Document:

<PAGE>

                                                                   EXHIBIT 10.18

[NOTE: CERTAIN PORTIONS OF THIS DOCUMENT HAVE BEEN MARKED TO INDICATE THAT
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CONFIDENTIALITY HAS BEEN REQUESTED FOR THIS CONFIDENTIAL INFORMATION. THE
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CONFIDENTIAL PORTIONS HAVE BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES
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AND EXCHANGE COMMISSION.]
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Clin Sites Logo
                              SERVICES AGREEMENT
                              ------------------

     THIS SERVICES AGREEMENT (this "Agreement") made and entered into as
November 1, 1999, by and between PHARMACEUTICAL DEVELOPMENT ASSOCIATES INC.
("CLINSITES/PDA") a North Carolina corporation, wholly owned subsidiary of
Clinical Site Services Corp. d.b.a. ClinSites, a Tennessee corporation (the
"Company"), and INSPIRE PHARMACEUTICALS, INC. a North Carolina corporation
("Sponsor").

WITNESSETH:
----------

     WHEREAS, the Company is engaged in the business of managing the pre-
clinical, clinical and/or regulatory testing and development ("Product
Development") required in the process of obtaining Food and Drug Administration
("FDA") approval to market or provide post-market support for Products (as
defined herein);

     WHEREAS, Sponsor has need for such Product Development services in order to
obtain FDA approval and to market such Products;

     WHEREAS, Sponsor desires to engage the Company to perform certain Product
Development services of its Products and the Company desires to perform such
Product Development services for Sponsor, all upon the terms and conditions
hereinafter set forth; and

AGREEMENT
---------

     NOW, THEREFORE, in consideration of the mutual covenants contained herein
and other good and valuable consideration, the receipt and sufficiency of which
is hereby acknowledged, Sponsor and the Company hereby agree as follows:

1.   Definitions.  As used in this Agreement, the following terms shall have the
     ------------
following meanings:

     1.1  Products. Products shall mean any proprietary drug, device, or
          --------
          cosmetic product, which is owned by, or to be developed by Sponsor or
          its assignees, licensees or licensors, and which has not currently
          been placed on the market in the United States (or any other
          applicable country) by Sponsor. It shall also include products
          currently on the market if such development is being conducted for an
          indication or application not currently approved by the appropriate
          federal agency(ies), or if the product is a generic drug.

     1.2  Development Plan and Exhibit. Development Plan shall mean an outline
          ----------------------------
          of the Product Development services to be performed, the timetable in
          which it is estimated to be performed, the standards of quality that
          shall apply, the budget within which it is estimated to be
          accomplished and a payment schedule and fees, all set forth on the
          exhibits appended hereto as Exhibits(s) A, B, C or D, etc. for each
          additional Development Plan agreed upon for each project. Each exhibit
          and this Agreement shall collectively and independent from each other
          exhibit, constitute the entire agreement for each Development Plan. To
          the extent any terms set forth in an exhibit shall conflict with the
          terms set forth in this Agreement, the terms of the exhibit shall
          control unless otherwise specifically set forth in the exhibit.

                                      -1-
<PAGE>

     1.3  Protocol.  Protocol shall mean the detailed plan for the
          --------
          accomplishment of an investigational study, including the forms on
          which all data will be recorded.

2.   Scope of Services.
     -----------------

     2.1  Scope of Services. The Company shall provide such Product Development
          ---  -----------------
          services in support of Sponsor Products, as shall be more fully
          described on the Development Plan(s) set forth on Exhibits A, B, etc.
          as attached or appended hereto. Such Development Plans will be based
          on the applicable Protocols, which Protocols shall be considered an
          integral part each respective Development Plan and will be attached as
          Attachment 1 of each Exhibit A, B, etc., as attached and made a part
          hereof. In addition, the Company will use commercially reasonable
          efforts to perform such other services, not included in any
          Development Plan or Protocol, which may be reasonably requested by
          Sponsor in writing.

     2.2  Conduct of Services. The Company shall use its best efforts to
          -------------------
          prepare, perform and complete the Development Plan in accordance with
          the timetable agreed upon between the parties. The Company shall
          conduct Product Development strictly in accordance with the formats
          and procedure set forth in the Company's Standard Operating Procedures
          ("SOP"). The current SOPs, as they apply to this protocol, shall not
          be changed without the prior notification and consent of the Sponsor
          and shall be available for review upon request by the Sponsor. All
          work shall be performed in a workmanlike and professional manner by
          the Company strictly in accordance with the Development Plan,
          Protocols and any applicable federal and state laws and regulations
          and guidelines provided by the FDA to include, but not to be limited
          to, Title 21 of the Code of Federal Regulations, International
          Congress of Harmonization Good Clinical Practice Guidelines as
          reported in the Federal Register on May 9, 1997, Good Laboratory
          Practices, and Good Manufacturing Practices if, and as applicable. The
          Company shall cooperate with any reasonable internal review or audit
          including GCP auditing by the Sponsor or Sponsor's appointee and make
          available to them for examination during normal business hours all
          documentation, data and information relating to Services.

     2.3  Obligation of Contractors and Sub-Contractors. The Company may,
          ---------------------------------------------
          subject to sponsor's prior written consent, sub-contract part of the
          Services with a third party. The Company shall ensure that
          sub-contractor assumes obligations equivalent to those assumed by the
          Company under this Agreement in particular as regards Sections 2.2
          (Conduct of Services), 5 (Record Storage), 6 (Publications), 8
          (Confidentiality) and 9 (Invention and Discoveries). The Company
          acknowledges and confirms that by sub-contracting its rights and
          obligation hereunder it shall not be released from any of its
          contractual obligation under this Agreement and that it shall remain
          fully responsible for the complete performance of such obligations
          under this Agreement.

3.   Fee, Expenses and Payment.
     -------------------------

     Fees and expenses will be in accordance with the terms of each appended
     Exhibit (A,B, etc.).  However, should work be requested which is not
     specifically covered by an appended Exhibit, the following rates shall
     apply.

