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Nitazoxanide use is limited by gastrointestinal side effects associated with increasing dose. In this drug repurposing study, we investigated the possibility of enhancing the exposure of its active metabolite, tizoxanide, through pharmacokinetic interaction with atazanavir/ritonavir. In this crossover drug–drug interaction study, 18 healthy participants received a single dose of 1000 mg of nitazoxanide alone and in combination with 300/100 mg atazanavir/ritonavir in period 1 and 2 respectively. On both days, blood samples for intensive pharmacokinetic analyses were collected at 0–12 h post-dose. To explore the utility of dried blood spots (DBS) as an alternative to plasma for tizoxanide quantification, 50 µL of blood from some participants was spotted on DBS cards and correlated with plasma concentrations. Pharmacokinetic parameters were derived by non-compartmental analysis and compared between both periods. Co-administration of nitazoxanide with atazanavir/ritonavir resulted in a significant increase in tizoxanide plasma exposure [GMR (90% CI) of AUC0–12h, Cmax and C12h being 1.872 (1.870–1.875), 2.029 (1.99–2.07) and 3.14 (2.268–4.352), respectively]. DBS concentration (%CV) was 46.3% (5.6%) lower than plasma concentrations, and there was strong correlation (R = 0.95, p < 0.001) between DBS-derived plasma concentration and plasma concentrations. Co-administration with atazanavir/ritonavir enhanced tizoxanide exposure with no report of adverse events in healthy volunteers. [ABSTRACT FROM AUTHOR]

A simple and rapid method for simultaneous determination of amodiaquine and pioglitazone in dried blood spots (DBS) was developed and validated. Blood samples were spotted on protein saver cards and dried and a 4-mm punch was extracted with methanol first and later with 1% acetic acid and dichloromethane. The separation was achieved on a C8 Zorbax Eclipse XDB analytical column (4 µm, 150 × 4.6 mm2i.d.) at 27°C with a mobile phase of methanol/0.2% acetic acid (60:40) at a flow rate of 0.8 mL/min and detected at 230 nm. The method was linear over the range 2–80 ng/mL for amodiaquine and 10–1500 ng/mL for pioglitazone with correlation coefficients greater than 0.9995. The limits of detection were 1.12 and 10.93 µg/L and the limits of quantification were 3.39 and 33.11 µg/L for amodiaquine and pioglitazone, respectively. The inter- and intra-day precision were <6.7 and <7% for amodiaquine and <6.3 and <3% for pioglitazone. The method was applied to estimate the pharmacokinetic (PK) parameters in four healthy volunteers and it was found to yield identical PK profiles with other earlier methods supporting the use of DBS as an alternative for PK study. [ABSTRACT FROM PUBLISHER]