期刊
DRUG METABOLISM AND DISPOSITION
卷 39, 期 12, 页码 2329-2337出版社
AMER SOC PHARMACOLOGY EXPERIMENTAL THERAPEUTICS
DOI: 10.1124/dmd.111.038646
关键词
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资金
- National Institutes of Health National Institute of General Medical Sciences [GM032165, GM07550]
- National Institutes of Health National Institute on Drug Abuse [K24-DA00417, R01-DA14211]
- National Institutes of Health National Center for Research Resources through the Clinical Research Center Facility at the University of Washington [M01-RR00037]
- Simcyp sponsored fellowship
- Achievement Rewards for College Scientists Foundation
Drug-drug interactions (DDIs) with the HIV protease inhibitors (PIs) are complex, paradoxical (e. g., ritonavir/alprazolam), and involve multiple mechanisms. As part of a larger study to better understand these DDIs and to devise a framework for in vitro to in vivo prediction of these DDIs, we determined the inductive effect of similar to 2 weeks of administration of two prototypic PIs, nelfinavir (NFV), ritonavir (RTV), and rifampin (RIF; induction positive control) on the cytochrome P450 enzymes CYP1A2, CYP2B6, CYP2C9, and CYP2D6 and the inductive or inductive plus inhibitory effect of NFV, RTV, or RIF on CYP3A and P-glycoprotein in healthy human volunteers. Statistically significant induction of CYP1A2 (2.1-, 2.9-, and 2.2-fold), CYP2B6 (1.8-, 2.4-, and 4-fold), and CYP2C9 (1.3-, 1.8-, and 2.6-fold) was observed after NFV, RTV, or RIF treatment, respectively (as expected, CYP2D6 was not induced). Moreover, we accurately predicted the in vivo induction of these enzymes by quantifying their induction by the PIs in human hepatocytes and by using RIF as an in vitro to in vivo scalar. On the basis of the modest in vivo induction of CYP1A2, CYP2B6, or CYP2C9, the in vivo paradoxical DDIs with the PIs are likely explained by mechanisms other than induction of these enzymes such as induction of other metabolic enzymes, transporters, or both.
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