                                      -2-
<PAGE>

     3.1  Fees.  In consideration of the services to be performed by the
          ----
          Company, Sponsor shall pay to the Company the following fees:

          (a)  For senior management, a rate of * per hour or a daily rate equal
               to *;

          (b)  For project manager, a rate of * per hour or a daily rate of *;

          (c)  For technical, clinical research associate, or clinical
               coordinator's time, a rate of * per hour or a rate equal to * per
               day; or

          (d)  For clerical or secretarial time, a rate of * per hour or a rate
               of * per day.

     3.2  Reimbursement of Expenses.  In addition to the foregoing, Sponsor
          -------------------------
          shall pay the Company its actual out-of-pocket expenses as reasonably
          incurred by the Company in furtherance of its performance hereunder.
          The Company agrees to provide Sponsor with access to such receipts,
          ledgers, and other records as may be reasonably necessary in order for
          Sponsor or its accountants to verify the amount and nature of any such
          expenses.

     3.3  Additional Work. The fees and charges for any follow-on or additional
          ---------------
          work not described in this Agreement or the Development Plan shall be
          performed pursuant to written authorization from Sponsor at the
          Company's then-current rates for such work.

     3.4  Business Travel. All out-of-town business travel will be construed to
          ---------------
          require a minimum of one (1) full day's time.

     3.5  Payment. Sponsor shall pay all fees and expenses owing to the Company
          -------
          hereunder within thirty (30) days after the Company has submitted to
          Sponsor an itemized invoice therfor.

4.   Term and Termination.
     --------------------

4.1  Term. The term of this Agreement shall commence on the date set forth on
     ----
     the first page hereof and shall continue through November 1, 2001 (the
     "Termination Date"), unless terminated earlier by either party in
     accordance with the terms of this Agreement. Exhibit shall become effective
     upon the date of complete execution by the parties and shall terminate upon
     the completion of the services unless earlier terminated in accordance with
     this Section.

4.2  Termination. This Agreement or Exhibit may be terminated for any reason or
     -----------
     for no reason by either party upon sixty (60) day's written notice, or if a
     party breaches any material representation, warranty or obligation provided
     hereunder and the breaching party fails to cure such breach within ten (10)
     days of receipt of such notice, the non-breaching party shall be entitled
     to terminate this agreement immediately upon expiration of such ten (10)
     day period; provided that the cure period for any failure of Sponsor to pay
     fees and charges due hereunder shall be fifteen (15) days from the date of
     receipt by Sponsor of notice of such failure.

*    [CONFIDENTIAL TREATMENT REQUESTED]

                                      -3-
<PAGE>

4.3  Remaining Payments. Within sixty (60) days of termination of this Agreement
     ------------------
     or Exhibit for any reason, except in case of the breach caused by either
     party, the Company shall submit to Sponsor an itemized invoice for any fees
     or expenses theretofore accrued and unpaid by the Sponsor under this
     Agreement or Exhibit. Sponsor, upon payment of accrued amounts so invoiced,
     shall thereafter have no further liability or obligation to the Company
     whatsoever for any further fees or expenses arising hereunder. In the event
     the Company terminates this Agreement or Exhibit because of the breach of
     Sponsor, the Company shall be entitled to reimbursement of all incurred
     expenses, a pro rata payment for work in progress based on the percentage
     of work then completed, plus the full amount of payment attributable to
     studies and testing already furnished by the Company. In the event this
     Agreement or Exhibit is terminated because of a material breach of the
     Agreement or Exhibit by the Company, the Company shall refund to the
     Sponsor all fees and expenses the Sponsor theretofore paid to the Company.

4.4  Renewals. This Agreement may be renewed for successive one (1) year terms
     --------
     (each an "Additional Term") by both parties agreeing in writing to the
     terms and conditions of such renewal sixty (60) days prior to the
     Termination Date or the termination of any Additional Term.

5.   Record Storage.  The Company shall retain in its archive all original data
     --------------
     and other materials arising out of the conduct of the Service by the
     Company for a period of two (2) years after the date of marketing approval
     by the US FDA for the Product.  At the end of the two (2) year period
     referred to above, the Company shall contact the Sponsor for instruction on
     the transfer, retention or disposal of materials.

6.   Publications. The Company and its employees, contractors, consultants
     ------------
     (specifically excluding clinical investigators) and all other contracted
     parties shall not make any publication related to Product Development
     services hereunder without the express written permission of Sponsor. The
     Company's agreements with all clinical investigators shall be constructed
     so as to require an opportunity for review and comment by Sponsor prior to
     any such publication. All data of a confidential or trade secret nature
     will be specifically excluded from such right to publish; provided, that
     Sponsor shall specify in writing to the Company what data it considers
     confidential pursuant to Section 8.1.

7.   Disclaimer of Benefits. It is expressly agreed that all services provided
     ----------------------
     by the Company and its employees, agents, or representatives pursuant to
     this Agreement are performed in the Company's capacity as an independent
     contractor and its employees, agents, or representatives are not employees
     of Sponsor. The Company retains the sole right to hire, discipline,
     evaluate, and terminate its own employees and to set their hours, wages,
     and terms and conditions of employment in accordance with the law and its
     obligations hereunder. Consequently, the Company's employees, agents, or
     representatives are not entitled to and will not receive from Sponsor in
     connection with the services hereunder any insurance coverage, pension,
     profit-sharing, paid vacation, disability or similar benefits normally
     provided by Sponsor to its employees.

8.   Confidentiality.
     ---------------

     8.1  Confidential Information. The Company hereby agrees to treat any
          ------------------------
          confidential or proprietary information obtained from Sponsor and
          generated or created by the Company as a direct and sole result of
          performing the services under this Agreement, including but not

                                      -4-
<PAGE>

          limited to, data, materials, equipment, experience (whether of a
          scientific, technical, engineering, operational or commercial nature),
          designs, specifications, know-how, product uses, processes, formulae,
          costs, financial data, marketing plans and direct selling systems,
          customer lists and technical and commercial information relating to
          customers or business projections used by Sponsor in its business
          (referred to hereinafter collectively as "Confidential Information"),
          whether or not the subject of any patent or patent application.  The
          company recognizes that Confidential Information is the exclusive
          property of Sponsor.

