Drug interactions with colesevelam hydrochloride, a novel, potent lipid-lowering agent.

Colesevelam hydrochloride (colesevelam) is a novel, potent, bile acid-binding agent that has been shown to lower LDL cholesterol a mean of 19% at a dose of 3.8 g/d. We studied the pharmacokinetics of colesevelam coadministered with six drugs: digoxin and warfarin, agents with narrow therapeutic indices; sustained-release verapamil and metoprolol; quinidine, an antiarrhythmic with a narrow therapeutic index; and valproic acid, an antiseizure medication. Six individual studies were single-dose, crossover, with or without a 4.5-g dose of colesevelam. Plasma levels were determined using validated analytical methods. Values for the ratio of ln[AUC(0-t)] with and without colesevelam were 107% for quinidine, 102% for valproic acid, 89% for digoxin, 102% for warfarin, 82% for verapamil, and 112% for metoprolol. Values for the ratio of ln[Cmax] with and without colesevelam were 107% for quinidine, 92% for valproic acid, 96% for digoxin, 99% for warfarin, 69% for verapamil, and 112% for metoprolol. The 90% confidence intervals for these ratios and for values of ln[AUC(0-inf)] that could be determined were within the 80-125% range, with the exception of verapamil. In this study, verapamil had great interindividual variability, with a 28-fold range in Cmax and an 11-fold range in AUC(0-t). In summary, pharmacokinetic studies with colesevelam did not show clinically significant effects on absorption of six other coadministered drugs.

Increased fatty acid uptake, a factor in increased hepatic triacylglycerol synthesis in aging rats.

The mechanisms responsible for the increased hepatic triacylglycerol synthesis in aging are not established. We studied [1-14C] palmitate uptake and its esterification to triacylglycerols in the isolated hepatocytes of 2-month, 10-month and 20-month-old normal rats. In all hepatocytes, palmitate uptake and its esterification were linearly related to medium palmitate concentration, but palmitate uptake and triacylglycerol synthesis by the hepatocytes of 10-month and 20-month-old rats were nearly double that observed with the cells of 2-month-old rats. These results suggest that increased fatty acid uptake by the liver cells was a contributory factor in the increased triacylglycerol synthesis observed in the liver of senescent rats. The changes in the hepatocyte leading to increased fatty acid uptake and hence increased triacylglycerol synthesis are detected as early as middle age of the rat.

Inhibition by adenosine triphosphate of heart microsomal neutral lipase activity.

Triacylglycerol lipolysis was inhibited by palmitate in the isolated perfused normal rat heart. Acetate or acetylcarnitine could reproduce the inhibitory effects of palmitate. Since heart neutral lipase plays an important role in the lipolysis of heart triacylglycerols, the effects of acetylcarnitine, acetyl CoA and related metabolites on the microsomal neutral lipase activity were studied. ATP inhibited the enzyme activity in a concentration-dependent manner without a lag phase. AMP and adenylyl imidodiphosphate, two compounds structurally related to ATP but whose phosphate groups cannot be transferred, did not inhibit the microsomal lipase activity. These results suggested that ATP inhibited the lipase activity through the transfer of its phosphate group. It is proposed that cellular ATP concentration is a determinant of tricylglycerol lipolysis in the heart.