Background: Nevirapine is a potent non-nucleoside inhibitor of HIV-1 reverse transcriptase and is indicated for use in combination with other antiretroviral agents for the treatment of HIV-1 infection. Piperine (1-piperoylpiperidine) is an alkaloid and the main pungency principle in both black and long pepper. There are indications that piperine inhibits, rather than stimulates, drug metabolism in most cases, thus increasing the bioavailability and effect of some drugs.
Methods: This was a crossover, placebo-controlled pilot study conducted in a total of eight healthy adult males aged 20–40 years. Subjects were randomly assigned to receive piperine 20mg or placebo each morning for 6 days, and on day 7, nevirapine 200mg plus piperine 20mg or nevirapine plus placebo in a crossover fashion. Blood samples were collected from 1 to 144 hours post-dose for pharmacokinetic analysis.
Results: Mean maximum plasma concentration (Cmax), area under the plasma concentration-time curve from 0 hours to the last measurable concentration (Clast) [AUCt], AUC extrapolated to infinity (AUC∞) and Clast values of nevirapine were increased by approximately 120%, 167%, 170% and 146%, respectively, when co-administered with piperine. The treatments were well tolerated, indicating few or no clinical adverse effects.
Conclusion: This pilot study provided evidence for enhanced bioavailability of nevirapine when administered with piperine. Further in-depth studies in a large number of patients receiving different dosage regimens are required to confirm these results and further our understanding of a possible clinical advantage arising from the bioenhancement capabilities of piperine in the treatment of HIV infection.
Felodipine Nevirapine Piperine Complementary Alternative Medicine Nevirapine Absorption
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No sources of funding were used to assist with this study. The authors are grateful to the staff of Bioserve Clinical Research Pvt Ltd, Hyderabad, India for conducting the clinical phase of the study, and to the bioanalytical staff of the Department of Clinical Pharmacology and Pharmacokinetics of Dr Reddy’s Laboratories, Generics Division, Hyderabad, India for analysis of the clinical samples. The authors have no potential conflicts of interest that are directly relevant to the content of this study, which was conducted as part of a PhD programme of one of the authors.
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