          All such Confidential Information shall be in writing and marked
          "Confidential" or if orally disclosed reduced to writing within thirty
          (30) days of such disclosure and marked accordingly.  Consequently,
          during the term of this Agreement and for 10 years thereafter, the
          Company shall not disclose to any unauthorized person or use in any
          unauthorized manner the Confidential Information.  Notwithstanding the
          foregoing, the Company may disclose Confidential Information to its
          directors, officials, employees and sub-contractors to the extent
          necessary for the performance of the Services under this Agreement,
          provided, however, the Company shall impose upon them the same
          confidentiality obligation the Company has under this Agreement.

          In the event of a breach or a threatened breach by the Company of the
          provisions of this Section 8, Sponsor shall be entitled to seek an
          injunction restraining the Company from disclosing, in whole or in
          part, said Confidential Information and the Company agrees it will not
          oppose the grant of such injunction on the grounds that monetary
          damages are an adequate remedy.  Nothing herein shall  be construed as
          prohibiting Sponsor from pursuing any other remedies available to
          Sponsor at law or equity for any such breach or threatened breach.

     8.2  Exceptions to Confidential Information.  This obligation of
          --------------------------------------
          confidentiality shall not apply to information which:

          (a)  at the time of disclosure is in the public domain;

          (b)  after disclosure becomes part of the public domain by publication
               or otherwise, other than by an unauthorized act or omission by
               the Company, its agents, employees, or subcontractors;

          (c)  was in the possession of the Company at the time of disclosure
               and Company promptly notifies Sponsor in writing of such
               possession and the circumstances relating to the possession, and
               was not acquired directly or indirectly from Sponsor;

          (d)  becomes known to the Company from a third party which has lawful
               access to such information and which may disclose the information
               without any obligation to Sponsor;

          (e)  with Sponsors written permission may be required for obtaining
               essential or desirable authorizations or rights relating to the
               Products from governmental authorities or as otherwise required
               by law.

     8.3  The parties agree to keep confidential and not to disclose to any
          other person, firm or entity this Agreement and discussions hereunder
          unless the other party gives its prior written consent to such
          disclosure.

                                      -5-
<PAGE>

9.   Inventions and Discoveries.
     --------------------------

     9.1  All rights to any and all data, inventions, discoveries, improvements,
          designs, ideas, materials, machines, devices, and the like
          (hereinafter, the "Inventions") developed by the Company under this
          Agreement shall be considered proprietary and confidential and to be
          owned by Sponsor. The Company agrees to promptly disclose all such
          Inventions made by the Company under this Agreement to Sponsor. The
          Company agrees not to disclose the Inventions to a third party or to
          use the Inventions for its own benefit without the prior express
          written consent of Sponsor.

     9.2  The Company agrees to provide Sponsor with all information, know-how
          and materials necessary for Sponsor to obtain and maintain patents or
          other rights in the Inventions in all and all countries designated by
          Sponsor. The writing, designation of countries and filing will be done
          by Sponsor and shall be attached or appended hereto as Appendix A, B,
          C or D, etc. Prosecution of applications and maintenance of patent or
          other rights will be done by Sponsor. All costs and expenses related
          to prosecution of applications or maintenance of patents or other
          rights will be paid by Sponsor.

     10.  Change in Circumstances. The Company and Sponsor agree that medical
          -----------------------
          device, drug, and cosmetic research and development are not exact
          sciences and therefore may be subject to unplanned changes when
          dictated by preliminary data findings, FDA directives, supply and
          logistics problems or any other reason outside of the control of
          either party. If necessitated, the Company and Sponsor agree to
          evaluate the necessity to amend and Development Plans if required by
          any of the factors set forth above or if amendment is not agreed to by
          Sponsor to terminate this Agreement. In such limited circumstances,
          Sponsor's liability for any existing Development Plan will be limited
          solely to costs already incurred, paid or committed to the Company and
          any additional penalties or damages between the parties must be
          specifically set forth in the respective Development Plan (Exhibit).

     11.  General.

          11.1 Notice. Any notice, request, consent or communication under this
               ------
               Agreement shall be effective only if it is in writing and
               personally delivered, sent by certified mail return receipt
               requested, postage prepaid, nationally recognized express
               delivery service with delivery confirmed or telexed or telecopied
               with receipt confirmed, addressed as follows:

               If to Sponsor:

                   INSPIRE Pharmaceuticals Inc.
                   4222 Emperor Boulevard
                   Suite 470
                   Durham, NC 27703

                   Attention:  Dr. Don Kellerman, Vice President for Development

                                      -6-
<PAGE>

          If to The Company:

               8701 Mallard Creek Road
               Charlotte, North Carolina 28262
               Fax No.:  704-593-1805

               Attention:  D. Scott Davis, President

          or at such subsequent address as either party may designate to the
          other in writing, and shall be deemed to have been given as of the
          date when properly set in accordance with the terms hereof.

