Pharmacokinetics and Bioavailability of An Essential Oil Compound (Thymol) After Oral Administration

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Pharmacokinetics and bioavailability of an essential oil compound (thymol)


after oral administration

Conference Paper  in  Focus on Alternative and Complementary Therapies · March 2001


DOI: 10.1111/j.2042-7166.2001.tb02833.x

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KOHLERTMEDICINE
AVAILABILITY
HERBAL ET AL
AND PHARMACOKINETICS OF THYMOL HERBAL MEDICINE

Systemic Availability and Pharmacokinetics


of Thymol in Humans
Claudia Kohlert, PhD, Gernot Schindler, MD, Reinhard W. März, PhD,
Gudrun Abel, PhD, Benno Brinkhaus, MD, Hartmut Derendorf, PhD, FCP,
Eva-Ulrike Gräfe, PhD, and Markus Veit, PhD

Essential oil compounds such as found in thyme extract are thymol sulfate and thymol glucuronide were found in urine
established for the therapy of chronic and acute bronchitis. and identified by LC-MS/MS. Plasma and urine samples were
Various pharmacodynamic activities for thyme extract and analyzed after enzymatic hydrolysis of the metabolites by
the essential thyme oil, respectively, have been demonstrated headspace solid-phase microextraction prior to GC analysis
in vitro, but availability of these compounds in the respective and flame ionization detection. Thymol sulfate, but not
target organs has not been proven. Thus, investigation of ab- thymol glucuronide, was detectable in plasma. Peak plasma
sorption, distribution, metabolism, and excretion are neces- concentrations were 93.1 ± 24.5 ng ml –1 and were reached af-
sary to provide the link between in vitro effects and in vivo ter 2.0 ± 0.8 hours. The mean terminal elimination half-life
studies. To determine the systemic availability and the was 10.2 hours. Thymol sulfate was detectable up to 41 hours
pharmacokinetics of thymol after oral application to hu- after administration. Urinary excretion could be followed
mans, a clinical trial was carried out in 12 healthy volunteers. over 24 hours. The amount of both thymol sulfate and
Each subject received a single dose of a Bronchipret® TP tab- glucuronide excreted in 24-hour urine was 16.2% ± 4.5% of
let, which is equivalent to 1.08 mg thymol. No thymol could the dose.
be detected in plasma or urine. However, the metabolites Journal of Clinical Pharmacology, 2002;42:731-737
©2002 the American College of Clinical Pharmacology

E ssential oil compounds such as found in thyme ex-


tract are frequently used for the therapy of chronic
and acute bronchitis. For these indications, several
Essential oils are mixtures of lipophilic, liquid, vola-
tile, and often terpenoid compounds present in higher
plants. More than 3000 compounds have been de-
clinical trials have been carried out. 1-4 Various scribed so far.8 A broad variety of pharmacological ac-
pharmacodynamic activities for thyme extract and the tivities of essential oils and their constituents have
essential thyme oil, respectively, have been demon- been investigated for potential use in medicine.9 One
strated in vitro,5-7 but bioavailability of thyme oil ingre- particular area of use for essential oils is respiratory
dients has not been proven. medicine, where the oils of pine, eucalyptus, and
thyme have a sound tradition and several clinical stud-
ies have provided evidence of efficacy.1-4,10-12 In particu-
From the German Central Institute for Pharmaceutical Research (Dr. lar, 1,8-cineol, originally a component of eucalyptus
Kohlert, Dr. Gräfe, Dr. Veit), Sinzig, Germany; Department of Medicine I,
Department of Complementary Medicine (Dr. Schindler, Dr. Brinkhaus),
oil,10,12 and standardized myrtol2,4,11 have been sub-
Friedrich-Alexander University, Erlangen-Nürnberg, Erlangen, Germany; jected to pharmacological and clinical studies focusing
Bionorica AG (Dr. Abel, Dr. März), Neumarkt/Opf., Germany; and Col- on respiratory diseases. Thyme extracts, which are
lege of Pharmacy (Dr. Derendorf), University of Florida, Gainesville. Sup- very popular in Germany for these disorders, have only
ported by Bayern Innovativ, government funds, and Bionorica AG. Sites a small record of clinical studies, but there is no dispute
where the study was performed include the following: German Central In- about their efficacy.1,3 Thyme extract products have
stitute for Pharmaceutical Research; Friedrich-Alexander University,
shown clinical efficacy against acute bronchitis in
Erlangen-Nürnberg; and Bionorica AG. Dedicated to Professor Otto
Sticher on the occasion of his 65th birthday. Submitted for publication Sep-
comparison to synthetic compounds,3 as well as vari-
tember 28, 2001; revised version accepted March 3, 2002. Address for ous activities in pharmacological assays.
reprints: Dr. Markus Veit, German Central Institute for Pharmaceutical Re- A dose-dependent anti-inflammatory effect of
search, Kranzweiherweg 10, 53489 Sinzig, Germany. thyme extract was shown in carrageenin-induced

