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Hirai T, Aoyama T, Tsuji Y, Ino K, Ikejiri M, Tawara I, Iwamoto T. Pharmacokinetic Model of Drug Interaction of Tacrolimus with Combined Administration of CYP3A4 Inhibitors Voriconazole and Clarithromycin After Bone Marrow Transplantation. Eur J Drug Metab Pharmacokinet 2024:10.1007/s13318-024-00915-2. [PMID: 39313741 DOI: 10.1007/s13318-024-00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND AND OBJECTIVES A pharmacokinetic model has been developed to quantify the drug-drug interactions of tacrolimus with concentration-dependent inhibition of cytochrome P450 (CYP) 3A4 from voriconazole and clarithromycin based on the CYP3A5 and CYP2C19 genotypes. METHODS This retrospective study recruited unrelated bone marrow transplant recipients receiving oral tacrolimus concomitantly with voriconazole and clarithromycin. The published population pharmacokinetic model that implemented genotypes of CYP3A5 (tacrolimus) and CYP2C19 (voriconazole) was integrated. The tested CYP3A4 inhibition models (Sigmoid efficacy maximum [Emax], Emax, log-linear, and linear) were a function of competitive inhibition of voriconazole and mechanism-based inhibition of clarithromycin in a virtual enzyme compartment. RESULTS The total tacrolimus trough concentrations were 119 points, with a median of 4.3 (range: 2.0-9.9) ng/mL (n = 3). The final model comprised the Sigmoid Emax model for voriconazole and clarithromycin, which depicted time-course alterations in tacrolimus concentration and clearance when given voriconazole and clarithromycin. CONCLUSIONS These findings could facilitate the model-informed precision dosing of tacrolimus after unrelated bone marrow transplant.
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Affiliation(s)
- Toshinori Hirai
- Department of Pharmacy, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pharmacy, Tokyo Medical and Dental University Hospital, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takahiko Aoyama
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, 7-7-1, Narashinodai, Funabashi, Chiba, 274-8555, Japan
| | - Yasuhiro Tsuji
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, 7-7-1, Narashinodai, Funabashi, Chiba, 274-8555, Japan
| | - Kazuko Ino
- Department of Hematology and Oncology, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Makoto Ikejiri
- Department of Clinical Laboratory, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Isao Tawara
- Department of Hematology and Oncology, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takuya Iwamoto
- Department of Pharmacy, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
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Saeed MS, Fahd F, Khan F, Chen B, Sadiq R. Human health risk model for microplastic exposure in the Arctic region. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 895:165150. [PMID: 37385486 DOI: 10.1016/j.scitotenv.2023.165150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023]
Abstract
Microplastics enriched with carcinogens like heavy metals, polycyclic aromatic hydrocarbons (PAHs), and their derivatives are ubiquitous in Arctic waters. They contaminate the local land and sea-based food sources, which is a significant health hazard. It is thus imperative to assess the risk posed by them to the nearby communities, which primarily rely on locally available food sources to meet their energy requirements. This paper proposes a novel ecotoxicity model to assess the human health risk posed by microplastics. The region's geophysical and environmental conditions affecting human microplastic intake, along with the human physiological parameters influencing biotransformation, are incorporated into the developed causation model. It investigates the carcinogenic risk associated with microplastic intake in humans via ingestion in terms of incremental excess lifetime cancer risk (IELCR). The model first evaluates microplastic intake and then uses reactive metabolites produced due to the interaction of microplastics with xenobiotic metabolizing enzymes to assess cellular mutations that result in cancer. All these conditions are mapped in an Object-Oriented Bayesian Network (OOBN) framework to evaluate IELCR. The study will provide a vital tool for formulating better risk management strategies and policies in the Arctic region, especially concerning Arctic Indigenous peoples.