     11.2 Indemnification; Limited Liability. Sponsor hereby indemnifies and
          ----------------------------------
          agrees to defend and hold harmless the Company, its directors,
          officers, agents, representatives, employees, shareholders, successors
          and assigns, from and against any and all losses, claims, damages,
          expenses or fees (including attorney's fees) arising out of or related
          to any injury, disability or death caused or alleged to have been
          caused as a direct and/or indirect result of the development or
          investigation of any Product on behalf of Sponsor, and any other costs
          and expenses incurred in connection therewith which the Company, or
          any of them, may sustain or incur in any actions by any person,
          organization or governmental entity or agency or otherwise as a result
          of the performance, breach or nonperformance by Sponsor, its agents,
          employees, representatives or assigns of any of Sponsor's obligations
          or duties under this Agreement. However, any such liability, loss or
          damage resulting from negligence, willful malfeasance or failure by
          Company to perform the study in strict compliance with the Protocol,
          SOPs, FDA guidelines and regulations, including, but not limited to
          International Congress of Harmonization-Good Clinical Practices
          (ICH-GCPs), or such failure is by the Company's investigators,
          contractors, or employees, there shall be excluded from this agreement
          any obligation to indemnify or to hold harmless Company, its
          directors, officers, agents, representatives, employees, shareholders,
          successors and assigns. Sponsor agrees to maintain in full force, at
          its sole expense, adequate product liability insurance coverage
          covering Sponsor, Company and its contractors and subcontractors when
          engaged in the development and investigation of Sponsor products.
          SPONSOR AGREES THAT IN NO EVENT SHALL THE COMPANY BE LIABLE FOR ANY
          SPECIAL, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES WHATSOEVER,
          INCLUDING, WITHOUT LIMITATION, THOSE ARISING FROM THE SALE OF THE
          PRODUCTS, ANY BREACH OF THE TERMS AND CONDITIONS OF THIS AGREEMENT,
          ANY SALES ORDER OR AGREEMENT FOR THE SALE OF PRODUCTS OR ANY BREACH OF
          ANY DIRECT OR INDIRECT OR EXPRESS OR IMPLIED WARRANTY OR
          REPRESENTATION BY THE COMPANY.

     11.3 Binding Agreement. This Agreement shall inure to the benefit of and be
          -----------------
          binding on Sponsor, its successors, transferees and assigns, and on
          the Company, its successors, tranferees and assigns.

     11.4 Waiver of Breach. The waiver by either party of a default or breach or
          ----------------
          the failure by either party to claim a default or breach of any
          provision of this Agreement by the other party shall not be or be held
          to be a waiver of any subsequent default or breach of the same
          provision or of any other provision of this Agreement11.5 Amendment.
          This Agreement cannot be amended, changed, ---- --------- modified or
          supplemented in any manner whatsoever, except by another agreement in
          writing executed by the parties hereto.

                                      -7-
<PAGE>

     11.6  Assignment. Neither this Agreement, nor any of the rights, duties or
           ----------
           obligations of Sponsor or the Company hereunder, may be assigned or
           otherwise delegated by Sponsor or the Company, respectively, without
           the prior written consent of Sponsor or the Company, respectively.

     11.7  Headings. The headings of the various sections of this Agreement are
           --------
           inserted merely for the purpose of convenience of the parties and do
           not expressly or by implication limit, define or extend the specific
           terms of the section so designated.

     11.8  Entire Agreement. This Agreement cancels, merges and supersedes all
           ----------------
           prior and contemporaneous understandings and agreements relating to
           the subject matter of this Agreement, written or oral, between the
           parties hereto and contains the entire agreement of the parties
           hereto, and the parties hereto have no agreements, representations or
           warranties relating to the subject matter of this Agreement which are
           not set forth herein. This Agreement shall not be amended, modified
           or supplemented in any manner whatsoever except as otherwise provided
           herein or in writing signed by each of the parties hereto.

     11.9  Severability. Except as otherwise expressly provided herein, if any
           ------------
           provisions of this Agreement shall be adjudicated to be invalid or
           unenforceable in any action or proceeding, whether in its entirety or
           in any portion, then such part shall be deemed amended, if possible,
           or deleted, as the case may be, from the Agreement in order to render
           the remainder of the Agreement and any provision thereof both valid
           and enforceable. Any such deletion or amendment shall apply only
           where the court rendering the same has jurisdiction.

     11.10 Effect of Termination. Termination of this Agreement for any or no
           ---------------------
           reason shall not release either party form liability to the other
           party which at the time of termination shall have already occurred or
           which thereafter may occur in respect of any act or omission prior to
           such termination; nor shall any such termination hereof affect in any
           way the survival of any right, duty or obligation of either party
           hereto which is to survive termination.

     11.11 Survival.  The obligations, rights and duties of the parties under
            --------
           Sections 6, 8, and 9 hereof shall survive the termination of this
           Agreement.

     11.12  Governing Law.  This Agreement and the rights and obligations of the
            -------------
            parties hereunder shall be subject to, governed by and construed and
            interpreted in accordance with, the laws of the State of North
            Carolina without regard to conflicts of laws principles of such
            State.

     11.13  Arbitration.  In the event of any dispute, the senior management of
            -----------
            Sponsor and Company will attempt in good faith to negotiate a
            mutually acceptable resolution. Any dispute arising out of or in
            connection with this Agreement, if not settled amicably between the
            parties hereto, shall be finally settled in accordance with the
            Rules of the American Arbitration Association by one (1) arbitrator
            selected mutually by the parties. If the parties are unable to agree
            on an arbitrator, then each party will select one (1) arbitrator and
            such arbitrators will then select one (1) arbitrator to hear the
            dispute. The arbitrator shall have the power to rule on his own
            competence and to give an award having force of law for the parties.
            The award shall be made in writing and shall be final and binding on
            the parties. The parties shall

                                      -8-
<PAGE>

            undertake to carry out the award without delay. The award may be
            made public only with the consent of both parties. The applicable
            law shall be the law of the United States and the State of North
            Carolina and the place of arbitration shall be, unless otherwise
            agreed between the parties, Charlotte, North Carolina.

     11.14  Compliance with Laws.  Sponsor and the Company agree that in the
            --------------------
            performance of their duties under this Agreement they will not,
            directly or indirectly, violate or assist or cooperate with any
            other party in violating any of the provisions of any applicable
            health, safety, environmental, export, import, tax, antiboycott,
            corrupt practices or other laws of the United States, any state of
            subdivision thereof. Sponsor shall be responsible for obtaining all
            approvals, permits and licenses requisite under the laws of any
            jurisdiction for the sale of the Products, and for registering this
            Agreement where required and obtaining any approvals necessary for
            this Agreement to be effective in accordance with its terms.

