Implications of the Digestion of Milk-Based Formulations for the Solubilization of Lopinavir/Ritonavir in a Combination Therapy

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  • Malinda Salim
  • Gisela Ramirez
  • Andrew J. Clulow
  • Adrian Hawley
  • Boyd, Ben

The development of formulation approaches to coadminister lopinavir and ritonavir antiretroviral drugs to children is necessary to ensure optimal treatment of human immunodeficiency virus (HIV) infection. It was previously shown that milk-based lipid formulations show promise as vehicles to deliver antimalarial drugs by enhancing their solubilization during the digestion of the milk lipids under intestinal conditions. In this study, we investigate the role of digestion of milk and infant formula on the solubilization behavior of lopinavir and ritonavir to understand the fate of drugs in the gastrointestinal (GI) tract after oral administration. Small angle X-ray scattering (SAXS) was used to probe the presence of crystalline drugs in suspension during digestion. In particular, the impact of one drug on the solubilization of the other was elucidated to reveal potential drug-drug interactions in a drug combination therapy. Our results showed that lopinavir and ritonavir affected the solubilization of each other during digestion in lipid-based formulations. While addition of ritonavir to lopinavir improved the overall solubilization of lopinavir, the impact of lopinavir was to reduce ritonavir solubilization as digestion progressed. These findings highlight the importance of assessing the solubilization of individual drugs in a combined matrix in order to dictate the state of drugs available for subsequent absorption and metabolism. Enhancement in the solubilization of lopinavir and ritonavir in a drug combination setting in vitro also supported the potential for food effects on drug exposure.

Original languageEnglish
JournalMolecular Pharmaceutics
Volume20
Issue number4
Pages (from-to)2256–2265
ISSN1543-8384
DOIs
Publication statusPublished - 2023

Bibliographical note

Funding Information:
This work was funded by the Bill and Melinda Gates Foundation under Investment ID OPP1160404 in collaboration with the Medicines for Malaria Venture (MMV). Funding is also acknowledged from the Australian Research Council under the Discovery Projects scheme DP160102906. The SAXS experiments for this work were conducted on the SAXS/WAXS beamline of the Australian Synchrotron, part of ANSTO. The authors thank Arla Food Ingredients Group P/S for the donation of MFGM. We thank Dr. Niya Bowers, Dr. Michael Mitchell, and Dr. Drazen Ostovic for technical and historical discussions around coadministration of OZ439 with infant formulas.

    Research areas

  • combination therapy, digestion, drug solubilization, infant formula, lopinavir, milk, ritonavir, X-ray scattering

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