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Affiliation(s)
- Mohammad Sadiq Saeed
- Centre for Risk, Integrity, and Safety Engineering (C-RISE) Faculty of Engineering & Applied Science, Memorial University, St John's, NL, Canada A1B 3X5; Mary Kay O'Connor Process Safety Center (MKOPSC), Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, College Station TX 77843, USA
| | - Faisal Fahd
- Centre for Risk, Integrity, and Safety Engineering (C-RISE) Faculty of Engineering & Applied Science, Memorial University, St John's, NL, Canada A1B 3X5
| | - Faisal Khan
- Mary Kay O'Connor Process Safety Center (MKOPSC), Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, College Station TX 77843, USA.
| | - Bing Chen
- Northern Region Persistent Organic Pollution Control Laboratory (NRPOP Lab), Faculty of Engineering & Applied Science, Memorial University, St John's, NL, Canada A1B 3X5
| | - Rehan Sadiq
- School of Engineering, Okanagan Campus, Faculty of Applied Science University of British Columbia, Okanagan, BC, Canada V1V 1V7
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Hong E, Shi A, Beringer P. Drug-drug interactions involving CFTR modulators: a review of the evidence and clinical implications. Expert Opin Drug Metab Toxicol 2023; 19:203-216. [PMID: 37259485 DOI: 10.1080/17425255.2023.2220960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Cystic fibrosis (CF) is characterized by mucus accumulation impairing the lungs, gastrointestinal tract, and other organs. Cystic fibrosis transmembrane conductance regulator (CFTR) modulators (ivacaftor, tezacaftor, elexacaftor, and lumacaftor) significantly improve lung function and nutritional status; however, they are substrates, inhibitors, and/or inducers of certain CYP enzymes and transporters, raising the risk of drug-drug interactions (DDI) with common CF medications. AREAS COVERED A literature search was conducted for DDIs involving CFTR modulators by reviewing new drug applications, drug package inserts, clinical studies, and validated databases of substrates, inhibitors, and inducers. Clinically, CYP3A inducers and inhibitors significantly decrease and increase systemic concentrations of elexacaftor/tezacaftor/ivacaftor, respectively. Additionally, lumacaftor and ivacaftor alter concentrations of CYP3A and P-gp substrates. Potential DDIs without current clinical evidence include ivacaftor and elexacaftor's effect on CYP2C9 and OATP1B1/3 substrates, respectively, and OATP1B1/3 and P-gp inhibitors' effect on tezacaftor. A literature review was conducted using PubMed. EXPERT OPINION Dosing recommendations for CFTR modulators with DDIs are relatively comprehensive; however, recommendations on timing of dosing transition of CFTR modulators when CYP3A inhibitors are initiated or discontinued is incomplete. Certain drug interactions may be managed by choosing an alternative treatment to avoid/minimize DDIs. Next generation CFTR modulator therapies under development are expected to provide increased activity with reduced DDI risk.
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Affiliation(s)
- Eunjin Hong
- Department of Clinical Pharmacy, USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - Alan Shi
- Department of Clinical Pharmacy, USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - Paul Beringer
- Department of Clinical Pharmacy, USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
- USC Anton Yelchin CF Clinic, Los Angeles, CA, USA
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Dual Inhibition of CYP3A4 by Voriconazole and Clarithromycin Influences Tacrolimus Pharmacokinetics: Case Series Study. Eur J Drug Metab Pharmacokinet 2022; 47:889-893. [PMID: 35978155 DOI: 10.1007/s13318-022-00790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 12/13/2022]
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5
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Kapetas AJ, Abuhelwa AY, Sorich MJ, McKinnon RA, Rodrigues AD, Rowland A, Hopkins AM. Evidence-Based Guidelines for Drug Interaction Studies: Model-Informed Time Course of Intestinal and Hepatic CYP3A4 Inhibition by Clarithromycin. AAPS JOURNAL 2021; 23:104. [PMID: 34467456 DOI: 10.1208/s12248-021-00632-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/29/2021] [Indexed: 01/10/2023]
Abstract
Drug-drug interaction (DDI) studies are mandated in drug development; however, protocols for evaluating the impact of cytochrome P450 (CYP) inhibition on new molecular entities are currently inconsistent. This study utilised validated physiologically based pharmacokinetic (PBPK) software to define the optimal dose, frequency, and duration of clarithromycin to achieve optimal characterisation of CYP3A4 inhibition in a study population. The Simcyp® Simulator (Version 19.0) was used to simulate clarithromycin-mediated CYP3A4 inhibition in healthy virtual cohorts. Between trial variability in magnitude and time course of CYP3A4 activity was assessed following clarithromycin dosing strategies obtained from the University of Washington Drug Interaction Database. Heterogeneity in CYP3A4 inhibition was evaluated across sex, race, and age. Literature review identified 500 mg twice daily for 5 days as the most common clarithromycin dosing protocol for CYP3A4 inhibition studies. On simulation, clarithromycin 500 mg twice daily resulted in the largest steady-state inhibition of hepatic (percent mean inhibition [95%CI] = 80 [77-83]) and small intestine (94 [94-95]) CYP3A4 activity (as compared to 500 mg once daily, 400 mg once/twice daily, or 250 mg once/twice daily). Additionally, 500 mg twice daily was associated with the shortest time for 90% of individuals to reach 90% of their minimum hepatic (4 days) and small intestine (1 days) CYP3A4 activity. The study presented herein supports that clarithromycin dosing protocol of 500 mg twice daily for 5 days is sufficient to achieve maximal hepatic and small intestine CYP3A4 inhibition. These findings were consistent between sex, race, and age differences.