     11.15  Integration. This Agreement, to include all appended Exhibits
            -----------
            entered into as of this date constitutes the entire agreement
            between the parties hereto relating to the subject matter hereof and
            no terms or provisions of this Agreement shall be varied or modified
            by any prior or subsequent statement, conduct, or act of either of
            the parties, except that hereafter the parties hereto may, subject
            to Section 10.

            (a)  amend this Agreement by written instruments specifically
                 referring to and executed in the same manner as this Agreement,
                 or

            (b) supplement this Agreement as provided herein by written
                instruments executed by both parties.

     11.16  Force Majeure. Neither party shall be in default hereunder by reason
            -------------
            of its delay in the performance of or failure to perform any of its
            obligations hereunder if such delay or failure is caused by strikes,
            acts of God or the public enemy, riots, incendiaries, interference
            by civil or military authorities, compliance with applicable laws,
            rules or regulations, inability to secure necessary governmental
            priorities for materials, or for any circumstances beyond each
            respective party's reasonable control and without its fault or
            negligence.

     11.17  Conflicts with Other Laws. If any of the terms or provisions of this
            -------------------------
            Agreement are in conflict with any applicable statue or rule of law,
            then such terms or provisions shall be deemed inoperative to the
            extent that they may conflict therewith and shall be modified to
            conform with such statute or rule of law in such forms which most
            closely reflect the commercial and mutual intent of the parties
            under this Agreement.

                                      -9-
<PAGE>

     IN WITNESS WHEREOF, the parties have cause this Agreement to be duly
executed as of the day and year first above written.

THIS CONTRACT CONTAINS A BINDING ARBITRATION PROVISION, WHICH MAY BE
ENFORCED BY THE PARTIES.

                            CLINSITES / PHARMACEUTICAL
                            DEVELOPMENT ASSOCIATES INC.

                            By:     /s/ D. Scott Davis
                                    -------------------------------------------
                                    D. Scott Davis
                                    President

                            INSPIRE PHARMACEUTICALS, INC.

                            By:     /s/ Donald J. Kellerman
                                    -------------------------------------------

                            Name:   Donald J. Kellerman
                                    -------------------------------------------

                            Title:  Vice President, Development
                                    -------------------------------------------

                                      -10-
<PAGE>

                                  EXHIBIT A-99
                                    11/22/99

I.  INTRODUCTION

Per letter from Robin Sylvester dated October 8, 1999, Inspire Pharmaceuticals,
Inc. (INSPIRE) has requested that Pharmaceutical Development Associates, Inc.
(PDA) submit a proposal for the conduct of a Phase II Dry Eye study in patients
with kcratoconjunctivitis sicca (Project/Protocol Number INS365 - Ophthalmic
(03)).  This study is to be conducted at approximately twelve investigative
sites and enroll up to 200 patients to complete 150 evaluable patients.

II. RESPONSIBILITIES

    A. Under the terms of this agreement, INSPIRE's responsibilities would be as
       follows:

       1.  Approval of this Development Plan, and signing of the appropriate
           support documentation
       2.  Final approval of all potential investigators
       3.  Providing for the production & shipment (to the investigator) of all
           clinical supplies
       4.  Providing for all regulatory submissions of FDA documentation
           regarding the study*
       5.  Generation and coordination of collection of regulatory documents*
       6.  Negotiating final grants and budgets with investigators*
       7.  Providing pre-study site evaluation*
       8.  Planning and conduct of the investigator's meeting*
       9.  Providing the medical monitor*
       10. Providing an in-house project manager for coordination and support
       11. Payment for site costs as required (i.e. investigator's fees, patient
           stipends, advertising, IRB fees,
           etc.) as needed.*
       12. Payment of 20% of the estimated budget to PDA upon signing of the
           contract and payment of
           monthly and/or bi-monthly invoices within 30 days of receipt

       *  These services can be provided by PDA if needed, however, they are not
          included in the current budget.

    B. Under the terms of this agreement, PDA responsibilities would be as
       follows:

       1.  Provision of a Lead CRA/Manager for study supervision and
           coordination with sponsor
       2.  Provision of a appropriate clerical support person
       3.  Providing consultation regarding site/investigator identification and
           evaluation/qualification
       4.  Assisting/advising with protocol design and assisting in completion
           of appendices, study manuals, etc.
       5.  Design and production of a study Case Report Form (CRF)
       6.  Performing site initiation, periodic, and close-out  monitoring
           visits for all centers
       7.  Assuring that all data obtained from investigators is accurate and
           complete and that discrepancies are properly resolved and addressed
       8.  Assuring that site investigator binders, IRB and regulatory
           compliance meet  guidelines
       9.  Assuring proper test article accountability is maintained by all
           investigators
       10. Assuring that the study is conducted under ICH/FDA guidelines, PDA
           and/or INSPIRE SOPs, study protocol requirements and INSPIRE
           guidelines
       11. Provision of weekly enrollment update and monthly summary of study
           progress throughout the study
       12. Design of data entry screens
       13. QA/QC and query resolution of clinical data
       14. Double-key entry of all clinical data

                                      -1-
<PAGE>

                           EXHIBIT A-99 (continued)

III.    ESTIMATED TIMETABLE*

                      [CONFIDENTIAL TREATMENT REQUESTED]

        *This timetable may be modified pending agreement between both INSPIRE
         and PDA

IV.     ASSUMPTIONS

It is assumed that the study design, timetables, numbers of sites, numbers of
patients and other key elements of the proposed study will not change
significantly and that investigator budgets are adequate to motivate clinical
investigators.  Since PDA is not choosing clinical investigators we cannot
guarantee investigator site quality and/or enrollment speed.  Should the study
duration be extended through no fault of PDA, monitoring, lead CRA and clerical
time, and other time related costs will increase accordingly.