J Clin Pharmacol 2002;42:731-737 731


KOHLERT ET AL

edema in rat paws.5 Antimicrobial activity against sev- mass index was 24.6 ± 2.0 kg m–2 (mean ± SD). Subjects
eral gram-positive and gram-negative bacteria was were not allowed to use any medicine during the study.
shown for different thyme oils.7,13 By means of a All subjects signed an informed consent form accord-
bioimpedometric method, the bacteriostatic activity of ing to good clinical practice (GCP) guidelines. The pro-
thyme oil was determined.7 The essential oil of tocol was approved by the ethics committee of the Uni-
thyme—applied in concentrations from 50 ppm to 400 versity of Erlangen, Germany.
ppm—resulted in a reduction in the rate of growth of
different bacteria. Concentrations of 200 ppm achieved Study Design
more than 50% inactivation of the majority of microor-
ganisms tested.7 Antibacterial activity against respira- Each subject received a single dose of Bronchipret® TP
tory tract pathogens by gaseous contact was investi- tablets containing 60 mg of primrose dry extract
gated recently.14 Petri dishes with thyme oil or thymol (6.0-7.0:1; extracted by ethanol 47% (v/v)) and 160 mg
were placed in an airtight box, and inhibitory concen- of thyme dry extract (5.9-10.0:1, extracted by ethanol
trations were measured. 50% (m/m)), which was batch-specific equivalent to
In addition, antiviral activities against influenza A 1.08 mg of thymol. The subjects were fasted at the time
virus and respiratory syncytial virus were found for they received the medication. They stayed in the clinic
thyme extract in the plaque reduction test.6 Recently, for the first 15 hours of the study and returned to the
antioxidant effects of thyme oil and thymol in various clinic for regular blood sampling visits. Prestudies in-
rat tissues were reported.15 dicated that long sampling times would be necessary to
However, the clinical relevance of these activities cover the elimination phase completely. Therefore, a
depends on the systemic availability of these com- sampling period of 72 hours was chosen. During the
pounds in the respective target organs. Thus, investiga- entire time, they were on an essential oil-free diet, and
tion of absorption, distribution, metabolism, and excre- they were not allowed to apply any cosmetics (e.g.,
tion would provide a significant link between in vitro toothpaste, aftershave, etc.) containing essential oil
effects and in vivo efficacy. They may also be important compounds to avoid interference with any other essen-
in context of the safety of herbal medicinal products.16 tial oil compounds. Therefore, the subjects were
Pharmacokinetics of most natural compounds such as handed out a list with food and cosmetics they were not
thymol have not yet been investigated satisfactorily. allowed to eat and apply during the time of the study
For several monoterpenoid and phenylpropanoid period.
compounds, there is a large amount of experimental
data, but—especially with respect to humans— Collection of Blood
pharmacokinetic data are lacking.16 and Urine Samples
To evaluate whether thymol, the main compound of
the essential oil of thyme, can contribute to the clinical Venous blood samples (9 ml per blood sample) were
efficacy observed for a preparation containing thyme collected into EDTA tubes once before subjects were
extract (Bronchipret® TP tablets), a bioavailability administered the medication and 0.25, 0.5, 0.75, 1, 1.5,
study after oral administration of a single dose was car- 2, 2.5, 3, 3.5, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 24, 31, 38, 48,
ried out. This study should also provide preliminary 55, 62, and 72 hours after administration. Blood was
data for further dose-finding studies and for the design centrifuged for 10 minutes at 4000 × g. The supernatant
of multiple-dose studies. plasma was transferred into reaction cups in aliquots of
0.5 ml, and 20 µl acetic acid 0.58 M were added to each
SUBJECTS AND METHODS aliquot for stabilization. The plasma was stored at
–20°C until analysis. Urine was collected in plastic bot-
Subjects tles in intervals of 0 to 3, 3 to 6, 6 to 9, 9 to 14, 14 to 24,
24 to 31, 38 to 48, 48 to 55, 55 to 62, and 62 to 72 hours.
The study was carried out at the Department of Medi- An aliquot of 50 ml of each sample was mixed with 0.1 g
cine I, Department of Complementary Medicine, ascorbic acid as antioxidant and stored at –20°C until
Friedrich-Alexander University, Erlangen-Nürnberg analysis.
(Erlangen, Germany).
Twelve healthy male volunteers were recruited for Analytical Methods
the study after complete clinical examination. Routine
blood and urine laboratory tests were performed. Mean For the determination of total concentration of thymol,
age was 29.5 ± 6.74 years (mean ± SD), and mean body thawed plasma samples were analyzed after enzymatic

