European Journal of Clinical Pharmacology

, Volume 60, Issue 10, pp 709–715 | Cite as

Pharmacokinetic interaction of chloroquine and methylene blue combination against malaria

  • Jens Rengelshausen
  • Jürgen Burhenne
  • Margit Fröhlich
  • Yorki Tayrouz
  • Shio Kumar Singh
  • Klaus-Dieter Riedel
  • Olaf Müller
  • Torsten Hoppe-Tichy
  • Walter E. Haefeli
  • Gerd Mikus
  • Ingeborg Walter-Sack
Pharmacokinetics and Disposition

Abstract

Objective

The combination of chloroquine and methylene blue is potentially effective for the treatment of chloroquine-resistant malaria caused by Plasmodium falciparum. The aim of this study was to investigate whether methylene blue influences the pharmacokinetics of chloroquine.

Methods

In a randomized, placebo-controlled, parallel group design, a 3-day course of therapeutic oral doses of chloroquine (total 2.5 g in male, 1.875 g in female participants) with oral co-administration of placebo or 130 mg methylene blue twice daily for 3 days was administered to 24 healthy individuals. Chloroquine, desethylchloroquine, and methylene blue concentrations were determined by means of HPLC/UV or LC/MS/MS assays in whole blood, plasma, and urine for 28 days after the last dose.

Results

During methylene blue exposure, the area under the chloroquine whole blood concentration–time curve normalized to body weight (AUC0-24 h/BW) yielded a trend of reduction (249±98.2 h μg l−1 kg−1 versus 315±65.0 h μg l−1 kg−1, P=0.06). The AUC0-24 h/BW of desethylchloroquine was reduced by 35% (104±40.3 h μg l−1 kg−1 versus 159±66.6 h μg l−1 kg−1, P=0.03), whereas the metabolic ratio between chloroquine and desethylchloroquine remained unchanged (2.25±0.49 versus 1.95±0.42, P=0.17). The renal clearance of chloroquine and the ratio between chloroquine in whole blood and plasma remained unchanged (P>0.1).

Conclusion

Oral co-administration of methylene blue appears to result in a small reduction of chloroquine exposure which is not expected to be clinically relevant and thus represents no concern for further development as an anti-malarial combination.

Notes

Acknowledgements

This study was supported by DSM Fine Chemicals Austria, Linz, Austria. We thank Mrs. Dorothea Schimpf, MS, for preparing the study medication; Mrs. Brigitte Tubach for study support; and Mrs. Andrea Deschlmayr and Mrs. Magdalena Longo for their excellent technical assistance. The study was approved by the ethics committee of the Medical Faculty of the University of Heidelberg, and was conducted at the Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology in accordance with the Declaration of Helsinki, as amended in Somerset West 1996, and the specific legal requirements in Germany.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Jens Rengelshausen
    • 1
  • Jürgen Burhenne
    • 1
  • Margit Fröhlich
    • 1
  • Yorki Tayrouz
    • 1
  • Shio Kumar Singh
    • 1
    • 4
  • Klaus-Dieter Riedel
    • 1
  • Olaf Müller
    • 2
  • Torsten Hoppe-Tichy
    • 3
  • Walter E. Haefeli
    • 1
  • Gerd Mikus
    • 1
  • Ingeborg Walter-Sack
    • 1
  1. 1.Department of Internal Medicine VI, Clinical Pharmacology and PharmacoepidemiologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Tropical Hygiene and Public HealthUniversity of HeidelbergHeidelbergGermany
  3. 3.Hospital PharmacyUniversity of HeidelbergHeidelbergGermany
  4. 4.Division of Pharmacokinetics and MetabolismCentral Drug Research Institute (CDRI)LucknowIndia

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