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Evaluation of Mutual Drug–Drug Interaction within Geneva Cocktail for Cytochrome P450 Phenotyping using Innovative Dried Blood Sampling Method
Author(s) -
Bosilkovska Marija,
Samer Caroline,
Déglon Julien,
Thomas Aurélien,
Walder Bernhard,
Desmeules Jules,
Daali Youssef
Publication year - 2016
Publication title -
basic and clinical pharmacology and toxicology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.805
H-Index - 90
eISSN - 1742-7843
pISSN - 1742-7835
DOI - 10.1111/bcpt.12586
Subject(s) - pharmacology , pharmacokinetics , cyp2d6 , cyp2c9 , dextromethorphan , metabolite , drug , blood sampling , active metabolite , bioequivalence , cytochrome p450 , drug interaction , chemistry , cyp3a4 , cyp3a , medicine , biochemistry , enzyme
Cytochrome P450 ( CYP ) activity can be assessed using a ‘cocktail’ phenotyping approach. Recently, we have developed a cocktail (Geneva cocktail) which combines the use of low‐dose probes with a low‐invasiveness dried blood spots ( DBS ) sampling technique and a single analytical method for the phenotyping of six major CYP isoforms. We have previously demonstrated that modulation of CYP activity after pre‐treatment with CYP inhibitors/inducer could be reliably predicted using Geneva cocktail. To further validate this cocktail, in this study, we have verified whether probe drugs contained in the latter cause mutual drug–drug interactions. In a randomized, four‐way, Latin‐square crossover study, 30 healthy volunteers received low‐dose caffeine, flurbiprofen, omeprazole, dextromethorphan and midazolam (a previously validated combination with no mutual drug–drug interactions); fexofenadine alone; bupropion alone; or all seven drugs simultaneously (Geneva cocktail). Pharmacokinetic profiles of the probe drugs and their metabolites were determined in DBS samples using both conventional micropipette sampling and new microfluidic device allowing for self‐sampling. The 90% confidence intervals for the geometric mean ratios of AUC metabolite/ AUC probe for CYP probes administered alone or within Geneva cocktail fell within the 0.8–1.25 bioequivalence range indicating the absence of pharmacokinetic interaction. The same result was observed for the chosen phenotyping indices, that is metabolic ratios at 2 hr ( CYP 1A2, CYP 3A) or 3 hr ( CYP 2B6, CYP 2C9, CYP 2C19, CYP 2D6) post‐cocktail administration. DBS sampling could successfully be performed using a new microfluidic device. In conclusion, Geneva cocktail combined with an innovative DBS sampling device can be used routinely as a test for simultaneous CYP phenotyping.