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Affiliation(s)
- Asha J Kapetas
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Ahmad Y Abuhelwa
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia.
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Ross A McKinnon
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - A David Rodrigues
- ADME Science, Pfizer Worldwide Research and Development, Groton, CT, USA
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
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Rodrigues AD, Rowland A. Profiling of Drug-Metabolizing Enzymes and Transporters in Human Tissue Biopsy Samples: A Review of the Literature. J Pharmacol Exp Ther 2019; 372:308-319. [DOI: 10.1124/jpet.119.262972] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
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Abu Mellal A, Hussain N, Said AS. The clinical significance of statins-macrolides interaction: comprehensive review of in vivo studies, case reports, and population studies. Ther Clin Risk Manag 2019; 15:921-936. [PMID: 31413581 PMCID: PMC6661989 DOI: 10.2147/tcrm.s214938] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
The objectives of this article were to review the mechanism and clinical significance of statins-macrolides interaction, determine which combination has the highest risk for the interaction, and identify key patients' risk factors for the interaction in relation to the development of muscle toxicity. A literature review was conducted in PubMed and Embase (1946 to December 2018) using combined terms: statins - as group and individual agents, macrolides - as group and individual agents, drug interaction, muscle toxicity, rhabdomyolysis, CYP3A4 inhibitors, and OAT1B inhibitors, with forward and backward citation tracking. Relevant English language in vivo studies in healthy volunteers, case reports, and population studies were included. The interaction between statins and macrolides depends on the type of statin and macrolide used. The mechanism of the interaction is due to macrolides' inhibition of CYP3A4 isoenzyme and OAT1B transporter causing increased exposure to statins. The correlation of this increased statin's exposure to the development of muscle toxicity could not be established, unless the patient had other risk factors such as advanced age, cardiovascular diseases, renal impairment, diabetes, and the concomitant use of other CYP3A4 inhibitors. Simvastatin, lovastatin, and to lesser extent atorvastatin are the statins most affected by this interaction. Rosuvastatin, fluvastatin, and pravastatin are not significantly affected by this interaction. Telithromycin, clarithromycin, and erythromycin are the most "offending" macrolides, while azithromycin appears to be safe to use with statins. This review presented a clear description of the clinical significance of this interaction in real practice. Also, it provided health care professionals with clear suggestions and recommendations on how to overcome this interaction. In conclusion, understanding the different characteristics of each statin and macrolide, as well as key patients' risk factors, will enable health care providers to utilize both groups effectively without compromising patient safety.
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Affiliation(s)
- Abdallah Abu Mellal
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nadia Hussain
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, UAE
| | - Amira Sa Said
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, UAE
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Labachevski N, Zafirov D, Trojacanec J, Jakjovski K, Atanasovska E, Gjorgjievska K, Kolovcevski N, Labachevski B, Svinarov D. Comparative single-dose bioavailability study of two 500 mg clarithromycin tablet formulations in healthy volunteers under fasting condition. MAKEDONSKO FARMACEVTSKI BILTEN 2019. [DOI: 10.33320/maced.pharm.bull.2019.65.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Clarithromycin is a semi-synthetic macrolide antibiotic, chemically 6-0-methylerythromycin, formulated as immediate-release tablets, extended-release tablets, and granules for oral suspension.
