Dicloxacillin induces CYP2C19, CYP2C9 and CYP3A4 in vivo and in vitro.
Br J Clin Pharmacol
; 84(3): 510-519, 2018 03.
Article
en En
| 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.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Dicloxacilina
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Citocromo P-450 CYP3A
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Citocromo P-450 CYP2C9
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Citocromo P-450 CYP2C19
Tipo de estudio:
Clinical_trials
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Prognostic_studies
Límite:
Adult
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Female
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Humans
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Male
Idioma:
En
Año:
2018
Tipo del documento:
Article