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Irreversible CYP3A Inhibition Accompanied by Plasma Protein–Binding Displacement: A Comparative Analysis in Subjects With Normal and Impaired Liver Function
Author(s) -
Orlando R,
De Martin S,
Pegoraro P,
Quintieri L,
Palatini P
Publication year - 2009
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1038/clpt.2008.216
Subject(s) - quinine , cirrhosis , cyp3a , pharmacology , chemistry , erythromycin , liver function , drug , pharmacokinetics , drug metabolism , displacement (psychology) , metabolism , endocrinology , medicine , biochemistry , antibiotics , cytochrome p450 , immunology , psychology , malaria , psychotherapist
In this study, quinine was used as a probe substrate and erythromycin as a prototypical irreversible inhibitor of CYP3A to ascertain whether, like reversible CYP inhibition, the magnitude of irreversible inhibition is also strictly dependent on the status of liver function. The effect of erythromycin on oral quinine disposition was studied in 10 healthy subjects and in 20 patients with cirrhosis of the liver who had varying degrees of liver dysfunction. This effect was shown to be the result of two types of interaction: (i) irreversible inhibition of CYP3A‐mediated quinine metabolism, the extent of which proved to be independent of liver function, and (ii) displacement of quinine from plasma protein–binding sites, the magnitude of the displacement increasing dramatically as liver function worsened. Such an interaction causes limited increases in the total concentration of the displaced drug but disproportionate increases in its free concentration; the latter increases are magnified by liver dysfunction, thereby requiring that the monitoring of free drug concentrations be made mandatory. Clinical Pharmacology & Therapeutics (2009); 85 , 3, 319–326 doi: 10.1038/clpt.2008.216