732 • J Clin Pharmacol 2002;42:731-737


AVAILABILITY AND PHARMACOKINETICS OF THYMOL

hydrolysis of conjugated thymol by headspace 40°C. The residues were dissolved in 12 µl acetonitrile
solid-phase microextraction (HS-SPME) prior to gas and 108 µl 2 mm ammonium acetate by means of
chromatographic analysis.17 For urine analysis, only 20 ultrasonication and used for HPLC analysis.
µl of acetic acid 0.58 M compared to 50 µl used in the Determination of free thymol in plasma was carried
plasma method were necessary to adjust to pH 5 be- out by HPLC with a 12-channel coulometric array de-
cause ascorbic acid was added before the samples were tector at the German Institute of Nutrition (Bergholz-
frozen. In addition, adaptation of the SPME extraction Rebrücke, Germany). To 400 µl of plasma (pH 5), 50 µl
time to 25 minutes instead of 35 minutes for plasma internal stock solution (o-Cresol, 4 µg ml–1), 50 µl water,
analysis was performed, which is due to the different and 500 µl methanol were added, vortexed, and centri-
matrix. fuged for 10 minutes at 7800 × g. The supernatant was
Validation of the methods was performed according used for HPLC analysis.
to the FDA Draft Guidance for Industry No. 2578 Determination of free thymol in urine was carried
(Bioanalytical Methods Validation for Human Studies). out by GC-MS. n-Heptane (250 µl) was added to 500 µl of
For both plasma and urine analysis, the international urine (pH 5) and vortexed for 20 minutes at 350 rpm.
acceptance criteria were in the ranges required. At the The supernatant was used for GC-MS analysis.
limit of quantification (LOQ), within-day precision of
the plasma and urine assay was below 19% and 12% Data Analysis
(coefficient of variation [CV]), respectively, and below
5.6% (plasma) and 7.2% (urine) at higher concentra- Pharmacokinetic data were determined by non-
tions. Accuracy was below 9% for plasma and below compartmental analysis using Microsoft Excel based
13% for urine. Stability of both plasma and urine sam- on the equations given by Gibaldi and Perrier.18 The
ples was given over 12 weeks at –20°C. The lower limit maximum observed plasma concentration Cmax and the
of quantification for plasma analysis was 8.1 ng ml–1 time to reach Cmax (tmax) were determined directly from
and for urine 10.9 ng ml–1. the data. The AUC0 → clast was calculated using the linear
Plasma samples were analyzed in 12 runs and the trapezoidal rule. The apparent terminal elimination
urine samples in 5 runs. Each run was checked for lin- half-life was determined by linear regression of the ter-
earity by a separate calibration curve. Precision and ac- minal phase of the semilogarithmic plasma concentra-
curacy were controlled by running six external quality tion versus time profiles. The mean absorption time
control samples (spiked blank plasma and urine sam- (MAT) was calculated from 1/ka, which was obtained
ples with reference compounds) covering the whole from ke and tmax by the Excel Solver function from tmax =
range. ln(ka/ke)/(ka – ke).
The identification of phase II metabolites and the de-
termination of free thymol in both plasma and urine RESULTS
were carried out exemplarily in 2 subjects each.
For identification of the phase II metabolites, Free thymol could not be detected in human plasma.
LC-MS/MS measurements were performed by A&M By means of LC-MS/MS analysis, only thymol sulfate
(Laboratory for Investigations in Analytics and Metab- but not the glucuronide was identified in human
olism, Bergheim, Germany). Prior to LC-MS/MS (ion- plasma (reference compound proved feasibility) (Fig-
ization mode: ESI negative), the following sample ure 1). The plasma concentration versus time curves of
preparation procedures were applied. After addition of thymol sulfate (measured by LC-MS) and total thymol
550 µl acetonitrile to 550 µl plasma, the solution was concentrations after enzymatic hydrolysis of plasma
vigorously shaken for 20 seconds and centrifuged at (measured by HS-SPME) showed parallel profiles (Fig-
7800 × g for 4 minutes. The solvent was removed under ure 2). Hence, the quantification of thymol in plasma
nitrogen stream at 40°C. The residue was dissolved in 5 was based on the total thymol concentration after enzy-
µl acetonitrile and 45 µl 2 mM ammonium acetate by matic hydrolysis of the sulfate.
ultrasonication. After centrifugation at 7800 × g for 4 No free thymol was found in urine either. Instead,
minutes, the supernatant was used for HPLC analysis. two phase II conjugates were identified by LC-MS/MS
For urine sample preparation, 4 ml urine were acidi- as thymol sulfate and thymol glucuronide (Figure 1).
fied with 8 µl formic acid; 14 ml ethylacetate were The ratio of peak areas of thymol sulfate and thymol
added, and the samples were shaken for 2 minutes. For glucuronide was constant over the different urine frac-
separation of the organic and aqueous phase, the sam- tions (Figure 3).
ples were centrifuged at 7800 × g for 4 minutes, and the The time course of the total thymol concentrations
supernatant was evaporated under nitrogen stream at in human plasma is shown in Figure 4. Pharma-