The objective of this study was to evaluate and compare the relative bioavailability, and therefore the bioequivalence of Clarithromycin 500 mg test formulation versus a reference Klacid® forte 500 mg formulation, following a single dose administration under fasting conditions.
The study was a single center, open, single dose, randomized, two-way crossover study in healthy male volunteers, with a wash-out period of one week between study periods. Twenty-four male healthy volunteers, aged 18-49 years were included into study. Blood samples for determination of clarithromycin and 14-OH clarithromycin concentrations were withdrawn at zero (pre-drug administration), 0.33, 0.66, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 12, 24 and 36 hours post-drug administration.
The determination of clarithromycin and 14-OH clarithromycin concentrations in plasma was performed using validated LC/MS/MS method and internal standardization after liquid/liquid extraction with methyl t-butyl ether.
The test formulation of clarithromycin, dosed at 500 mg is bioequivalent for primary clarithromycin and 14-OH clarithromycin parameters (Cmax, AUC0-t and AUC0-∞) to the reference formulation after a single oral administration of 500 mg clarithromycin. Both medications were well tolerated with no serious adverse events. Thus, in view of the clinical use, both formulations are exchangeable without restrictions.
Keywords: clarithromycin, 14-OH clarithromycin, bioavailability, bioequivalence study, single-dose
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Affiliation(s)
- Nikola Labachevski
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Dimche Zafirov
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Jasmina Trojacanec
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Krume Jakjovski
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Emilija Atanasovska
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Kalina Gjorgjievska
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Nikola Kolovcevski
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Bojan Labachevski
- Department of Preclinical and Clinical Pharmacology and Toxicology, Ss. Cyril and Methodius University, Medical Faculty, 50 divizija, 1000 Skopje, Republic of North Macedonia
| | - Dobrin Svinarov
- Central Laboratory of TDM & Clinical Pharmacology, Alexander Univ. Hospital, Faculty of Medicine, Medical University of Sofia, Blvd. Akademik Ivan Evstratiev Geshov 15, 1431 Sofia, Republic of Bulgaria
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Dias FR, Novais JS, Devillart TADNS, da Silva WA, Ferreira MO, Loureiro RDS, Campos VR, Ferreira VF, de Souza MC, Castro HC, Cunha AC. Synthesis and antimicrobial evaluation of amino sugar-based naphthoquinones and isoquinoline-5,8-diones and their halogenated compounds. Eur J Med Chem 2018; 156:1-12. [DOI: 10.1016/j.ejmech.2018.06.050] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 11/25/2022]
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10
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Umehara KI, Huth F, Won CS, Heimbach T, He H. Verification of a physiologically based pharmacokinetic model of ritonavir to estimate drug-drug interaction potential of CYP3A4 substrates. Biopharm Drug Dispos 2018; 39:152-163. [DOI: 10.1002/bdd.2122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Ken-ichi Umehara
- PK Sciences, Novartis Institutes for BioMedical Research; CH-4002 Basel Switzerland
| | - Felix Huth
- PK Sciences, Novartis Institutes for BioMedical Research; CH-4002 Basel Switzerland
| | - Christina S. Won
- PK Sciences, Novartis Institutes for BioMedical Research; East Hanover NJ 07936 USA
| | - Tycho Heimbach
- PK Sciences, Novartis Institutes for BioMedical Research; East Hanover NJ 07936 USA
| | - Handan He
- PK Sciences, Novartis Institutes for BioMedical Research; East Hanover NJ 07936 USA
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11
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Pakkir Maideen NM, Manavalan G, Balasubramanian K. Drug interactions of meglitinide antidiabetics involving CYP enzymes and OATP1B1 transporter. Ther Adv Endocrinol Metab 2018; 9:259-268. [PMID: 30181852 PMCID: PMC6116761 DOI: 10.1177/2042018818767220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/16/2018] [Indexed: 12/11/2022] Open
Abstract
Meglitinides such as repaglinide and nateglinide are useful to treat type 2 diabetes patients who follow a flexible lifestyle. They are short-acting insulin secretagogues and are associated with less risk of hypoglycemia, weight gain and chronic hyperinsulinemia compared with sulfonylureas. Meglitinides are the substrates of cytochrome P450 (CYP) enzymes and organic anion transporting polypeptide 1B1 (OATP1B1 transporter) and the coadministration of the drugs affecting them will result in pharmacokinetic drug interactions. This article focuses on the drug interactions of meglitinides involving CYP enzymes and OATP1B1 transporter. To prevent the risk of hypoglycemic episodes, prescribers and pharmacists must be aware of the adverse drug interactions of meglitinides.
