h. This was followed by a rapid disappearance, the kinetics of which paralleled the terminal phase of plasma 1,25-(OH)2D3 disappearance. Intact 1,25-(OH)2D3 accounted for more than 75% of the total radioactivity in the duodenal mucosa for at least 36 h, but fell to 30% of the total radioactivity in plasma by 8 h. An unidentified metabolite which cochromatographed with 1,24...

Furmonertinib was designed for the treatment of non-small cell lung cancer (NSCLC) patients with EGFR T790M mutation. In this study, we investigated the metabolic disposition and mass balance in humans and tissue distribution in rats. After a single oral administration of 97.9 μCi/81.5 mg [14C]-furmonertinib mesylate to six healthy male volunteers, the absorption process of furmonertinib was fast with a tmax of total plasma radioactivity at 0.75 h. Afterward, furmonertinib was extensively metabolized, with the parent drug and active metabolite AST5902 accounting for 1.68% and 0.97% of total radioactivity in plasma. The terminal t1/2 of total radioactivity in plasma was as long as 333 h, suggesting that the covalent binding of drug-related substances to plasma proteins was irreversible to a great extent. The most abundant metabolites identified in feces were desmethyl metabolite (AST5902), cysteine conjugate (M19), and parent drug (M0), which accounted for 6.28%, 5.52%, and 1.38% of the dose, respectively. After intragastric administration of 124 μCi/9.93 mg/kg [14C]-furmonertinib to rats, drug-related substances were widely and rapidly distributed in tissues within 4 h. The concentration of total radioactivity in the lung was 100-fold higher than that in rat plasma, which could be beneficial to the treatment of lung cancer. Mass balance in humans was achieved with 77.8% of the administered dose recovered in excretions within 35 days after administration, including 6.63% and 71.2% in urine and feces, respectively. In conclusion, [14C]-furmonertinib is completely absorbed and rapidly distributed into lung tissue, extensively metabolized in humans, presented mostly as covalent conjugates in plasma, and slowly eliminated mostly via fecal route.

This trial (NCT04013048) investigated the metabolite profiles, mass balance and pharmacokinetics of fuzuloparib, a novel poly (ADP-ribose) polymerase inhibitor, in subjects with advanced solid cancers. A single dose of 150 mg [14 C]fuzuloparib was administered to five subjects with advanced solid cancers. Blood, urine and faecal samples were collected, analysed for radioactivity and unchanged fuzuloparib, and profiled for metabolites. The safety of the medicine was assessed during the study. The maximum concentrations (Cmax ) of the total radioactivity (TRA) and unchanged fuzuloparib in plasma were 5.39 μg eq./mL and 4.19 μg/mL, respectively, at approximately 4hours post dose. The exposure (AUC0-t ) of fuzuloparib accounted for 70.7% of the TRA in plasma, and no single metabolite was observed accounting for more than 10% of the plasma TRA. The recovery of TRA in excreta was 103.3 ± 3.8% in 288 hours, including 59.1 ± 9.9% in urine and 44.2 ± 10.8% in faeces. Sixteen metabolites of fuzuloparib were identified, including mono-oxidation (M1), hydrogenation (M2), di-oxidation (M3), trioxidation (M4), glucuronidation (M5, M7, M8) and de-ethylation (M6) products, and there was no specific binding between these metabolites and blood cells. Aliphatic hydroxylated fuzuloparib (M1-1) was the primary metabolite in the excreta, accounting for more than 40% of the dose for subjects. There were no serious adverse events observed in the study. Fuzuloparib was widely metabolized and excreted completely through urine and faeces in subjects with advanced solid cancer. Unchanged fuzuloparib was indicated to be the primary drug-related compound in circulation. [14 C]fuzuloparib was well-tolerated at the study dose.

