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Klose M, Cristofoletti R, Silva CDM, Mangal N, Turgeon J, Michaud V, Lesko LJ, Schmidt S. Exploring the impact of CYP2D6 and UGT2B7 gene-drug interactions, and CYP-mediated DDI on oxycodone and oxymorphone pharmacokinetics using physiologically-based pharmacokinetic modeling and simulation. Eur J Pharm Sci 2024; 194:106689. [PMID: 38171419 DOI: 10.1016/j.ejps.2023.106689] [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: 09/01/2023] [Revised: 11/30/2023] [Accepted: 12/31/2023] [Indexed: 01/05/2024]
Abstract
Oxycodone is one of the most commonly used opioids to treat moderate to severe pain. It is metabolized mainly by CYP3A4 and CYP2D6, while only a small fraction of the dose is excreted unchanged into the urine. Oxymorphone, the metabolite primarily formed by CYP2D6, has a 40- to 60-fold higher mu-opioid receptor affinity than the parent compound. While CYP2D6-mediated gene-drug-interactions (GDIs) and drug-drug interactions (DDIs) are well-studied, they only account for a portion of the variability in oxycodone and oxymorphone exposure. The combined impact of CYP2D6-mediated GDIs and DDIs, CYP3A4-mediated DDIs, and UGT2B7 GDIs is not fully understood yet and hard to study in head-to-head clinical trials given the relatively large number of scenarios. Instead, we propose the use of a physiologically-based pharmacokinetic model that integrates available information on oxycodone's metabolism to characterize and predict the impact of DDIs and GDIs on the exposure of oxycodone and its major, pharmacologically-active metabolite oxymorphone. To this end, we first developed and verified a PBPK model for oxycodone and its metabolites using published clinical data. The verified model was then applied to determine the dose-exposure relationship of oxycodone and oxymorphone stratified by CYP2D6 and UGT2B7 phenotypes respectively, and administered perpetrators of CYP-based drug interactions. Our simulations demonstrate that the combination of CYP2D6 UM and a UGT2B7Y (268) mutation may lead to a 2.3-fold increase in oxymorphone exposure compared to individuals who are phenotyped as CYP2D6 NM / UGT2B7 NM. The extent of oxymorphone exposure increases up to 3.2-fold in individuals concurrently taking CYP3A4 inhibitors, such as ketoconazole. Inhibition of the CYP3A4 pathway results in a relative increase in the partial metabolic clearance of oxycodone to oxymorphone. Oxymorphone is impacted to a higher extent by GDIs and DDIs than oxycodone. We predict oxymorphone exposure to be highest in CYP2D6 UMs/UGT2B7 PMs in the presence of ketoconazole (strong CYP3A4 index inhibitor) and lowest in CYP2D6 PMs/UGT2B7 NMs in the presence of rifampicin (strong CYP3A4 index inducer) covering a 55-fold exposure range.
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Affiliation(s)
- Marian Klose
- Center for Pharmacometrics & Systems Pharmacology, College of Pharmacy, University of Florida, Florida
| | - Rodrigo Cristofoletti
- Center for Pharmacometrics & Systems Pharmacology, College of Pharmacy, University of Florida, Florida
| | - Carolina de Miranda Silva
- Center for Pharmacometrics & Systems Pharmacology, College of Pharmacy, University of Florida, Florida
| | | | | | - Veronique Michaud
- GalenusRx Inc, Florida, USA; Faculty of Pharmacy, Université de Montréal, Canada
| | - Lawrence J Lesko
- Center for Pharmacometrics & Systems Pharmacology, College of Pharmacy, University of Florida, Florida
| | - Stephan Schmidt
- Center for Pharmacometrics & Systems Pharmacology, College of Pharmacy, University of Florida, Florida.