HERBAL MEDICINE 733


KOHLERT ET AL

thymol sulfate
thymol glucuronide

peak area
RO

Compound R 3 6 9 14
time [h]

-------------------------------- ------------------------------ Figure 3. Cumulative renal excretion of thymol sulfate and thymol
glucuronide in 1 subject.

thymol H—

thymol sulfate plasma concentration versus time profile was biphasic,


HO3S subdivided into a distribution phase and a slow termi-
nal elimination phase beginning at about 10 hours after
administration and lasting up to an average of 38 hours.
thymol glucuronide HOOC Elimination half-life was calculated to be 10.2 ± 1.4
O hours (mean ± SD) (Table I).
HO In urine, the elimination of thymol conjugates was
HO
OH detectable for the first 24-hour interval, with most be-
ing eliminated after 6 hours. The combined amount of
Figure 1. Structures of thymol, thymol sulfate, and thymol
glucuronide.
both thymol sulfate and glucuronide excreted in
24-hour urine was 16.2% ± 4.5% of intake. The renal
clearance was calculated to be 0.271 ± 0.7 L h–1.

DISCUSSION
140
thymol sulfate [response/250000]

120
Thymol was present in human plasma only as thymol
100 sulfate. Hence, the quantification of thymol was based
Cp [ng.mL-1]

