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Br J Clin Pharmacol ; 84(3): 510-519, 2018 03.
Article in English | MEDLINE | ID: mdl-29105855

ABSTRACT

AIM: The aim of this study was to study potential cytochrome P450 (CYP) induction by dicloxacillin. METHODS: We performed an open-label, randomized, two-phase, five-drug clinical pharmacokinetic cocktail crossover study in 12 healthy men with and without pretreatment with 1 g dicloxacillin three times daily for 10 days. Plasma and urine were collected over 24 h and the concentration of all five drugs and their primary metabolites was determined using a liquid chromatography coupled to triple quadrupole mass spectrometry method. Cryopreserved primary human hepatocytes were exposed to dicloxacillin for 48 h and changes in gene expression and the activity of CYP3A4, CYP2C9, CYP2B6 and CYP1A2 were investigated. The activation of nuclear receptors by dicloxacillin was assessed using luciferase assays. RESULTS: A total of 10 days of treatment with dicloxacillin resulted in a clinically and statistically significant reduction in the area under the plasma concentration-time curve from 0 to 24 h for omeprazole (CYP2C19) {geometric mean ratio [GMR] [95% confidence interval (CI)]: 0.33 [0.24, 0.45]}, tolbutamide (CYP2C9) [GMR (95% CI): 0.73 (0.65, 0.81)] and midazolam (CYP3A4) [GMR (95% CI): 0.54 (0.41, 0.72)]. Additionally, other relevant pharmacokinetic parameters were affected, indicating the induction of CYP2C- and CYP3A4-mediated metabolism by dicloxacillin. Investigations in primary hepatocytes showed a statistically significant dose-dependent increase in CYP expression and activity by dicloxacillin, caused by activation of the pregnane X receptor. CONCLUSIONS: Dicloxacillin is an inducer of CYP2C- and CYP3A-mediated drug metabolism, and we recommend caution when prescribing dicloxacillin to users of drugs with a narrow therapeutic window.


Subject(s)
Cytochrome P-450 CYP2C19/drug effects , Cytochrome P-450 CYP2C9/drug effects , Cytochrome P-450 CYP3A/drug effects , Dicloxacillin/pharmacology , Adult , Anti-Bacterial Agents/pharmacology , Area Under Curve , Chromatography, Liquid , Cross-Over Studies , Cytochrome P-450 CYP2C19/biosynthesis , Cytochrome P-450 CYP2C9/biosynthesis , Cytochrome P-450 CYP3A/biosynthesis , Cytochrome P-450 Enzyme System/biosynthesis , Cytochrome P-450 Enzyme System/drug effects , Drug Interactions , Enzyme Induction/drug effects , Female , Hepatocytes/drug effects , Hepatocytes/enzymology , Humans , Male , Mass Spectrometry , Young Adult
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