Objective: The objective of this study was to determine the sites of zanami
vir deposition in the respiratory tract and the pharmacokinetics of zanamiv
ir after oral inhalation from the Diskhaler(TM) device and from a prototype
of a novel breath-activated device.
Design: This was a 2-period block-randomised study in which participants in
haled zanamivir from a Diskhaler(TM) and/or the prototype device on separat
e days.
Study participants: 13 healthy volunteers (5 men and 8 women) aged 20 to 42
years (mean age 29 years) and weighing 54.0 to 94.0kg (mean bodyweight 69.
2kg) entered the study.
Interventions: Participants were given dry powder zanamivir 10mg formulated
with Tc-99m from the Diskhaler(TM) or the prototype device on separate day
s. Scintigraphic images of the chest and oropharynx were recorded. Blood sa
mples for determination of serum zanamivir and urine for excretion studies
were taken up to 8 hours after drug administration. Safety was evaluated by
monitoring lung function tests, adverse events and laboratory parameters.
Results: Orally inhaled zanamivir was well tolerated, as demonstrated by lu
ng function tests. A mean of 13.2% (n = 11) of the 10mg dose from the Diskh
aler(TM) was deposited in the bronchi and lungs. The deposition pattern var
ied between individuals, showing a preferentially central deposition patter
n in some and a uniform distribution pattern in others. The major depositio
n site was the oropharynx (mean 77.6%), with a mean of 1.2% deposited on th
e trachea and a mean of 3.2% retained in the blister. Similar data were obt
ained with the prototype device. Inhalation of zanamivir gave a broad peak
of systemic absorption with mean maximum serum concentrations of approximat
ely 30 to 40 mu g/L after 1.5 hours. The rate and extent of absorption were
similar irrespective of inhalation device. Less than 5% of drug was excret
ed unchanged in urine within 8 hours of inhalation, confirming the low bioa
vailability of zanamivir after pulmonary delivery. A significant correlatio
n existed between systemic exposure and peripheral lung deposition.
Conclusions: The local concentrations of zanamivir that result from oral in
halation via the Diskhaler(TM) are estimated to be >10 mu mol/L throughout
the respiratory tract, well in excess of the concentrations observed to inh
ibit influenza virus neuraminidases by 50% (0.64 to 7.9 nmol/L). Similar de
position data were obtained with the Diskhaler(TM) and the prototype device
, which was consequently not developed further. Pharmacoscintigraphy was co
nfirmed as being a reliable technique for measuring zanamivir deposition in
the respiratory tract.