Effects of itraconazole and diltiazem on the pharmacokinetics of fexofenadine, a substrate of P-glycoprotein

Mikiko Shimizu, Tsukasa Uno, Kazunobu Sugawara, Tomonori Tateishi

Research output: Contribution to journalArticle

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Abstract

Aims: Fexofenadine is a substrate of several drug transporters including P-glycoprotein. Our objective was to evaluate the possible effects of two P-glycoprotein inhibitors, itraconazole and diltiazem, on the pharmacokinetics of fexofenadine, a putative probe of P-glycoprotein activity in vivo, and compare the inhibitory effect between the two in healthy volunteers. Methods: In a randomized three-phase crossover study, eight healthy volunteers were given oral doses of 100 mg itraconazole twice daily, 100 mg diltiazem twice daily or a placebo capsule twice daily (control) for 5 days. On the morning of day 5 each subject was given 120 mg fexofenadine, and plasma concentrations and urinary excretion of fexofenadine were measured up to 48 h after dosing. Results: Itraconazole pretreatment significantly increased mean (± SD) peak plasma concentration (Cmax) of fexofenadine from 699 (± 366) ng ml-1 to 1346 (± 561) ng ml-1 (95% CI of differences 253, 1040; P < 0.005) and the area under the plasma concentration-time curve [AUC(0,∞)] from 4133 (± 1776) ng ml-1 h to 11287 (± 4552) ng ml-1 h (95% CI 3731, 10575; P < 0.0001). Elimination half-life and renal clearance in the itraconazole phase were not altered significantly compared with those in the control phase. In contrast, diltiazem pretreatment did not affect Cmax (704 ± 316 ng ml-1, 95% CI -145, 155), AUC(0, ∞) (4433 ± 1565 ng ml-1 h, 95% CI -1353, 754), or other pharmacokinetic parameters of fexofenadine. Conclusions: Although some drug transporters other than P-glycoprotein are thought to play an important role in fexofenadine pharmacokinetics, itraconazole pretreatment increased fexofenadine exposure, probably due to the reduced first-pass effect by inhibiting the P-glycoprotein activity. As diltiazem pretreatment did not alter fexofenadine pharmacokinetics, therapeutic doses of diltiazem are unlikely to affect the P-glycoprotein activity in vivo.

Original languageEnglish
Pages (from-to)538-544
Number of pages7
JournalBritish Journal of Clinical Pharmacology
Volume61
Issue number5
DOIs
Publication statusPublished - 2006 May
Externally publishedYes

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fexofenadine
Itraconazole
Diltiazem
P-Glycoprotein
Pharmacokinetics
Area Under Curve
Healthy Volunteers

Keywords

  • Diltiazem
  • Drug interaction
  • Fexofenadine
  • Itraconazole
  • P-glycoprotein
  • Pharmacokinetics

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Effects of itraconazole and diltiazem on the pharmacokinetics of fexofenadine, a substrate of P-glycoprotein. / Shimizu, Mikiko; Uno, Tsukasa; Sugawara, Kazunobu; Tateishi, Tomonori.

In: British Journal of Clinical Pharmacology, Vol. 61, No. 5, 05.2006, p. 538-544.

Research output: Contribution to journalArticle

Shimizu, Mikiko ; Uno, Tsukasa ; Sugawara, Kazunobu ; Tateishi, Tomonori. / Effects of itraconazole and diltiazem on the pharmacokinetics of fexofenadine, a substrate of P-glycoprotein. In: British Journal of Clinical Pharmacology. 2006 ; Vol. 61, No. 5. pp. 538-544.
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AU - Uno, Tsukasa

AU - Sugawara, Kazunobu

AU - Tateishi, Tomonori

PY - 2006/5

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N2 - Aims: Fexofenadine is a substrate of several drug transporters including P-glycoprotein. Our objective was to evaluate the possible effects of two P-glycoprotein inhibitors, itraconazole and diltiazem, on the pharmacokinetics of fexofenadine, a putative probe of P-glycoprotein activity in vivo, and compare the inhibitory effect between the two in healthy volunteers. Methods: In a randomized three-phase crossover study, eight healthy volunteers were given oral doses of 100 mg itraconazole twice daily, 100 mg diltiazem twice daily or a placebo capsule twice daily (control) for 5 days. On the morning of day 5 each subject was given 120 mg fexofenadine, and plasma concentrations and urinary excretion of fexofenadine were measured up to 48 h after dosing. Results: Itraconazole pretreatment significantly increased mean (± SD) peak plasma concentration (Cmax) of fexofenadine from 699 (± 366) ng ml-1 to 1346 (± 561) ng ml-1 (95% CI of differences 253, 1040; P < 0.005) and the area under the plasma concentration-time curve [AUC(0,∞)] from 4133 (± 1776) ng ml-1 h to 11287 (± 4552) ng ml-1 h (95% CI 3731, 10575; P < 0.0001). Elimination half-life and renal clearance in the itraconazole phase were not altered significantly compared with those in the control phase. In contrast, diltiazem pretreatment did not affect Cmax (704 ± 316 ng ml-1, 95% CI -145, 155), AUC(0, ∞) (4433 ± 1565 ng ml-1 h, 95% CI -1353, 754), or other pharmacokinetic parameters of fexofenadine. Conclusions: Although some drug transporters other than P-glycoprotein are thought to play an important role in fexofenadine pharmacokinetics, itraconazole pretreatment increased fexofenadine exposure, probably due to the reduced first-pass effect by inhibiting the P-glycoprotein activity. As diltiazem pretreatment did not alter fexofenadine pharmacokinetics, therapeutic doses of diltiazem are unlikely to affect the P-glycoprotein activity in vivo.

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KW - Diltiazem

KW - Drug interaction

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KW - Itraconazole

KW - P-glycoprotein

KW - Pharmacokinetics

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