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Tűz B, Noszál B, Hosztafi S, Mazák K. β-cyclodextrin complex formation and protonation equilibria of morphine and other opioid compounds of therapeutic interest. Eur J Pharm Sci 2022; 171:106120. [PMID: 34999212 DOI: 10.1016/j.ejps.2022.106120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022]
Abstract
The inclusion complex formation of morphine and its 18 opioid derivatives with β-cyclodextrin has been studied using nuclear magnetic resonance spectroscopy. Initially, the protonation equilibria and the acid-base properties of dibasic opioid compounds have been fully characterized. Apparent protonation constants and the relative concentration of the microspecies in cyclodextrin excess were also determined. The 1:1 complex stoichiometry was confirmed by the continuous variation method of Job using UV-VIS spectroscopy. The stability constants of the different protonation forms were determined by 1H NMR titrations. The highest stability was observed in highly alkaline solutions where the amino group is in its unprotonated, neutral state. The structures of the complexes were investigated by two-dimensional ROESY experiments. Based on the stability constants and ROESY experiments, morphine derivatives with longer side chain on the nitrogen atom such as nalbuphine and naltrexone show stronger complexation. The protonation state of the phenolate group, positioned outside the CD cavity, has only a slight influence on the complex stability.
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Affiliation(s)
- Boglárka Tűz
- Department of Pharmaceutical Chemistry, Semmelweis University, Hőgyes Endre u. 9., Budapest H-1092, Hungary
| | - Béla Noszál
- Department of Pharmaceutical Chemistry, Semmelweis University, Hőgyes Endre u. 9., Budapest H-1092, Hungary
| | - Sándor Hosztafi
- Department of Pharmaceutical Chemistry, Semmelweis University, Hőgyes Endre u. 9., Budapest H-1092, Hungary
| | - Károly Mazák
- Department of Pharmaceutical Chemistry, Semmelweis University, Hőgyes Endre u. 9., Budapest H-1092, Hungary.
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Stancil SL, Abdel-Rahman S, Wagner J. Developmental Considerations for the Use of Naltrexone in Children and Adolescents. J Pediatr Pharmacol Ther 2021; 26:675-695. [PMID: 34588931 DOI: 10.5863/1551-6776-26.7.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Abstract
Naltrexone (NTX) is a well-tolerated drug with a wide safety margin and mechanism of action that affords use across a wide variety of indications in adults and children. By antagonizing the opioid reward system, NTX can modulate behaviors that involve compulsivity or impulsivity, such as substance use, obesity, and eating disorders. Evidence regarding the disposition and efficacy of NTX is mainly derived from adult studies of substance use disorders and considerable variability exists. Developmental changes, plausible disease-specific alterations and genetic polymorphisms in NTX disposition, and pharmacodynamic pathways should be taken into consideration when optimizing the use of NTX in the pediatric population. This review highlights the current state of the evidence and gaps in knowledge regarding NTX to facilitate evidence-based pharmacotherapy of mental health conditions, for which few pharmacologic options exist.
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Physicochemical Properties of Zwitterionic Drugs in Therapy. ChemMedChem 2020; 15:1102-1110. [DOI: 10.1002/cmdc.202000164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Indexed: 01/24/2023]
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Meyer J, Del Vecchio G, Seitz V, Massaly N, Stein C. Modulation of μ-opioid receptor activation by acidic pH is dependent on ligand structure and an ionizable amino acid residue. Br J Pharmacol 2019; 176:4510-4520. [PMID: 31355457 PMCID: PMC6932940 DOI: 10.1111/bph.14810] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose Adverse side effects of conventional opioids can be avoided if ligands selectively activate peripheral opioid receptors in injured tissue. Injury and inflammation are typically accompanied by acidification. In this study, we examined influences of low pH and mutation of the ionizable amino acid residue H2976.52 on μ‐opioid receptor binding and signalling induced by the μ‐opioid receptor ligands fentanyl, DAMGO, and naloxone. Experimental Approach HEK 293 cells stably transfected with μ‐opioid receptors were used to study opioid ligand binding, [35S]‐GTPγS binding, and cAMP reduction at physiological and acidic pH. We used μ‐opioid receptors mutated at H2976.52 to A (MOR‐H2976.52A) to delineate ligand‐specific interactions with H2976.52. Key Results Low pH and the mutant receptor MOR‐H2976.52A impaired naloxone binding and antagonism of cAMP reduction. In addition, DAMGO binding and G‐protein activation were decreased under these conditions. Fentanyl‐induced signalling was not influenced by pH and largely independent of H2976.52. Conclusions and Implications Our investigations indicate that low pH selectively impairs μ‐opioid receptor signalling modulated by ligands capable of forming hydrogen bonds with H2976.52. We propose that protonation of H2976.52 at acidic pH reduces binding and subsequent signalling of such ligands. Novel agonists targeting opioid receptors in injured tissue might benefit from lack of hydrogen bond formation with H2976.52.
