Aerosol delivery of ergotamine tartrate via a breath-synchronized plume-control inhaler in humans

Objective: To compare systemic delivery of ergotamine tartrate (ET) via a breath-synchronized, plume-control inhaler (BSPCI) (Tempo ET*) with a sublingual ergot preparation and a commercial inhaler. Methods: Study 1 determined plasma ET concentrations in seven healthy subjects after administration of ET by a 2 mg tablet (Lingraine dagger) and a BSPCI delivering 258 mu g of ET. Study 2 determined plasma ET concentrations in 16 healthy subjects after administration via an ET metered dose inhaler (ME) (Medihaler double dagger) delivering 2052 mu g of ET and a BSPCI delivering 129 mu g of ET. Gamma scintigraphy with Tc-99m validation was used to quantify lung deposition. Results: For both studies, ET C-max was higher with the BSPCI (study 1: sublingal ET 134pg/mL at 37 min; BSPCI 3743 pg/mL at 3 min; study 2: metered-dose inhaler 1109 pg/mL at 4 min; BSPCI 1210pg/mL at 2.5 min). Mean dose normalized AUC was several-fold higher with the BSPCI compared with sublingual ET and ME dosing. Lung deposition of ET with the BSPCI was 33.5, 8.9, 11.4, and 13.2% for whole, central, intermediate, and peripheral lung, respectively, with a 1.5 peripheral: central ratio. Conclusion: Based on these open-label studies, the BSPCI allows rapid delivery of potentially therapeutic plasma concentrations of ET at approximately 1/15th the dose of comparators.