80 on the thymol concentration obtained after enzymatic


60 hydrolysis. Intake of one Bronchipret® TP tablet re-
40 sulted in plasma concentrations that showed the same
20 profile among all subjects. Thymol was absorbed
0 quickly. Considerable plasma concentrations of thymol
0 1 2 3 4 5 6 sulfate could already be detected after 20 minutes. This
t [h] fast absorption indicates that thymol is mainly ab-
Figure 2. Thymol plasma concentration determined after enzy- sorbed in the upper part of the gut. This confirms previ-
matic hydrolysis of plasma ( ) and thymol sulfate measured by ous observations made by Somerville et al19 with
LC-MS in 1 subject ( ). ileostomy patients. In this study, the renally excreted
amount of menthol after oral intake of peppermint oil
by ileostomy patients was only 11% less compared to
healthy volunteers. After oral application of 1,8-cineol
cokinetic data analysis was performed with only 11 and α-pinene, these compounds were detectable after
subjects, as thymol was already detected in the blank 10 to 30 minutes in plasma as well.20,21 This fast absorp-
samples (plasma and urine) of 1 subject. Thymol was tion of essential oil compounds might have been fa-
rapidly absorbed. Thymol sulfate could be detected in vored by the small size and the lipophilic characteris-
plasma 20 minutes after application. Maximum plasma tics of the molecules.
levels of 93.1 ± 24.5 ng ml–1 (mean ± SD) were reached Maximum plasma concentrations of 93.1 ng ml–1 were
after 1.97 ± 0.77 hours (mean ± SD) (Table I). The reached after 1.97 hours (Table I), which is in accordance

734 • J Clin Pharmacol 2002;42:731-737


AVAILABILITY AND PHARMACOKINETICS OF THYMOL

Table I Pharmacokinetic Data of Total Thymol Absorption and Elimination


in Human Plasma after Single Oral Administration of One Bronchipret® TP Tablet
Mean SD Minimum Value Median Maximum Value Geometric Mean Number

Dose (mg) 1.08


Cmax (ng/ml) 93.11 24.47 55.90 99.01 125.82 90.04 11
tmax (h) 1.97 0.77 0.80 2.03 3.13 1.81 11
t1/2 (h) 10.2 1.4 8.3 9.9 12.9 10.1 11
AUC0 → clast (ng h/ml) 837.3 278.5 456.7 835.8 1281.6 793.6 11
MRTabs (h) 12.6 2.1 8.1 12.5 15.2 12.4 11
MAT (h) 0.53 0.04 0.46 0.54 0.59 0.53 11
CLtot/f (L/h) 1.2 0.3 0.8 1.1 1.8 1.2 11
Vdss/f (L) 14.7 5.1 6.1 13.8 23.3 13.9 11
Vdarea/f (L) 17.7 5.6 10.8 17.2 29.5 16.9 11
Cmax, peak plasma concentration; tmax, time to reach Cmax; t1/2, elimination half-life; AUC0 → clast, area under the concentration-time curve from time 0 to
clast; MRTabs, mean residence time after extravascular administration; MAT, mean absorption time; CLtot/f, total body clearance with respect to unknown
bioavailability f; Vdss/f, volume of distribution at steady state with respect to unknown bioavailability f; Vdarea/f, volume of distribution during the elimination
phase with respect to unknown bioavailability f.

pounds investigated.22-25 The terminal elimination


1000 phase set in after 10 to 12 hours, and thymol could be
mean
detected up to an average of 38 hours. Elimination
median
100
half-life was determined to be 10.2 hours (Table I).
Cp [ng .mL -1]

Other compounds such as 1,8-cineol and α-pinene


showed elimination half-lives of 3.6 and 5.8 hours, re-
10
spectively.20,21 Although plasma levels were detectable
up to an average of 38 hours, the renal elimination of
1 thymol conjugates was completed within 24 hours. This
0 5 10 15 20 25 30 35 40 discrepancy might be due to the fact that very small
tim e [h] amounts of renally eliminated thymol conjugates could
not be quantified any more after 24 hours (< LOQ).
The fact that thymol sulfate is eliminated slowly can
120 also be deduced from the small clearance (Cltot/f) of 1.2
100
mean
L h–1. The renal clearance of 0.271 L h–1 indicates high
median
80
protein binding and/or reabsorption in the kidney, re-
Cp [ng.mL-1]