V.    BUDGET ESTIMATES*

      A.  CRO Management, Monitoring, Administrative (Non-Passthrough) Costs*
Item                                                     Basis              Cost

1. Protocol review/ supplemental material development
2. Case report form development
3. Investigator meeting preparation (presentation of CRF)
4. Personnel time to attend investigator/planning meetings
5. Personnel time for prestudy/initiation visits
6. Personnel time for periodic and close-out visits
7. Site contact and phone reports
8. CRA report writing (2.5 hours/visit)                      [CONFIDENTIAL
9. Study oversight/management (Lead CRA / manager)             TREATMENT
10.Study clerical/administrative support                       REQUESTED]
11.Data validation: completed patients
12.Data validation: screen failure & dropouts
13.Database data-screen design & logic check
   programming/testing
14.Double-key data entry/query resolution
15.Report writing Assistance with integrated report
16.Statistical Services: creation of statistical output for
   final report
   Subtotal

                                      -2-
<PAGE>

                           EXHIBIT A-99 (continued)

IV.  BUDGET ESTIMATE (Continued)*

     B. CRO Support Service (Passthrough) Costs*

Item                                                  Basis                 Cost

1. Travel expenses investigator/planning meetings
2. Travel expenses monitoring
3. Support services (phone, fax, copying, shipping, etc.)      [CONFIDENTIAL
4. Printing/binding of case report form                          TREATMENT
   Subtotal                                                      REQUESTED]

TOTAL ESTIMATED CRO COSTS

   *  These totals are based on initiation of a total of 12 sites.  Additional
      sites and/or patients will increase the final budget figures
      proportionally.  Actual CRO final costs may be increased or decreased in
      the following ways:

      1)  Travel expenses, support services and printing/binding costs as listed
          above are estimates only. Actual expenses will be invoiced to INSPIRE
          as incurred. PDA will use its best efforts to travel and perform study
          overhead functions as cost effectively as possible.

      2)  Personnel costs will vary according to the actual number of monitoring
          visits conducted and day/hours spent at the site. The total number of
          monitoring visits and days spent at the site will not exceed what is
          described above except at the specific request of designated INSPIRE
          personnel.

      3)  Study oversight and administration costs are fixed rate expenses and
          will vary only if the duration of the study changes (terminated early
          or extended), or if the scope of responsibilities is significantly
          changed. This will only occur at the specific request of designated
          INSPIRE personnel.

VI.  MISCELLANEOUS

NOTE: Once this development plan is signed, subsequent modifications shall be
renegotiated as indicated in paragraph 4.4 and 4.5 of the general contractual
"AGREEMENT."  INSPIRE may terminate (cancel) this agreement in its entirety as
described in the "Services Agreement" Section 4, upon payment to PDA of all non-
reimbursed costs incurred/committed which cannot be renegotiated.  Additionally,
if this agreement is terminated without cause, a penalty of 5% of the remaining
unpaid balance will be applied to the contract.

Unless otherwise specified in attached Addenda to this EXHIBIT, the conditions,
rights and obligations of the parties shall be as set forth in the General
Agreement between the parties dated November 1, 1999.

By: /s/ D. Scott Davis, President            By: /s/ Donald J. Kellerman
    -------------------------------              -------------------------------
    D. Scott Davis, President                    Inspire

                                      -3-Exhibit 10.19

[NOTE: CERTAIN PORTIONS OF THIS DOCUMENT HAVE BEEN MARKED TO INDICATE THAT
CONFIDENTIALITY HAS BEEN REQUESTED FOR THIS CONFIDENTIAL INFORMATION. THE
CONFIDENTIAL PORTIONS HAVE BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES
AND EXCHANGE COMMISSION.]

                                   QUOTATION
                                                      [Simbec Logo]
    Dr. Richard Evans
To: Inspire Pharmaceuticals Inc
    4222 Emperor Boulevard
    Suite 470
    Durham
    NC 27703
    USA

DATE:          17 DECEMBER 1999
QUOTATION NO:  RD580/22535 (Issue 1)

          COSTS OF A GAMMA SCINTIGRAPHIC AND PHARMACODYNAMIC STUDY TO
         EVALUATE THE DEPOSITION AND EFFECT OF INS 365 ON MUCOCILIARY
           CLEARANCE IN HEALTHY SMOKERS FOLLOWING INHALATION FROM AN
                 * PULMONARY DELIVERY SYSTEM OR A * NEBULISER

<TABLE>
<CAPTION>
                Item                          Hours         Events    Unit Cost    Per                Number        Total
--------------------------------------------------------------------------------------------------------------------------
<S>                                           <C>           <C>          <C>      <C>                  <C>             <C>
 1  Protocol Design
    Protocol Preparation                                                   *       Study                      0          *
    Protocol Review                                                        *       Study                      1          *
                                                                                                      sub-Total          *
--------------------------------------------------------------------------------------------------------------------------
 2  Case Record Forms
    CRF Design & Preparation                                               *       Page                      48          *
    CRF Review                                                             *       CRF                       12          *
    CRF Binding & Printing - Triplicate                                    *       Page                     576          *
                                                                                                      sub-Total          *
--------------------------------------------------------------------------------------------------------------------------
 3  Ethics/Regulatory
    Presentation to SEC (Ethics Committee)                                 *       Study                      1          *
    ARSAC Submission and Review                                            *       Study                      1          *
                                                                                                      sub-Total          *
--------------------------------------------------------------------------------------------------------------------------
 4  Volunteers
    Volunteer Selection                                                    *       Subject                   12          *
    Volunteer Recruitment                                                  *       Subject                   12          *
    Volunteer Screening: pre Study                                         *       Subject                   12          *
    Volunteer Screening: post Study                                        *       Subject                   12          *
    Volunteer Payments                                                     *       Subject                   12          *
                                                                                                      sub-Total          *
--------------------------------------------------------------------------------------------------------------------------
 5  Study Conduct, Supervision, etc
    Per Visit Per Group of Subjects
    Main Study Days                                24                      *       Days                       1          *
    Medical Supervision                             8                      *       Days                       1          *
    Bed occupancy                                               6          *       Subject/Day                1          *
    Catering                                                    6          *       Subject/Day                1          *
    Per Visit Per Group of Subjects                                                                   sub-Total          *
    Per Study                                                                                         sub-Total          *
--------------------------------------------------------------------------------------------------------------------------
 6  Pharmacy
    Validation Work                                                        *       Study                      1          *
    Laboratory Preparation and supplies                                    *       Study                      1          *
    Dosing                                                                 *       Study Phase                7          *
                                                                                                      sub-Total          *
--------------------------------------------------------------------------------------------------------------------------
                                                                                              Carried forward            *
--------------------------------------------------------------------------------------------------------------------------
</TABLE>

