Single-dose pharmacokinetics and safety of azilsartan medoxomil in children and adolescents with hypertension as compared to healthy adults

Abstract

Purpose

This open-label, multicenter, single-dose study characterized the pharmacokinetics and short-term safety of azilsartan medoxomil (AZL-M) in hypertensive pediatric subjects (12–16 years [cohort 1a; n = 9]; 6–11 years [cohort 2; n = 8]; 4–5 years [cohort 3; n = 3]).

Methods

Model-based simulations were performed to guide dosing, especially in 1–5-year olds, who were difficult to enroll. AZL-M was dosed according to body weight (20–60-mg tablet, cohorts 1a and 2; 0.66 mg/kg granule suspension, cohort 3). In cohort 1, gender-matched healthy adults (cohort 1b; n = 9) received AZL-M 80 mg.

Results

Exposure to AZL (active moiety of AZL-M), measured by dose-/body weight-normalized C _max and AUC _0–∞, was ∼15–30 % lower in pediatric subjects versus adults. In simulations, exposure with 0.66 mg/kg AZL-M in pediatric subjects weighing 8–25 kg approximated to AZL-M 40 mg (typical starting dose) in adults. The simulations suggest that 25–50-kg subjects require half the adult dose (10–40 mg), whereas 50–100-kg subjects can use the same dosing as adults. Adverse events were mild in intensity, apart from one moderate event (migraine).

Conclusions

This dosing strategy should be safe in pediatric patients, as AZL exposure would not exceed that seen in adults with the highest approved AZL-M dose (80 mg).

Electronic supplementary material

The online version of this article (doi:10.1007/s00228-015-1987-8) contains supplementary material, which is available to authorized users.