Pharmacokinetics and pharmacodynamics of clomethiazole after oral and rectal administration in healthy subjects

Abstract

Clomethiazole, a sedative-hypnotic and anticonvulsant drug, has been successfully administered orally and intravenously, but in cases where either of these methods presents complications, rectal administration may represent a practical alternative. We sought to compare the single-dose pharmacokinetics and pharmacodynamics of clomethiazole after oral and rectal administration. Ten healthy adult volunteers were given 600 mg clomethiazole edisylate (corresponding to 390 mg clomethiazole ase) in 2 capsules as a single oral or rectal dose in a double-masked, doubledummy, crossover fashion. Serum concentrations were measured up to 10 hours after administration using a specific highperformance liquid chromatography method. Computerized reaction-time measurement and visual analogue scales (VAS) were used to assess drug effects. Peak serum concentrations were significantly higher after oral administration (mean ±SEM, oral 1.76 ± 0.47 (μg/mL vs rectal 0.48 ± 0.14 μg/mL; P = 0.03) and appeared earlier (55 ± 12 vs 89 ± 11 min; P = 0.04). Area under the concentrationtime curve values were similar after administration by both routes (oral 116 ±20.6 vs rectal 105 ± 36.0 μg·min/mL), with a relative rectal bioavailability of 90% compared with oral administration. The objective pharmacodynamic effects on reaction time (increase of 104 ± 26 vs 66 ± 22 ms, oral vs rectal) and working speed (decrease of 132 ± 38 vs 97 ± 32 ms, oral vs rectal) were not significantly different. Subjective pharmacodynamic effects, as measured on the VAS, were comparable with both routes of administration. Clomethiazole was well tolerated, with a similar adverse effect profile for both routes of administration. The effects of rectal dosing of clomethiazole were similar to those of oral dosing but appeared to occur later. Our results suggest that rectal administration of a single 600-mg Clomethiazole edisylate dose bears no safety risk. Therefore, rectal administration could be considered when neither oral nor parenteral administration is possible and a later onset of effect is not critical.