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Affiliation(s)
- Johanna Meyer
- Department of Experimental Anesthesiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Giovanna Del Vecchio
- Department of Experimental Anesthesiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Viola Seitz
- Department of Experimental Anesthesiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Nicolas Massaly
- Department of Experimental Anesthesiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Christoph Stein
- Department of Experimental Anesthesiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
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Mazák K, Noszál B, Hosztafi S. Advances in the Physicochemical Profiling of Opioid Compounds of Therapeutic Interest. ChemistryOpen 2019; 8:879-887. [PMID: 31312587 PMCID: PMC6610444 DOI: 10.1002/open.201900115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/24/2019] [Indexed: 01/27/2023] Open
Abstract
This review focuses on recent developments in the physicochemical profiling of morphine and other opioids. The acid-base properties and lipophilicity of these compounds is discussed at the microscopic, species-specific level. Examples are provided where this type of information can reveal the mechanism of pharmacokinetic processes at the submolecular level. The role of lipophilicity in quantitative structure-activity relationship (QSAR) studies of opioids is reviewed. The physicochemical properties and pharmacology of the main metabolites of morphine are also discussed. Recent studies indicate that the active metabolite morphine-6-glucuronide (M6G) can contribute to the analgesic activity of systemically administered morphine. The unexpectedly high lipophilicity of M6G partly accounts for its analgesic activity. When administered parenterally, another suspected minor metabolite, morphine-6-sulfate (M6S) has superior antinociceptive effects to those of morphine. However, because sulfate esters of morphine derivatives cannot cross the blood-brain barrier these esters may be good candidates to develop peripheral analgesic drugs.
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Affiliation(s)
- Károly Mazák
- Semmelweis UniversityDepartment of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9.H-1092BudapestHungary
| | - Béla Noszál
- Semmelweis UniversityDepartment of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9.H-1092BudapestHungary
| | - Sándor Hosztafi
- Semmelweis UniversityDepartment of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9.H-1092BudapestHungary
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Romañuk CB, Garro-Linck Y, Alves de Santana MS, Manzo RH, Ayala AP, Monti GA, Chattah AK, Olivera ME. Application of 1-Dimensional and 2-Dimensional Solid-State Nuclear Magnetic Resonance Spectroscopy to the Characterization of Morphine, Morphine Hydrochloride, and Their Hydrates. J Pharm Sci 2017; 106:3033-3040. [DOI: 10.1016/j.xphs.2017.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/24/2017] [Accepted: 05/08/2017] [Indexed: 01/26/2023]
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Mazák K, Noszál B. Passive Membrane Penetration of the Serotonin Precursor 5-Hydroxytryptophan is Controlled by Its Zwitterion. Chem Biodivers 2017; 14. [DOI: 10.1002/cbdv.201700162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Károly Mazák
- Department of Pharmaceutical Chemistry; Semmelweis University; Hőgyes E. u. 9. H-1092 Budapest Hungary
| | - Béla Noszál
- Department of Pharmaceutical Chemistry; Semmelweis University; Hőgyes E. u. 9. H-1092 Budapest Hungary
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Physico-chemical profiling of semisynthetic opioids. J Pharm Biomed Anal 2016; 135:97-105. [PMID: 28012310 DOI: 10.1016/j.jpba.2016.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 11/23/2022]
Abstract
Species-specific acid-base and partition equilibrium constants were experimentally determined for the therapeutically important semisynthetic opioid receptor agonist hydromorphone, dihydromorphine, and mixed agonist-antagonist nalorphine and nalbuphine. The acid-base microequilibria were characterized by combining pH-potentiometry and deductive methods using synthesized auxiliary compounds. Independent of the pH, there are approximately 4.8 times as many zwitterionic microspecies than non-charged ones in nalbuphine solutions, while for nalorphine it is the non-charged form that predominates by the same ratio. The non-charged microspecies is the dominant one also in the case of hydromorphone, although its concentration exceeds only 1.3 times that of its zwitterionic protonation isomer. The pH-independent partition coefficients of the individual microspecies were determined by a combination of experimentally measured, pH-dependent, conditional distribution constants and a custom-tailored evaluation method, using highly similar auxiliary compounds. The pH-independent contribution of the zwitterionic microspecies to the distribution constant is 1380, 1070, 3160 and 72,440 times smaller than that of the inherently more lipophilic non-charged one for hydromorphone, dihydromorphine, nalbuphine and nalorphine, respectively.