The mass balance and pharmacokinetics of telavancin, a semisynthetic lipoglycopeptide antimicrobial agent, were characterized in an open-label, phase 1 study of six healthy male subjects. After a single 1-h intravenous infusion of 10 mg/kg [14C]telavancin (0.68 microCi/kg), blood, urine, and feces were collected at regular intervals up to 216 h postdose. Whole blood, plasma, urine, and fecal samples were assayed for total radioactivity using scintillation counting; plasma and urine were also assayed for parent drug and metabolites using liquid chromatography with tandem mass spectrometry. The concentration-time profiles for telavancin and total radioactivity in plasma were comparable from 0 to 24 h after the study drug administration. Telavancin accounted for >95% and 83% of total radioactivity in plasma at 12 h and 24 h, respectively. By 216 h, approximately 76% of the total administered dose was recovered in urine while only 1% was collected in feces. Unchanged telavancin accounted for most (83%) of the eliminated dose. Telavancin metabolite THRX-651540 along with two other hydroxylated metabolites (designated M1 and M2) accounted for the remaining radioactivity recovered from urine. The mean concentrations of total radioactivity in whole blood were lower than the concentration observed in plasma, and mean concentrations of THRX-651540 in plasma were minimal relative to mean plasma telavancin concentrations. These observations demonstrate that most of an administered telavancin dose is eliminated unchanged via the kidneys. Intravenous telavancin at 10 mg/kg was well tolerated by all subjects.

Mitapivat, a first‐in‐class, oral, small‐molecule, allosteric activator of the red blood cell‐specific form of pyruvate kinase (PKR), was approved for the treatment of hemolytic anemia in adults with pyruvate kinase (PK) deficiency. In this phase I mass balance study in healthy males, we administered a single ~120 mg oral dose of [14C]mitapivat and a concomitant intravenous ~0.1 mg microdose of [13C6]mitapivat. We determined (1) the routes of total radioactivity excretion, including the mass balance of total radioactivity in urine and feces; (2) the pharmacokinetics of mitapivat and [13C6]mitapivat in plasma and total radioactivity in whole blood and plasma; (3) the absolute oral bioavailability of mitapivat; and (4) the metabolite profiles in plasma and excreta. Mean recovery of the radioactive dose was 89.1% (49.6% in urine and 39.6% in feces). [14C]Mitapivat was rapidly absorbed and extensively metabolized as <4% of the total radioactive dose was excreted unaltered in urine and feces. Mean absolute oral bioavailability was 72.7%. A total of 17 metabolites were identified. Mitapivat accounted for 57% and 34% of plasma radioactivity in AUC0–24 and AUC0–72 pooled samples, respectively. The remaining radioactivity was attributable to several metabolites, each representing <10% of the total radioactivity in pooled samples; none were disproportionate metabolites as defined by the US Food and Drug Administration and International Conference on Harmonisation M3 guidelines. Metabolite structures suggest that the primary metabolic pathways for [14C]mitapivat in humans include N‐dealkylation of the cyclopropylmethyl moiety, oxygenation of the quinoline‐8‐sulfonamide, oxidation/unsaturation, scission of the piperazine moiety, and amide hydrolysis.

