1
|
Lim SYM, Al Bishtawi B, Lim W. Role of Cytochrome P450 2C9 in COVID-19 Treatment: Current Status and Future Directions. Eur J Drug Metab Pharmacokinet 2023; 48:221-240. [PMID: 37093458 PMCID: PMC10123480 DOI: 10.1007/s13318-023-00826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
The major human liver drug metabolising cytochrome P450 (CYP) enzymes are downregulated during inflammation and infectious disease state, especially during coronavirus disease 2019 (COVID-19) infection. The influx of proinflammatory cytokines, known as a 'cytokine storm', during severe COVID-19 leads to the downregulation of CYPs and triggers new cytokine release, which further dampens CYP expression. Impaired drug metabolism, along with the inevitable co-administration of drugs or 'combination therapy' in patients with COVID-19 with various comorbidities, could cause drug-drug interactions, thus worsening the disease condition. Genetic variability or polymorphism in CYP2C9 across different ethnicities could contribute to COVID-19 susceptibility. A number of drugs used in patients with COVID-19 are inducers or inhibitors of, or are metabolised by, CYP2C9, and co-administration might cause pharmacokinetic and pharmacodynamic interactions. It is also worth mentioning that some of the COVID-19 drug interactions are due to altered activity of other CYPs including CYP3A4. Isoniazid/rifampin for COVID-19 and tuberculosis co-infection; lopinavir/ritonavir and cobicistat/remdesivir combination therapy; or multi-drug therapy including ivermectin, azithromycin, montelukast and acetylsalicylic acid, known as TNR4 therapy, all improved recovery in patients with COVID-19. However, a combination of CYP2C9 inducers, inhibitors or both, and plausibly different CYP isoforms could lead to treatment failure, hepatotoxicity or serious side effects including thromboembolism or bleeding, as observed in the combined use of azithromycin/warfarin. Further, herbs that are CYP2C9 inducers and inhibitors, showed anti-COVID-19 properties, and in silico predictions postulated that phytochemical compounds could inhibit SARS-CoV-2 virus particles. COVID-19 vaccines elicit immune responses that activate cytokine release, which in turn suppresses CYP expression that could be the source of compromised CYP2C9 drug metabolism and the subsequent drug-drug interaction. Future studies are recommended to determine CYP regulation in COVID-19, while recognising the involvement of CYP2C9 and possibly utilising CYP2C9 as a target gene to tackle the ever-mutating SARS-CoV-2.
Collapse
Affiliation(s)
- Sharoen Yu Ming Lim
- Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Semenyih, Malaysia.
| | - Basel Al Bishtawi
- Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Semenyih, Malaysia
| | - Willone Lim
- Faculty of Engineering, Computing and Science, Swinburne University of Technology, 93350, Kuching, Malaysia
| |
Collapse
|
2
|
Nakashima T, Tanaka T, Koido K, Nishibuchi Y, Hashimoto H, Ito A, Inamoto Y, Kurosawa S, Kim SW, Fukuda T, Terakado H. Comparison of valproate and levetiracetam for the prevention of busulfan-induced seizures in hematopoietic stem cell transplantation. Int J Hematol 2019; 109:694-699. [DOI: 10.1007/s12185-019-02637-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 12/13/2022]
|
3
|
Zaporojan L, McNamara PH, Williams JA, Bergin C, Redmond J, Doherty CP. Seizures in HIV: The case for special consideration. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:38-43. [PMID: 30013932 PMCID: PMC6022180 DOI: 10.1016/j.ebcr.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 12/21/2022]
Abstract
Purpose This study aimed to determine the rate, cause and management of seizures in the context of potential ART–ASD interactions in a cohort of HIV + individuals. Methods Records of 604 HIV + patients were reviewed and those reporting epilepsy/seizure diagnosis were further evaluated. Results This cohort exhibited a seizure rate of 2.4%. HIV + patients treated for epilepsy displayed low serum ASD levels and failed to achieve seizure control. They were more likely to disengage from Neurology follow-up. Conclusion For HIV + patients presenting with seizures/epilepsy the ASD prescription and the provision of supplementary support services needs to be carefully considered. ID and Neurology services should be involved in the evaluation and treatment of seizures in the context of HIV infection. ART-ASD interactions could have been the cause of ineffective treatment and other poor outcomes in this small cohort. In this group of patients it is important to apply published guidelines when it comes to making treatment decisions. Counseling and supportive services need to be provided to ensure engagement with services and adherence to treatment.
Collapse
Affiliation(s)
- Lilia Zaporojan
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
- Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
- Corresponding author at: Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland.
| | - Patricia H. McNamara
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
- Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Jennifer A. Williams
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
- Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Janice Redmond
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Colin P. Doherty
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
- Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| |
Collapse
|
4
|
Management of adult infectious encephalitis in metropolitan France. Med Mal Infect 2017; 47:206-220. [PMID: 28336304 DOI: 10.1016/j.medmal.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
Infectious encephalitis is a severe disease leading to a high mortality and morbidity. The most frequent causes include Herpes simplex virus, Varicella Zoster virus, Listeria monocytogenes, and Mycobacterium tuberculosis. Urgent treatment is required (anti-infective therapy and nonspecific supportive care). The aim of this study was to define treatment strategy, empirical and after microbiological documentation at 48hours, through a systematic literature review.