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12
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Greenblatt DJ. Mechanisms and Consequences of Drug-Drug Interactions. Clin Pharmacol Drug Dev 2017; 6:118-124. [DOI: 10.1002/cpdd.339] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- David J. Greenblatt
- Program in Pharmacology and Experimental Therapeutics; Tufts University School of Medicine; Boston MA USA
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13
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Berlin S, Kirschbaum A, Spieckermann L, Oswald S, Keiser M, Grube M, Venner M, Siegmund W. Pharmacological indices and pulmonary distribution of rifampicin after repeated oral administration in healthy foals. Equine Vet J 2017; 49:618-623. [DOI: 10.1111/evj.12662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
- S. Berlin
- Department of Clinical Pharmacology Centre of Drug Absorption and Transport (C_DAT) University Medicine of Greifswald Greifswald Germany
| | | | | | - S. Oswald
- Department of Clinical Pharmacology Centre of Drug Absorption and Transport (C_DAT) University Medicine of Greifswald Greifswald Germany
| | - M. Keiser
- Department of Clinical Pharmacology Centre of Drug Absorption and Transport (C_DAT) University Medicine of Greifswald Greifswald Germany
| | - M. Grube
- Department of General Pharmacology Centre of Drug Absorption and Transport (C_DAT) University Medicine of Greifswald Greifswald Germany
| | - M. Venner
- Veterinary Clinic for Horses Destedt Germany
| | - W. Siegmund
- Department of Clinical Pharmacology Centre of Drug Absorption and Transport (C_DAT) University Medicine of Greifswald Greifswald Germany
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Moj D, Hanke N, Britz H, Frechen S, Kanacher T, Wendl T, Haefeli WE, Lehr T. Clarithromycin, Midazolam, and Digoxin: Application of PBPK Modeling to Gain New Insights into Drug–Drug Interactions and Co-medication Regimens. AAPS JOURNAL 2016; 19:298-312. [DOI: 10.1208/s12248-016-0009-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/25/2016] [Indexed: 12/26/2022]
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Management of Tacrolimus-Telaprevir Drug-Drug Interaction in a Liver Transplant Patient With Hepatitis C Virus: Practical Considerations. Transplantation 2015; 99:e163-4. [PMID: 26308424 DOI: 10.1097/tp.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Greenblatt DJ, Harmatz JS. Ritonavir is the best alternative to ketoconazole as an index inhibitor of cytochrome P450-3A in drug-drug interaction studies. Br J Clin Pharmacol 2015; 80:342-50. [PMID: 25923589 DOI: 10.1111/bcp.12668] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 12/16/2022] Open
Abstract
AIMS The regulatory prohibition of ketoconazole as a CYP3A index inhibitor in drug-drug interaction (DDI) studies has compelled consideration of alternative inhibitors. METHODS The biomedical literature was searched to identify DDI studies in which oral midazolam (MDZ) was the victim, and the inhibitory perpetrator was either ketoconazole, itraconazole, clarithromycin, or ritonavir. The ratios (RAUC ) of total area under the curve (AUC) for MDZ with inhibitor divided by MDZ AUC in the control condition were aggregated across individual studies for each inhibitor. RESULTS Mean (± SE) RAUC values were: ketoconazole (15 studies, 131 subjects), 11.5 (±1.2); itraconazole (five studies, 48 subjects), 7.3 (±1.0); clarithromycin (five studies, 73 subjects), 6.5 (±10.9); and ritonavir (13 studies, 159 subjects), 14.5 (±2.0). Differences among inhibitors were significant (F = 5.31, P < 0.005). RAUC values were not significantly related to inhibitor dosage or to duration of inhibitor pre-exposure prior to administration of MDZ. CONCLUSIONS Ritonavir produces CYP3A inhibition equivalent to or greater than ketoconazole, and is the best index CYP3A inhibitor alternative to ketoconazole. Cobicistat closely resembles ritonavir in structure and function, and can also be considered. Itraconazole and clarithromycin are not suitable alternatives since they do not produce inhibition comparable with ketoconazole or ritonavir, and have other significant disadvantages as well.
