The effect of mannitol on the oral bioavailability of cimetidine

The aim of the study was to investigate whether mannitol at amounts relevant to pharmaceutical formulations would alter the oral bioavailability of cimetidine, a drug primarily absorbed from the small bowel. Seven healthy male subjects each received four formulations, a chewable tablet or a solution, containing 0.200 g of cimetidine and either 2.264 g of mannitol or sucrose, in a randomized four-way cross-over study. Frequent blood samples were taken over a 24 h period to allow a cimetidine plasma profile to be obtained for each formulation. Transit of the radiolabeled formulations was followed by gamma scintigraphy. Statistically significant reductions in the AUC0-24 and maximum plasma concentration values were observed with the mannitol dosage forms compared to the sucrose controls. The mean small intestinal transit times were shortened after administration of the mannitol solution and tablet; the transit time of the solution was significantly shorter with values 23% of those for the sucrose solution. The implication of the study findings is that excipients cannot always be regarded as "inert" substances that can be incorporated into a formulation without having any deleterious effect on the overall in vivo behaviour of the product.