*  [CONFIDENTIAL TREATMENT REQUESTED]

                            SIMEC RESEARCH LIMITED
                    Merthyr Tydfil CF48 4DR United Kingdom
                  Tel: +(0) 1443 690977 Fax +(0) 1443 692494
          VAT No.: GB 289 0833 21  Registered in England No. 1191772
<PAGE>

                                                                Simbec

                                                                Page 2
   RD580/22535  (Issue1)

<TABLE>
<CAPTION>
                         Item                       Hours     Events        Unit Cost     Per            Number      Total (E)
-------------------------------------------------------------------------------------------------------------------------------
                                                                                             Brought forward
-------------------------------------------------------------------------------------------------------------------------------
<C>  <S>                                           <C>       <C>        <C>            <C>             <C>          <C>
  7  Pre -Study Laboratory Testing
     Biochemistry/Haematology/Urinalysis/DoA                                        *  Specimen                 12            *
     Virology                                                                       *  Specimen                 12            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
  8  Other Procedures
     Spirometry (FEV1 and PEFR)                                                     *  Procedure                24            *
     Haemoglobin Saturation                                                         *  Procedure               288            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
  9  Post Study Laboratory Testing
     Biochemistry/Haematology/Urinalysis                                            *  Samples @                12            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
 10  Data Management
     Database and Data Entry Screen design               16                         *  Study                     1            *
     CRF Page Double Data Entry                                                     *  CRF Page                576            *
     Data Validation, queries & resolution                                          *  CRF                      12            *
     Study Close out                                                                *  Subject                  12            *
     Database Lock                                                                  *  Study                     1            *
     Scintigraphic Imaging and Analysis                                             *  Study                     1            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
 11  Quality Assurance
     Protocol, CRF and Reports                           12                         *  Study                     1            *
     Study Monitoring                                    32                         *  Study                     1            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
 12  Reports
     Final Clinical Report Writing                       24                         *  Study                     1            *
     Final Clinical Report production                    12                         *  Study                     1            *
     Scintigraphic Report Generation                                                *  Study                     1            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
 13  Administrative
     Meetings/Monitoring attendance                                                 *  Meeting                   3            *
     Project Management                                  60                         *  Study                     1            *
                                                                                                         sub-Total            *
-------------------------------------------------------------------------------------------------------------------------------
                                                                                        TOTAL ((Pounds) Sterling)             *
-------------------------------------------------------------------------------------------------------------------------------
</TABLE>

   Additional: Packaging and Shipment of Samples/Trial Supplies - at cost plus *
handling charge

*  [CONFIDENTIAL TREATMENT REQUESTED]
<TABLE>
<CAPTION>
------------------------------------------------------------------------------------------------------------------
                                      QUOTATION ACCEPTANCE

         I/We accept this quotation and wish the study to proceed subject to contract
with stipulation of 10 weeks from end of closing to acceptance of draft report agreed to in e-mail dated 20 Dec 99
<S>                          <C>                                                  <C>
Signed:    /s/               Position in Company: Senior Director Pharm Dev       Date: 10 JAN 2000
       ---------------------                     ---------------------------------     ---------------
------------------------------------------------------------------------------------------------------------------
</TABLE>

                             SIMEC RESEARCH LIMITED
                     Merthyr Tydfil CF48 4DR United Kingdom
                   Tel: +(0) 1443 690977 Fax +(0) 1443 692494
        VAT No.: GB 289 0833 21      Registered in England No. 1191772
<PAGE>

                            SIMBEC RESEARCH LIMITED

                         STANDARD TERMS AND CONDITIONS

Projects undertaken by Simbec Research Limited (hereinafter referred to as
Simbec) on behalf of Sponsors are subject to the following terms and conditions.

     DEFINITION OF THE PROJECT

1.   The project is defined as the work agreed to be undertaken by Simbec on
     behalf of the Sponsor, as strictly defined in a Protocol which originates
     from either Simbec or the Sponsor and is agreed by both parties.

     CONFIDENTIALITY

2.   Simbec shall keep confidential and shall not disclose to any third party at
     anytime without the written consent of the Sponsor any information received
     in confidence from the Sponsor or any information arising from the conduct
     of the project by Simbec unless such disclosures are required by law, in
     which event Simbec shall immediately notify the Sponsor in writing.

     REGULATORY REQUIREMENTS

3.   The Project will be performed by Simbec to Good Laboratory Practice (GLP)
     and Good Clinical Practice (GCP) regulations and guidelines as appropriate.
     Simbec agrees that the Sponsor's scientific and quality assurance personnel
     may visit Simbec at any mutually convenient times to monitor the Project.

     VARIATIONS

4.   Simbec will give written notification to the Sponsor in advance of any
     anticipated changes in the implementation of the Project.  No changes shall
     be implemented before the written consent of the Sponsor has been received.

5.   Should Minor changes to the Protocol be advisable during the course of the
     Project, Simbec will obtain the written consent of the Sponsor prior to
     implementing any variations, which will be documented in the form of
     Protocol amendments.
<PAGE>

6.   Any increased charges consequent to variations in the Project as described
     in paragraphs 4 and 5 shall be agreed in writing with the Sponsor prior to
     implementation, and will become payable at the conclusion of the Project.