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Affiliation(s)
- David J Greenblatt
- From the Program in Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Sackler School of Graduate Biomedical Sciences, Boston, MA, USA
| | - Jerold S Harmatz
- From the Program in Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Sackler School of Graduate Biomedical Sciences, Boston, MA, USA
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Okada K, Chikumi H, Takata M, Yamaguchi K, Makino H, Kitaura T, Nakamoto M, Yamasaki A, Igishi T, Burioka N, Shimizu E. Effect of Clarithromycin on the Expression of UL16-Binding Protein 2 in Human Cells. Yonago Acta Med 2015; 58:31-38. [PMID: 26190895 PMCID: PMC4502423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Clarithromycin is a macrolide antibiotic that possesses anti-inflammatory and immunomodulatory properties. Although recent data suggests that macrolide antibiotics enhance Pseudomonas aeruginosa clearance from the lung, involving natural killer (NK) T cells in this process by activating the NKG2D-NKG2D ligand system, the precise underlying mechanism is still unclear. In this study, we examined the effect of clarithromycin on a potent NKG2D ligand, UL16-binding protein 2 (ULBP2), in the lung and its shedding mechanism. METHODS The gene expressions of ULBP2 and the shredder proteinases of ULBP2, a disintegrin and metalloproteinase domain 10 (ADAM10) and ADAM17, were measured using real-time PCR. The cell surface ULBP2 expression was measured by flow cytometry. The amount of solubilized ULBP2 (sULBP2) was measured using an ELISA. The activity of ADAM17 was examined by measurement of fluorescence intensity from the fluorescence resonance energy transfer peptide substrate cleaved by ADAM17. RESULTS Clarithromycin significantly induced transcription of ULBP2 and ADAM17 in both A549 and LCSC #2 cells, which endogenously express minimal and abundant levels of ULBP2, respectively. However, there was no significant change on transcription of ADAM10. The same tendency was observed when LCSC #2 cells were treated with tumor necrosis factoralpha processing inhibitor-2 to inhibit ADAM17 activity. The amount of sULBP2 was significantly decreased in both A549 and LCSC #2 cells by treatment with clarithromycin. Finally, clarithromycin significantly inhibited the activity of ADAM17 in LCSC #2 cells. CONCLUSION These findings suggest that clarithromycin induces ULBP2 expression and reduces the amount of sULBP2, by possibly inhibiting the activity of the potent ULBP2-shedding enzyme ADAM17. Because these changes in ULBP2 and sULBP2 levels could activate NKT cells, this finding might indicate a novel mechanism by which clarithromycin improves the clearance of P. aeruginosa in chronic respiratory diseases.