spectively. The volume of distribution (Vdss/f) of 14.7


60
L indicates that thymol sulfate stays mainly in the
40 extracellular space (Table I). The bioavailability of
20 thymol sulfate after administration of thymol is at least
16%, because 16% of the dose administered was ex-
0
0 5 10 15 20 25 30 35 40
creted into the urine as thymol conjugates. However,
time [h] since Vdss/f is only 14.7 L, a much larger number for f is
likely.
Figure 4. Thymol concentration (after enzymatic cleavage) in Thymol was present in human plasma only in its
plasma (mean ± SD; median) of 11 volunteers after administration of conjugated form. Our LC-MS/MS experiments gave ev-
®
one Bronchipret TP tablet. idence only for thymol sulfate; the glucuronide was not
detected. However, for other phenolic compounds,
there is evidence for both metabolites. After oral appli-
with the tmax from other essential oil compounds after cation of a mixture of phenol, guaiacol, p-cresol, and
oral intake.20,21 Thymol plasma concentrations— after creosol (15-32 mg each), formation of glucuronide
enzymatic hydrolysis of thymol sulfate—showed a and—except for creosol—sulfate was observed in se-
biphasic profile like most of the essential oil com- rum.26 The absence of thymol glucuronide in plasma

HERBAL MEDICINE 735


KOHLERT ET AL

could be the result of lower activity of hepatic UDP- glucuronidation of paracetamol,34 1-naphtol,38 and
glucuronyltransferase compared to sulfotransferase. 4-dimethylaminophenol39 was demonstrated by means
Thus, conjugation to sulfuric acid and glucuronic acid of the isolated perfused rat kidney. Furthermore, vari-
would compete, and only after application of much able activities of UDP-glucuronyltransferases were
higher doses, formation of glucuronide could be ob- demonstrated for different tissues.36 The constant ratio
served.26 Free thymol was not present in human of sulfate and glucuronide over the different urine frac-
plasma, which is in accordance with investigations tions supports the hypothesis of renal cleavage of
from Ogata et al.26 Despite much higher doses of phe- thymol sulfate with subsequent conjugation to
nols, only a small amount of free phenols could be de- glucuronic acid. However, to confirm this hypothesis,
tected in serum. The data available so far indicate that further investigations concerning the mechanism of re-
thymol is systemically available only as thymol sulfate. nal metabolism are necessary.
In urine, both thymol glucuronide and thymol sul- The data available so far indicate that a pharmaco-
fate were present, which confirms previous observa- logical effect observed in vivo after oral administration
tions made by Takada et al.27 After oral application of of a preparation containing thyme extract would be due
thymol to humans and rats, both metabolites were to thymol sulfate. However, the pharmacodynamic ef-
identified in urine, but confirmation of structure by MS fects of this conjugate have not been investigated yet.
was lacking. Phenol applied intravenously to mice re- The pharmacodynamic effect is not necessarily exerted
sulted in excretion of both metabolites, with sulfate be- by conjugates present in plasma as they may be cleaved
ing the main metabolite. Increasing dose shifted the ra- at the site of action by sulfatases. Activity of this group
tio from sulfate toward glucuronide.28 For phenol, of enzymes has been proven in human lung tissue for a
guaiacol, p-cresol, and creosol, formation of both con- number of model compounds.40 Thus, pulmonary
jugates—except for creosol—was observed.26 elimination of thymol despite the absence of free
Free thymol was not found in urine. After oral appli- thymol in human plasma could be explained.41 This
cation of 500 mg menthol to volunteers, no free men- way, free thymol could be effective at the target organ
thol could be detected in urine.29 Unconjugated phe- respiratory system. Evidence of cleavage of sulfate to
nol, guaiacol, p-cresol, and creosol were found in urine thymol would provide a further link between in vitro
only in small amounts, although the dose was more and in vivo results. In addition, the pharmacodynamic
than 15 times higher than applied in our study.26 activity of potential phase I metabolites of thymol as
Data available so far indicate that—despite its ab- observed in rats42 would be of great interest for under-
sence in plasma—thymol glucuronide is eliminated standing its clinical efficacy.
renally. For other compounds (e.g., probenecid), the Dedicated to Professor Otto Sticher on the occasion of his 65th
presence of the glucuronide in urine was proven, al- birthday.
though it was not detected in plasma.30,31 In the case of
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