7.   REPORTS

     Upon completion of the Project Simbec will provide a Draft Final Report of
     the Project.  Comments and queries on the Draft Final Report shall be
     submitted to Simbec within thirty days of receipt.

8.   DATA QUERIES

     In the first year after study completion, data queries will be addressed
     free of charge.  Simbec reserves the right to levy a charge when data
     queries are raised more than one year after the clinical completion of the
     project.  As this will inevitably involve extracting data from the archive,
     a charge will be made to cover the Archivist's and Study Manager's time at
     the rate of [CONFIDENTIAL TREATMENT REQUESTED] per hour.

     TERMINATION

9.   In the event it becomes necessary for the Sponsor to terminate the Project
     prior to completion, the Sponsor will reimburse Simbec with all reasonable
     costs associated with the work carried out to date of termination and other
     costs associated with the termination.

10.  In the event of discussions over Project termination for medical reasons
     the clinical decision of Simbec's Principal Investigator must be final.
     The Principal Investigator may refer to the Simbec Independent Ethics
     Committee for advice and guidance in such circumstances.

     FORCE MAJEURE

11.  In the event of fire, storm, explosion, war, revolution, civil commotion,
     strikes, disease, Acts of God, governmental prohibition or legislation or
     any other contingency beyond the control of either party, which prevents
     Simbec from completing the Project, Simbec will not be held liable by the
     Sponsor.  Simbec shall be reimbursed with all reasonable costs as described
     in paragraph 9 above.

     INDEMNITY

12.  Simbec carries "No Fault" insurance to compensate for injury, accident, ill
     health or death caused by participation in clinical trials without regard
     to proof of negligence and without delay.  Where there is any doubt over
     causation the benefit of doubt will be given to the claimant.
<PAGE>

13.  Simbec is indemnified under this policy against professional negligence in
     the form of injuries or damages caused by failure to exercise all proper
     and reasonable care and skill in the conduct of the Project.

14.  The Sponsor undertakes to provide product liability cover against injury
     and damages arising from the use of products in the Project.

15.  Simbec shall inform the Sponsor of any claims or legal actions arising out
     of the Project without delay.

16.  The obligations of Simbec and Sponsor under these Indemnity clauses shall
     commence at the commencement of the Project and continue in perpetuity.

17.  Provisions for arbitration in the event of disagreement must be agreed with
     Simbec who shall arrange for a Barrister of at least ten years standing to
     be appointed by the Royal College of Physicians as arbiter.

18.  The Sponsor agrees to indemnify and hold harmless Simbec from and against
     any loss, damage, cost or expense (including reasonable legal fees)
     suffered or incurred by Simbec arising out of any claims or proceedings in
     respect of death or bodily injury to Volunteers recruited to the Project
     caused by participation in the Project unless such loss, damage, cost or
     expense is due either to the failure of Simbec to conduct the Project in
     accordance with the Protocol or is as a result of Simbec's negligence,
     wilful default, failure or omission whether by itself, its employees,
     servants or agents.

19.  The Sponsor agrees to indemnify and hold harmless the Principal
     Investigator from and against any loss, damage, cost or expense (including
     reasonable legal fees) suffered or incurred by the Principal Investigator
     arising our of any claims or proceedings in respect of death or bodily
     injury to Volunteers recruited to the Project caused by participation in
     the Project unless such loss, damage, cost or expense is due either to the
     failure of the Principal Investigator to conduct the Project in accordance
     with the Protocol or is as a result of the Principal Investigator's
     negligence, wilful default, failure or omission whether by itself, its
     employees, servants or agents.

20.  Simbec agrees to indemnify and hold harmless the Sponsor from and against
     any loss, damage, cost or expense (including reasonable legal fees)
     suffered or incurred by the Sponsor arising out of any claims or
     proceedings in respect of death or bodily injury to Volunteers recruited to
     the Project caused by Simbec's negligence, wilful default, failure or
     omission in the conduct of the Project whether by itself, its employees,
     servants or agents.

21.  Paragraphs 11 to 16 are in accordance with the spirit of Pages 11-13 of the
     Report of the Royal College of Physicians entitled "Research in Healthy
     Volunteers" published in the College Journal Vol 20 No 4 October 1986.
<PAGE>

     PAYMENT

22.  Other than by separate prior agreement of both parties the schedule of
     payments shall be:

     [CONFIDENTIAL TREATMENT REQUESTED]

     Invoices are payable upon receipt.

23.  The Sponsor shall provide Simbec with the name and address of the person
     authorised to receive invoices and make remittances.

24.  Quotations are valid for sixty days from the date of issue.  Projects which
     are continuing obligations over a long time period may be subject to cost
     review annually and price increases will be notified to the Sponsor prior
     to implementation.

25.  Should payment(s) not be received under the terms of the agreement Simbec
     reserves the right to suspend the Project after due notice in writing to
     the Sponsor.

     COSTS OF POSTPONEMENT AND CANCELLATION

26.  In the event of postponement of the Project by the Sponsor after scheduled
     dates for commencement have been agreed by both parties, Simbec shall be
     reimbursed for all reasonable additional costs incurred, including
     volunteer screening costs, etc.  [CONFIDENTIAL TREATMENT REQUESTED].

27.  In the event of cancellation of the Project by the Sponsor after scheduled
     dates for commencement have been agreed by both parties, Simbec shall be
     reimbursed for all reasonable costs incurred for the Project to date and
     additional costs associated with loss of revenue,. [CONFIDENTIAL TREATMENT
     REQUESTED].

     NOTICE

28.  Any notice required to be given by either party shall be deemed to be
     sufficiently given if sent to the other party by pre-paid post at addresses
     shown on the Quotation.
<PAGE>

     ARBITRATION

29.  In the event of a dispute arising between the parties such differences
     shall be referred to a mutually acceptable arbitrator.

30.  The Terms and Conditions are issued subject to the Laws of England and any
     legal proceedings are subject to the jurisdiction of the English Courts.

                  S t r i v i n g  f o r  E x c e l l e n c e

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