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Affiliation(s)
- Kensaku Okada
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hiroki Chikumi
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan ; †Center for Infectious diseases, Tottori University Hospital, Yonago 683-8504, Japan
| | - Miyako Takata
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kosuke Yamaguchi
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Haruhiko Makino
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tsuyoshi Kitaura
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Masaki Nakamoto
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan ; †Center for Infectious diseases, Tottori University Hospital, Yonago 683-8504, Japan
| | - Akira Yamasaki
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tadashi Igishi
- †Center for Infectious diseases, Tottori University Hospital, Yonago 683-8504, Japan
| | - Naoto Burioka
- ‡Department of Pathological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Eiji Shimizu
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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Alshammari TM. Drug safety: The concept, inception and its importance in patients' health. Saudi Pharm J 2014; 24:405-12. [PMID: 27330371 PMCID: PMC4908051 DOI: 10.1016/j.jsps.2014.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/28/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Drug safety is one of the hottest topics in daily medical practice, particularly with regard to approving new medication or questioning the possibility of withdrawing a drug from the market. AIM The aim of this review is to highlight the importance of the drug safety concept and its impact on patients' health. METHODS A literature search was conducted using Pubmed®, EMBASE®, EBSCO and Medline in the period between 1980 and 2013. The terms used in the search included "Drug Safety", "Medication Safety", "Patient Safety", "Drug Interaction", "Drug Pharmacokinetic", and "Adverse Drug Reaction". All retrieved abstracts were evaluated within the context of the review objectives. The full texts of the selected articles were included in this review. Studies in non-English language were excluded in this review. RESULTS Since the early days of the past century, many acts, laws, or amendments have been created to make sure that approved drugs are first safe and then effective. Furthermore, these regulations are continuing to change to make sure that these drugs have a positive benefit-risk balance. Personalized medicine should be considered when medications are given to patients because the pharmacokinetic process inside the body varies from patient to patient and from one specific disease state to another. However, adverse drug reactions can be minimized if more precautions are taken by healthcare professionals, especially including the patient as one pillar of the therapeutic plan and providing more patient counseling, which will improve drug safety. CONCLUSION The drug safety concept has earned a lot of attention during the past decade due to the fact it plays a major role in patients' health. Recent laws stress this concept should be included in the process of new medications' approval and continued conduct of post-marketing drug evaluations. Benefit-risk assessment should be considered by all health care professionals when they need to give specific drugs to specific groups of patients. Therefore, more care should be given to some patients, such as pregnant women, children and the elderly, since they are considered vulnerable populations.
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Hendrikx JJMA, Lagas JS, Wagenaar E, Rosing H, Schellens JHM, Beijnen JH, Schinkel AH. Oral co-administration of elacridar and ritonavir enhances plasma levels of oral paclitaxel and docetaxel without affecting relative brain accumulation. Br J Cancer 2014; 110:2669-76. [PMID: 24781280 PMCID: PMC4037831 DOI: 10.1038/bjc.2014.222] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/19/2014] [Accepted: 03/27/2014] [Indexed: 11/09/2022] Open
Abstract
Background: The intestinal uptake of the taxanes paclitaxel and docetaxel is seriously hampered by drug efflux through P-glycoprotein (P-gp) and drug metabolism via cytochrome P450 (CYP) 3A. The resulting low oral bioavailability can be boosted by co-administration of P-gp or CYP3A4 inhibitors. Methods: Paclitaxel or docetaxel (10 mg/kg) was administered to CYP3A4-humanised mice after administration of the P-gp inhibitor elacridar (25 mg kg−1) and the CYP3A inhibitor ritonavir (12.5 mg kg−1). Plasma and brain concentrations of the taxanes were measured. Results: Oral co-administration of the taxanes with elacridar increased plasma concentrations of paclitaxel (10.7-fold, P<0.001) and docetaxel (four-fold, P<0.001). Co-administration with ritonavir resulted in 2.5-fold (paclitaxel, P<0.001) and 7.3-fold (docetaxel, P<0.001) increases in plasma concentrations. Co-administration with both inhibitors simultaneously resulted in further increased plasma concentrations of paclitaxel (31.9-fold, P<0.001) and docetaxel (37.4-fold, P<0.001). Although boosting of orally applied taxanes with elacridar and ritonavir potentially increases brain accumulation of taxanes, we found that only brain concentrations, but not brain-to-plasma ratios, were increased after co-administration with both inhibitors. Conclusions: The oral availability of taxanes can be enhanced by co-administration with oral elacridar and ritonavir, without increasing the brain penetration of the taxanes.