Collapse
|
5
|
Miranda Herrero MC, Alcaraz Romero AJ, Escudero Vilaplana V, Fernández Lafever SN, Fernández-Llamazares CM, Barredo Valderrama E, Vázquez López M, de Castro P. Pharmacological interaction between valproic acid and carbapenem: what about levels in pediatrics? Eur J Paediatr Neurol 2015; 19:155-61. [PMID: 25578527 DOI: 10.1016/j.ejpn.2014.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/10/2014] [Accepted: 12/13/2014] [Indexed: 11/19/2022]
Abstract
UNLABELLED Valproic acid (VPA) is the most commonly used antiepileptic drug in pediatric patients, but its major drawback is its multiple pharmacological interactions. OBJECTIVE To study children who had been simultaneously treated with carbapenems and valproic acid, considering drug levels, pharmacological interactions and clinical follow-up. MATERIAL AND METHODS Retrospective study of children who simultaneously received treatment with VPA and carbapenems between January 2003 and December 2011. Demographic variables, indication of treatment, dose, VPA plasma levels, interactions, clinical manifestations and medical management were analyzed. RESULTS 28 children with concomitant treatment with both drugs were included in the study. 64.3% were males. 78.6% of the interactions were observed in the Intensive Care Unit. 60.7% of children had been previously treated VPA and its major indication were generalized seizures. Basal plasma levels of VPA were recorded in 53% and at 24 h after admittance in 60%. "40% of basal VPA levels were below therapeutic range prior to the administration of carbapenem. After the introduction of carbapenem 88% of level determinations were below therapeutic range". 54.5% of the patients that were chronically receiving VPA and had good control of epilepsy before admission had seizures during the coadministration. One patient that was on VPA before admission but with bad control of epilepsy worsened, and one patient that acutely received VPA did not achieve seizure freedom. In these cases it was necessary to either increase VPA dose or change to a different antiepileptic drug. CONCLUSIONS Little is known about the mechanism of pharmacologic interactions between carbapenems and VPA, but it leads to a reduction in plasma levels that may cause a loss of seizure control, so simultaneous use of both drugs should be avoided when possible. If not, VPA levels should be monitored.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Pedro de Castro
- Department of Neuropediatrics, H.G.U Gregorio Marañón, Madrid, Spain
| |
Collapse
|
6
|
Jung-Cook H. Pharmacokinetic variability of anthelmintics: implications for the treatment of neurocysticercosis. Expert Rev Clin Pharmacol 2014; 5:21-30. [DOI: 10.1586/ecp.11.72] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
7
|
Taha FA, Hammond DN, Sheth RD. Seizures from valproate-carbapenem interaction. Pediatr Neurol 2013; 49:279-81. [PMID: 23932807 DOI: 10.1016/j.pediatrneurol.2013.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 03/23/2013] [Accepted: 03/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antiepileptic medication interactions can complicate the management of epilepsy, by either increasing or reducing the effective serum concentrations thereby causing adverse effects or loss of seizure control. RESULTS A 14-year-old girl with well-controlled juvenile absence epilepsy lost control of her seizures acutely following the administration of carbapenem for pneumonia. Serum valproate concentrations fell by 90% within 48 hours following carbapenem and returned to baseline following its discontinuation. CONCLUSIONS Awareness of this clinically significant interaction alters clinical practice by avoiding carbapenem or temporary use of adjunctive medication to prevent the clinical consequences of this significant drug interaction.
Collapse
Affiliation(s)
- Firas A Taha
- Division of Pediatric Neurology, Nemour's Children's Clinic, and the Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | | | | |
Collapse
|
8
|
Antiepileptic treatment in patients with epilepsy and other comorbidities. Seizure 2010; 19:375-82. [PMID: 20554455 DOI: 10.1016/j.seizure.2010.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 04/18/2010] [Accepted: 05/20/2010] [Indexed: 02/08/2023] Open
|
9
|
Mani R, Pollard JR. Antiepileptic drugs and other medications: what interactions may arise? Curr Treat Options Neurol 2009; 11:253-61. [PMID: 19523351 DOI: 10.1007/s11940-009-0029-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many patients with epilepsy are on lifelong therapy with antiepileptic drugs (AEDs), and AEDs are used for other conditions such as mood stabilization and headache prophylaxis. These drugs have high potential for clinically significant interaction with nonepilepsy drugs. Interactions occur largely through altered pharmacokinetics. One drug may increase the hepatic clearance of another, leading to attenuated efficacy of the affected drug. Alternatively, inhibition of liver metabolism by one drug can cause acute toxicity by reducing clearance of another drug. To identify potential drug interactions before they lead to toxicity or therapy failure, the treating clinician should combine knowledge of the patient's overall history with a general knowledge of comorbid conditions in which significant interactions involving AEDs are most likely to occur. Treatments susceptible to interactions include anticoagulants, antiarrhythmics, antibiotics, antiretroviral drugs, immunosuppressives, antineoplastics, and contraceptives. Therefore, it is important to obtain periodically a thorough history of medical problems, use of medications or herbal remedies, and adverse effects of medications. Physicians managing epilepsy patients should also strive to avoid potential drug interactions by favoring low-interaction AEDs in patients taking many other types of drugs. There is quite a large degree of patient heterogeneity in the extent of any given interaction between an AED and another drug. Indeed, some groups of patients may have different susceptibilities to such interactions because of genetic and environmental influences on drug metabolism. Effective treatment with AEDs should include attention to drug interactions.
Collapse
Affiliation(s)
- Ram Mani
- John R. Pollard, MD Penn Epilepsy Center, Department of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
10
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
11
|
Singh G, Prabhakar S. The effects of antimicrobial and antiepileptic treatment on the outcome of epilepsy associated with central nervous system (CNS) infections. Epilepsia 2008; 49 Suppl 6:42-6. [DOI: 10.1111/j.1528-1167.2008.01755.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Satishchandra P, Sinha S. Seizures in HIV-seropositive individuals: NIMHANS experience and review. Epilepsia 2008; 49 Suppl 6:33-41. [DOI: 10.1111/j.1528-1167.2008.01754.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|