The disposition and metabolism of bempedoic acid, a selective inhibitor of ATP citrate lyase, were examined in healthy male subjects. After a single administration of [14C] bempedoic acid (240 mg, 113 μCi) oral solution, mean concentrations of total radioactivity in plasma as a function of time indicated absorption was rapid with peak concentrations achieved at 1 hour after dose administration. Radioactivity was decreased in a multiexponential fashion with an estimated elimination half-life of 26.0 hours. Radiolabeled dose was predominantly recovered in urine (62.1% of dose) and a smaller amount in feces (25.4% of dose). Bempedoic acid was extensively metabolized with 1.6%-3.7% of dose excreted unchanged in urine and feces combined. Overall, the major clearance route of bempedoic acid is metabolism by uridine 5'-diphosphate glucuronosyltransferases. Metabolism in hepatocyte cultures of human and nonclinical species were generally in agreement with clinical metabolite profiles. Pooled plasma samples were characterized by the presence of bempedoic acid (ETC-1002), which accounted for 59.3% of total plasma radioactivity, ESP15228 (M7; a reversible keto metabolite of bempedoic acid), and their respective glucuronide conjugates. The acyl glucuronide of bempedoic acid (M6) represented 23%-36% of radioactivity in plasma and accounted for approximately 37% of dose excreted in urine. In feces, the majority of radioactivity was associated with a co-eluting mixture of a carboxylic acid metabolite of bempedoic acid (M2a), a taurine conjugate of bempedoic acid (M2c), and hydroxymethyl-ESP15228 (M2b), which collectively accounted for 3.1%-22.9% of bempedoic acid dose across subjects. SIGNIFICANCE STATEMENT: This study characterizes the disposition and metabolism of bempedoic acid, an inhibitor of ATP citrate lyase for hypercholesterolemia. This work provides further understanding of bempedoic acid clinical pharmacokinetics and clearance pathways in adult subjects.

The pharmacokinetics, metabolism, excretion, mass balance, and tissue distribution of [14C]aficamten were evaluated following oral administration of an 8 mg/kg dose in Sprague Dawley rats and in a quantitative whole-body autoradiography study in Long Evans rats. [14C]Aficamten accounted for ∼80% and a hydroxylated metabolite (M1) accounted for ∼12% of total radioactivity in plasma over 48-h (AUC0–48). Plasma t max was 4-h and the t 1/2 of total plasma radioactivity was 5.8-h. Tissues showing highest Cmax exposures were myocardium and semitendinosus muscle. Most [14C]aficamten-derived radioactivity was excreted within 48-h post-administration. Mean cumulative recovery in urine and faeces over 168-h was 8.3% and 90.7%, respectively. In urine and bile, unchanged aficamten was detected at <0.1 and <0.2% of dose, respectively; however, based on total radioactivity excreted in urine (8.0%) and bile (51.7%), approximately 60% of dose was absorbed. [14C]Aficamten was metabolised by hydroxylation with subsequent glucuronidation where the most abundant metabolite recovered in bile was M5 (35.2%), the oxygen-linked glucuronide of hydroxylated aficamten (M1a). The major metabolite detected in faeces was a 1,2,4-oxadiazole moiety ring-cleaved metabolite (M18, 35.3%), shown to be formed from the metabolism of M5 in incubations with rat intestinal contents solution.

The pharmacokinetics (PK), metabolism, excretion, mass balance, and tissue distribution of [14C]praliciguat were evaluated following oral administration of a 3‐mg/kg dose in Sprague‐Dawley rats and in a quantitative whole‐body autoradiography (QWBA) study conducted in male Long‐Evans rats. Plasma Tmax was 1 hour and the t1/2 of total plasma radioactivity was 23.7 hours. Unchanged praliciguat accounted for 87.4%, and a minor metabolite (N‐dealkylated‐praliciguat) accounted for 7.6% of the total radioactivity in plasma through 48 hours (AUC0‐48). Tissues with the highest exposure ratios relative to plasma were liver, intestines, adrenal gland, and adipose, and those with the lowest values were seminal vesicle, blood, CNS tissues, lens of the eye, and bone. Most of the [14C]praliciguat‐derived radioactivity was excreted within 48 hours after oral administration. Mean cumulative recovery of the administered radioactivity in urine and feces over 168 hours was 3.7% and 95.7%, respectively. Unchanged praliciguat was not quantifiable in urine or bile of cannulated rats; however, based on the total radioactivity in these fluids, a minimum of approximately 82% of the orally administered dose was absorbed. [14C]Praliciguat was metabolized via oxidative and glucuronidation pathways and the most abundant metabolites recovered in bile were praliciguat‐glucuronide and hydroxy‐praliciguat‐glucuronide. These results indicate that praliciguat had rapid absorption, high bioavailability, extensive tissue distribution, and elimination primarily via hepatic metabolism.