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Affiliation(s)
- J J M A Hendrikx
- 1] Department of Pharmacy and Pharmacology, Slotervaart Hospital, PO 90440, 1006 BK Amsterdam, The Netherlands [2] Division of Molecular Oncology, The Netherlands Cancer Institute, PO 90203, 1006 BE Amsterdam, The Netherlands
| | - J S Lagas
- Department of Pharmacy and Pharmacology, Slotervaart Hospital, PO 90440, 1006 BK Amsterdam, The Netherlands
| | - E Wagenaar
- Division of Molecular Oncology, The Netherlands Cancer Institute, PO 90203, 1006 BE Amsterdam, The Netherlands
| | - H Rosing
- Department of Pharmacy and Pharmacology, Slotervaart Hospital, PO 90440, 1006 BK Amsterdam, The Netherlands
| | - J H M Schellens
- 1] Department of Clinical Pharmacology, The Netherlands Cancer Institute, PO 90203, 1006 BE Amsterdam, The Netherlands [2] Department of Pharmaceutical Sciences, Utrecht University, PO 80082, 3508 TB Utrecht, The Netherlands
| | - J H Beijnen
- 1] Department of Pharmacy and Pharmacology, Slotervaart Hospital, PO 90440, 1006 BK Amsterdam, The Netherlands [2] Department of Pharmaceutical Sciences, Utrecht University, PO 80082, 3508 TB Utrecht, The Netherlands
| | - A H Schinkel
- Division of Molecular Oncology, The Netherlands Cancer Institute, PO 90203, 1006 BE Amsterdam, The Netherlands
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Holmberg MT, Tornio A, Joutsi-Korhonen L, Neuvonen M, Neuvonen PJ, Lassila R, Niemi M, Backman JT. Grapefruit juice markedly increases the plasma concentrations and antiplatelet effects of ticagrelor in healthy subjects. Br J Clin Pharmacol 2014; 75:1488-96. [PMID: 23126367 DOI: 10.1111/bcp.12026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/31/2012] [Indexed: 12/21/2022] Open
Abstract
AIM This study examined the effects of grapefruit juice on the new P2Y12 inhibitor ticagrelor, which is a substrate of CYP3A4 and P-glycoprotein. METHODS In a randomized crossover study, 10 healthy volunteers ingested 200 ml of grapefruit juice or water thrice daily for 4 days. On day 3, they ingested a single 90 mg dose of ticagrelor. RESULTS Grapefruit juice increased ticagrelor geometric mean peak plasma concentration (Cmax ) to 165% (95% confidence interval 147, 184%) and area under the concentration-time curve (AUC(0,∞)) to 221% of control (95% confidence interval 200, 245%). The Cmax and AUC(0,34 h) (P < 0.05) but not the AUC(0,∞) of the active metabolite C12490XX were decreased significantly. Grapefruit juice had a minor effect on ticagrelor elimination half-life prolonging it from 6.7 to 7.2 h (P = 0.036). In good correlation with the elevated plasma ticagrelor concentrations, grapefruit juice enhanced the antiplatelet effect of ticagrelor, assessed with VerifyNow® and Multiplate® methods, and postponed the recovery of platelet reactivity. CONCLUSIONS Grapefruit juice increased ticagrelor exposure by more than two-fold, leading to an enhanced and prolonged ticagrelor antiplatelet effect. The grapefruit juice-ticagrelor interaction seems clinically important and indicates the significance of intestinal metabolism to ticagrelor pharmacokinetics.
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Affiliation(s)
- Mikko T Holmberg
- Department of Clinical Pharmacology, University of Helsinki and HUSLAB, Helsinki, Finland
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Abstract
This chapter describes the types of irreversible inhibition of drug-metabolizing enzymes and the methods commonly employed to quantify the irreversible inhibition and subsequently predict the extent and time course of clinically important drug-drug interactions.
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Affiliation(s)
- Michael Mohutsky
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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Kakuda TN, Van Solingen-Ristea RM, Onkelinx J, Stevens T, Aharchi F, De Smedt G, Peeters M, Leopold L, Hoetelmans RM. The effect of single- and multiple-dose etravirine on a drug cocktail of representative cytochrome P450 probes and digoxin in healthy subjects. J Clin Pharmacol 2013; 54:422-31. [DOI: 10.1002/jcph.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/17/2013] [Indexed: 11/11/2022]
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