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Szöcs L, Orgován G, Tóth G, Kraszni M, Gergó L, Hosztafi S, Noszál B. Site- and species-specific hydrolysis rates of heroin. Eur J Pharm Sci 2016; 89:105-14. [PMID: 27130543 DOI: 10.1016/j.ejps.2016.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/15/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
The hydroxide-catalyzed non-enzymatic, simultaneous and consecutive hydrolyses of diacetylmorphine (DAM, heroin) are quantified in terms of 10 site- and species-specific rate constants in connection with also 10 site- and species-specific acid-base equilibrium constants, comprising all the 12 coexisting species in solution. This characterization involves the major and minor decomposition pathways via 6-acetylmorphine and 3-acetylmorphine, respectively, and morphine, the final product. Hydrolysis has been found to be 18-120 times faster at site 3 than at site 6, depending on the status of the amino group and the rest of the molecule. Nitrogen protonation accelerates the hydrolysis 5-6 times at site 3 and slightly less at site 6. Hydrolysis rate constants are interpreted in terms of intramolecular inductive effects and the concomitant local electron densities. Hydrolysis fraction, a new physico-chemical parameter is introduced and determined to quantify the contribution of the individual microspecies to the overall hydrolysis. Hydrolysis fractions are depicted as a function of pH.
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Affiliation(s)
- Levente Szöcs
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group for Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hőgyes E. u. 9, H-1092 Budapest, Hungary
| | - Gábor Orgován
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group for Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hőgyes E. u. 9, H-1092 Budapest, Hungary
| | - Gergő Tóth
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group for Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hőgyes E. u. 9, H-1092 Budapest, Hungary
| | - Márta Kraszni
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group for Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hőgyes E. u. 9, H-1092 Budapest, Hungary
| | - Lajos Gergó
- Eötvös Loránd University, Faculty of Informatics, Department of Numerical Analysis, Hungary
| | - Sándor Hosztafi
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group for Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hőgyes E. u. 9, H-1092 Budapest, Hungary
| | - Béla Noszál
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group for Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hőgyes E. u. 9, H-1092 Budapest, Hungary.
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Mazák K, Noszál B. Advances in microspeciation of drugs and biomolecules: Species-specific concentrations, acid-base properties and related parameters. J Pharm Biomed Anal 2016; 130:390-403. [PMID: 27066736 DOI: 10.1016/j.jpba.2016.03.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 01/14/2023]
Abstract
The pharmacokinetic and pharmacodynamic behaviour of drugs and the interacting biomolecules are highly influenced by their species-specific physico-chemical properties. The first of such bio-relevant, structure-dependent properties were the species-specific acid-base constants and the co-dependent concentrations, but the past decade brought significant advances to previously uncharted territories, including the experimental determination of species-specific partition coefficients, solubilities and redox equilibrium constants. This review gives an overview of the types and definitions of species-specific physico-chemical and analytical properties. We survey the pertinent literature, the fundamental relationships, and summarize some of our recent work that enabled the determination of species-specific partition coefficients for coexisting, inseparable protonation isomers and pH-independent, microscopic redox equilibrium constants. The thorough insight provided by these species-specific properties improves our understanding of the submolecular mechanism of pharmacokinetic processes. As a result, there are some pieces of clear-cut evidence of practical significance. A few of them are as follows: - passive diffusion into lipophilic media is not necessarily predominated by the non-charged species, contrary to the widespread misbelief. - the reactive microspecies in structure-controlled, highly specific biochemical reactions is not necessarily the major one. - a preventive defence system against oxidative stress can be based upon thiol-disulfide equilibria of custom-tailored redox potentials.
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Affiliation(s)
- Károly Mazák
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9., H-1092 Budapest, Hungary
| | - Béla Noszál
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9., H-1092 Budapest, Hungary.
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