Thalidomide is approved in the United States for treating erythema nodosum
leprosum, a complication of leprosy; The present study determined the singl
e-dose oral pharmacokinetics and dose proportionality from 50 to 400 mg of
Celgene's commercial Thalomid (R) thalidomide formulation in an open-label,
single-dose, three-way crossover study. Fifteen healthy subjects were give
n 50, 200, and 400 mg of thalidomide on three occasions, and blood samples
were collected over 48 hours. Pharmacokinetic parameters were determined us
ing noncompartmental methods, and dose proportionality was assessed by line
ar regression of dose-normalized C-max and AUC(0-infinity). No serious or u
nexpected adverse events occurred. The most common adverse events were dizz
iness, somnolence, headache, and nausea. One patient was discontinued becau
se of pharyngitis. There was a significant deviation from proportionality f
or C-max with increases being less than proportionally than changes in dose
normalized C,, creases being less than proportional than changes in dose.
AUC(0-infinity) increased proportionally with dose, suggesting that the ove
rall amount of thalidomide absorbed, as well as ifs clearance, is independe
nt of dose over the range used. V/F was found 50 increase with dose. This w
as most likely due to the terminal rate constant, which is used to calculat
e V/F, actually representing the absorption process rather than elimination
(i.e., flip-flop phenomenon). The terminal rate constant (absorption rate
constant) for She highest dose was 50% less than for the other two lower do
ses. The less than proportional increases in C-max were most likely due to
thalidomide's low aqueous solubility. Thalidomide shows reasonable dose pro
portionality with respect to AUC from 50 to 400 mg.